Dynamics of hormonal and biochemical markers of stress response during reconstructive surgery in children with craniosynostosis

INTRODUCTION. Craniosynostoses (CS) are a group of malformations of the skull bones, manifested by the congenital absence or premature closure of cranial sutures. The method of correction of CS from 6 months is reconstructive surgery, which is characterized by high morbidity, and risk of perioperative complications, as well as a high frequency of transfusions of donor blood components. The issues of surgical stress response (SSR) after reconstructive operations with CS in children remain poorly studied.

Aim. To analyze hormonal and biochemical markers of SSR in CS children who underwent reconstructive surgery to substantiate the methods of SSR modulation for reducing the risk of postoperative complications.

MATERIALS AND METHODS. A prospective study of SSR markers was conducted in 32 patients with CS (24 boys and 8 girls) aged 10.29±4.99 months who underwent reconstructive surgery in the period 10.2021 to 06.2022 at the National Medical Research Center of Neurosurgery named after Academician N. N. Burdenko. Non–syndromic forms of CS were presented in 25 (78.1 %) cases, and in 7 (21.9 %) cases – there were syndromic forms. Several markers of metabolic, hormonal and hematological SSR were studied. Laboratory studies were carried out before surgery and on the 1^st, 3^rd and 5^th days after.

RESULTS. The article presents the dynamics of the studied clinical and laboratory parameters after reconstructive surgery for CS in children, as well as the characteristics of typical homeostasis disorders.

CONCLUSION. The course of the early postoperative period after reconstructive operations in children is accompanied by statistically significant changes in the level of stress response hormones, as well as a number of metabolic changes that cause the severity of the course of the postoperative period and determine the risks of undesirable consequences and complications. The study revealed the development of hypoferriemia in the early postoperative period, signs of insulin resistance and hyperglycemia, transient euthyroid sick syndrome. The absence of typical changes on the part of the levels of adrenocorticotrophin and cortisol was a consequence of the use of dexamethasone. The severity of the revealed changes testifies to the high morbidity of reconstructive operations in CS children, and also dictates the need for drug modulation of the stress response, and justifies the need to reduce surgical trauma due to the active introduction of minimally invasive surgery into clinical practice. 

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