Recovery From Surgery for Central Nervous System Tumors Occurring During Infancy

Postoperative Orders 

• ICU vs. standard care unit: Fluid shift and electrolyte disturbance can occur rapidly, and infants require very careful, intense observation. The postoperative environment must allow an appropriate level of nursing intensity, with low patient-to-nurse ratios. The definition of ICU vs. standard care unit varies by locale, but close observation is required in a unit capable of responding rapidly to any postoperative needs.

Medications

• Drug dosages: Drug dosages must be carefully calculated using infant-specific formulae.
• Analgesia: Pain relief by means of rectal NSAIDs may be provided at the end of surgery as well as nurse-controlled opiate infusions titrated to the patient’s needs.
• Steroids: Steroids are commonly administered after surgery, and a planned, tapered reduction of them is instituted when appropriate.

Laboratory and radiology studies

• Laboratory: Laboratory studies are tailored to the individual patient.
• Imaging: Postoperative imaging is recommended to determine the extent of resection. This imaging should be performed within 72 hours of surgery to avoid interpretive difficulty of differentiating the breakdown products of blood from residual tumor on MRI after the immediate postoperative period.

Consultations

• Physical therapy and orthotics: These are obtained as indicated.
• Neuropsychology
• Oncology
• Community pediatric team/health visitor (nurse).
• Patient/parental support groups

Postoperative Morbidity

• Weight loss and the superior mesenteric artery syndrome: Infants are prone to weight loss in the postoperative period. One condition that can be associated with weight loss and can lead to unexplained postoperative vomiting is the superior mesenteric artery (Wilkie) syndrome, where loss of the fat pad supporting the superior mesenteric artery can cause mechanical obstruction to the third part of the duodenum. This condition will respond to weight gain, but a nasojejunal feeding tube may be required temporarily (11).