Hyponatremia and Pediatric Craniofacial Surgery

Based on reports of a disturbingly high rate of significant intraoperative hyponatremia during major pediatric craniofacial surgery, researchers at Women’s and Children’s Hospital in Adelaide, Australia, embarked on a study to establish the incidence, severity, and associated risk factors of hyponatremia during and after major craniofacial surgery for craniosynostosis in their institution.

The researchers reviewed case notes and blood test results for cases of major craniofacial surgery for craniosyostosis on patients under the age of 10 between January 2007 and May 2011. For the purposes of the study, they defined mild hyponatremia as serum sodium of 131-134 mmol/L, moderate hyponatremia as serum sodium of 126-130 mmol/L, and severe hyponatremia as serum sodium of ≤125 mmol/L.

The researchers identified 102 cases. Of these, mild intraoperative hyponatremia occurred in five (5%) of the patients and was associated with lower body weight. There were no cases of moderate or severe intraoperative hyponatremia. Mild postoperative hyponatremia occurred on the day of surgery in three other children (3%) with no identifiable associations. Again, there were no cases of moderate or severe postoperative hyponatremia on the day of the surgery. On the first postoperative day, mild hyponatremia occurred in 23 other children (24%) and moderate hyponatremia occurred in one child (1%). Hyponatremia on the first postoperative day was associated with male gender.

The study was published online Jan. 23 in Pediatric Anesthesia.