Comparison of syndromic and non-syndromic craniosynostosis cases followed in a tertiary pediatric intensive care unit: a case control study

Abstract

Introduction: Craniosynostosis, marked by premature skull suture closure, manifests as isolated or syndromic cases. While isolated cases are more common, syndromic craniosynostoses are associated with a range of complications. This study aims to compare postoperative outcomes in isolated and syndromic craniosynostosis, hypothesizing greater complications in the latter.

Materials and methods: A case-control study was conducted with 30 pediatric patients with isolated (Group C) and syndromic (Group S) craniosynostosis undergoing surgery. Data on demographics, operative details, blood product transfusions, and postoperative complications were analyzed. Statistical analysis employed Chi-square, Fisher exact tests, and Mann-Whitney U tests.

Results: Perioperative bleeding and postoperative packed red blood cell (PRBC) transfusions were significantly higher in isolated cases. Morbidity analysis, including reoperation, massive bleeding, infection, hydrocephalus, and seizures indicated higher rates in syndromic cases. The rates of postoperative morbidities were 30% in syndromic and 10% in isolated cases (p = 0.053). Correlations revealed a low positive association between body weight and both PICU and hospital stays. Additionally, a low positive correlation was found between perioperative PRBC transfusion amount and PICU length of stay. The total number of morbidities showed a moderate positive correlation with PICU length of stay and a low positive correlation with hospital length of stay.

Conclusion: Isolated craniosynostosis cases exhibited higher perioperative bleeding and PRBC transfusions, potentially influenced by surgery at an earlier age. Although complications tended to be elevated in syndromic cases, no significant differences were observed. This study underscores the necessity for meticulous perioperative care, emphasizing individualized approaches considering age-related factors and associated complications in managing craniosynostosis cases.

Keywords: Complication; Craniosynostosis; Fronto-orbital advancement; Morbidity; Syndromic.