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Updated: Apr 12, 2026
Midface Hypoplasia and Cranial Base Morphology in Syndromic Craniosynostosis: A Comparative Analysis Study Using a Predictive Regression Model
Published on: November 4, 2025
Metabolic changes and factors influencing base deficit in infants undergoing craniosynostosis surgery: a
Achmet Ali1, Burcu Basaran, Gamze Tanirgan
1Istanbul Faculty of Medicine, Department of Anesthesiology and Reanimation Fatih, Istanbul University, Istanbul, Turkey.
Insights
Infants undergoing corrective craniosynostosis surgery often experience metabolic disturbances, specifically negative base deficit (BD). Blood loss and hypotension are key risk factors for prolonged BD issues, impacting recovery time.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Metabolic Disorders
Background:
- Corrective craniosynostosis surgery poses risks of significant blood loss and metabolic disturbances in infants.
- Understanding the severity, duration, and risk factors of these metabolic issues is crucial for patient management.
Purpose of the Study:
- To investigate the severity and duration of metabolic disturbances in infants undergoing craniosynostosis surgery.
- To identify causal risk factors associated with these metabolic disturbances.
Main Methods:
- Retrospective analysis of 36 infants undergoing craniosynostosis surgery.
- Evaluation of demographics, surgical details, blood loss, transfusions, hemodynamic parameters, and base deficit (BD) values.
- Analysis of the time to normalize BD values postoperatively and correlation with clinical outcomes.
Main Results:
- 88% of patients exhibited subnormal base deficit (BD) levels, with 22% experiencing metabolic acidosis.
- Lower BD values correlated significantly with longer hypotension duration and greater intraoperative blood loss.
- Lowest intraoperative BD values showed a negative correlation with intensive care unit (ICU) and hospital stay duration.
Conclusions:
- Intraoperative negative base deficit (BD) is common in infants undergoing craniosynostosis repair and can persist postoperatively.
- The primary risk factors contributing to negative BD are substantial blood loss and prolonged hypotension.
- These findings highlight the importance of managing blood loss and hemodynamic stability during surgery.
Background:
Corrective craniosynostosis surgery is often associated with a large amount of blood loss and metabolic disturbances. In the present study, we investigated the severity, duration of metabolic disturbances, and causal risk factors in infants.
Methods:
A retrospective analysis was performed of 36 infants who underwent craniosynostosis surgery. We analyzed the following: demographics, duration of surgery, intraoperative blood loss, RBC, FFP and fluids transfused, urine output, hemodynamic parameters, and electrolyte and base deficit (BD) values. The lowest intraoperative BD value and time required (period I: <6 h; period II: 6-12 h; period III: >12 h) for BD values to return to normal (-4 to +2) in the postoperative period were determined. In addition, we recorded the postoperative length of stay in the ICU and hospital, postoperative blood loss, and early complications.
Results:
We detected that 88% of the patients had subnormal BD levels and 22% had metabolic acidosis. The lowest average BD measured during the operation was -8.4 ± 2.6 mmol/l. We carried out a multiple regression analysis, which revealed that lower BD values were associated with a longer duration of hypotension (p = 0.002, R(2) = 0.453) and greater intraoperative blood loss (p = 0.002, R(2) = 0.674). We examined the amount of intraoperative blood loss and found that that there were fewer blood product transfusions in period I patients and longer hypotensive episodes in period III patients. Also, a negative correlation was detected between the lowest intraoperative BD value with ICU duration (p = 0.004, r = -0.466) and hospital stay (p < 0.001, r = -0.764).
Conclusion:
Almost all patients developed intraoperative negative BD, which was prolonged in the postoperative period. The most important risk factors for developing negative BD are the amount of blood loss and duration of hypotension.
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