title: Hyponatremia with intracranial malignant tumor resection in children.
abstract: OBJECTIVE
  Intracranial neoplasms are the second most common childhood cancer, and lead to significant morbidity and mortality. Hyponatremia is a complication associated with neurosurgical procedures, but children undergoing intracranial tumor resection have not been selectively studied. In this study, the authors aimed to determine the incidence and risk factors associated with hyponatremia among children undergoing intracranial neoplasm resection.
  
  
  METHODS
  A retrospective cohort was compiled using the 2006 Kids' Inpatient Database to identify children younger than 21 years of age who underwent intracranial neoplasm resection. Hyponatremia was ascertained by diagnosis codes. Bivariate analyses were conducted using chi-square and Mann-Whitney U-tests. Logistic regression models were developed to evaluate factors associated with hyponatremia in bivariate analyses.
  
  
  RESULTS
  Hyponatremia occurred in 205 (8.7%) of 2343 annual weighted cases, and was independently associated with tumor location in the deep brain structures and ventricles compared with the cortical area (adjusted odds ratio [aOR] 2.4; 95% CI 1.1-5.3). Hyponatremia was also associated with obstructive hydrocephalus (aOR 2.7; 95% CI 1.7-4.3) and emergency department admission (aOR 1.7; 95% CI 1.1-2.4). Hyponatremia was significantly associated with mechanical ventilation, ventriculostomy placement, ventriculoperitoneal shunt placement, and sepsis. Hyponatremia was also associated with a significantly longer average length of stay (24.6 vs 10.2 days), higher average charges ($191,000 vs $92,000), and a higher percentage of discharges to intermediate-care facilities.
  
  
  CONCLUSIONS
  Hyponatremia commonly occurs with resection of intracranial malignant tumors, especially for lesions located in the deep brain and in patients with obstructive hydrocephalus. Hyponatremia was associated with higher morbidity. Further research is needed to develop targeted monitoring and intervention strategies to decrease perioperative hyponatremia and to determine if this could decrease the number of complications in this specialized population.
authors.affiliation: Department of Pediatric Critical Care, University of Utah School of Medicine, Salt Lake City, UT, USA. Cydni.Williams@hsc.utah.edu
authors.forename: Cydni
authors.initials: C
authors.lastname: Williams
authors.forename: Tamara D
authors.initials: TD
authors.lastname: Simon
authors.forename: Jay
authors.initials: J
authors.lastname: Riva-Cambrin
authors.forename: Susan L
authors.initials: SL
authors.lastname: Bratton
mesh_terms: D000293:Adolescent; D000465:Algorithms; D001932:Brain Neoplasms / Q000191:economics / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D016208:Databases, Factual; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000150:complications; D007010:Hyponatremia / Q000191:economics / Q000453:epidemiology* / Q000209:etiology*; D007223:Infant; D007231:Infant, Newborn; D038801:International Classification of Diseases; D007902:Length of Stay; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D015233:Models, Statistical; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000191:economics; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology* / Q000209:etiology*; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000150:complications; D014481:United States / Q000453:epidemiology; D017287:Ventriculoperitoneal Shunt; D014696:Ventriculostomy; D055815:Young Adult