Hyponatremia and poor cognitive outcome following pediatric brain tumor surgery.
OBJECTIVE
Pediatric intracranial neoplasms are common and cause substantial neurological morbidity. Postoperative hyponatremia is also common and may exacerbate neurological injury. The authors performed an exploratory analysis to evaluate an exposure-response relationship between hyponatremia severity and cognitive function at discharge.


METHODS
A retrospective cohort of patients 0-19 years old who underwent a first intracranial neoplasm surgery at a pediatric tertiary care hospital was reviewed. Outcome was assessed by Pediatric Cerebral Performance Category (PCPC) score of 1-6 at hospital discharge. Poor outcome was defined as PCPC score 3-6, corresponding to moderate or worse disability.


RESULTS
Of 319 total children, 80 (25%) had poor outcomes. One hundred thirty-seven children (43%) had serum sodium concentrations ≤ 131-135 mEq/L and 39 (12%) had serum sodium concentrations ≤ 130 mEq/L. Lower nadir sodium concentration and longer duration of hyponatremia were significantly associated with worsening PCPC score (p < 0.001). Rapid sodium decreases and more hyponatremic episodes were also significantly associated with worsening PCPC score (p < 0.001). After adjustment for patient factors, tumor characteristics, and measures of sodium disruption, multivariable analysis revealed noncortical tumor locations and lower nadir sodium concentration (adjusted odds ratio 0.86, 95% confidence interval 0.78-0.95) were important independent risk factors for poor cognitive outcome.


CONCLUSIONS
Neurocognitive disability and hyponatremia are common in children undergoing surgery for intracranial neoplasms. This study found a significant association between severity of hyponatremia and worsened cognitive outcome, with an apparent exposure-response relationship. These data support the need for careful postoperative monitoring of serum sodium. Further research is needed to determine if prevention and treatment of hyponatremia can improve outcomes in these children.
Department of Pediatrics, Oregon Health & Science University, Portland, Oregon;
Cydni N
CN
Williams
Jay
J
Riva-Cambrin
Angela P
AP
Presson
Susan L
SL
Bratton
D000293:Adolescent; D001932:Brain Neoplasms / Q000523:psychology* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003071:Cognition; D005260:Female; D006801:Humans; D007010:Hyponatremia / Q000097:blood / Q000209:etiology / Q000523:psychology*; D007223:Infant; D008297:Male; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D016017:Odds Ratio; D011184:Postoperative Period; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012964:Sodium / Q000097:blood*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D012964:Sodium
CI = confidence interval; ICD-9-CM = International Classification of Diseases, Ninth Revision, Clinical Modification; IQR = interquartile range; OR = odds ratio; PCPC = Pediatric Cerebral Performance Category; VIF = variance inflation factor; cognitive function; hyponatremia; intracranial neoplasm; oncology; serum sodium