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Glycemic profile in infants who have undergone the arterial switch operation: hyperglycemia is not associated with

Joseph W Rossano1, Michael D Taylor, E O'Brian Smith

  • 1Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Tex 77030, USA. jrossano@bcm.tmc.edu

The Journal of Thoracic and Cardiovascular Surgery
|April 1, 2008
PubMed

Insights

Infants undergoing arterial switch operations had more adverse events when glucose levels were tightly controlled. Hyperglycemia was not detrimental, suggesting a different ideal glycemic profile for these infants.

Area of Science:

  • Pediatric Cardiology
  • Critical Care Medicine
  • Endocrinology

Background:

  • Tight glycemic control is beneficial for critically ill adults.
  • Limited data exist on glycemic profiles in infants post-cardiac surgery.
  • The arterial switch operation is a common procedure for congenital heart defects.

Purpose of the Study:

  • To evaluate the association between hyperglycemia and hypoglycemia and adverse events in infants after arterial switch operations.
  • To determine the impact of glycemic profiles on postoperative outcomes in this population.

Main Methods:

  • A retrospective review of 93 infants undergoing arterial switch operations (2000-2005).
  • Serum glucose values were documented during the first 24 postoperative hours.
  • The effect of time spent in specific glycemic bands on adverse events was analyzed.

Main Results:

  • 25% of infants spent >50% of time with glucose 80-110 mg/dL (Group 1); 14% spent >50% of time with glucose >200 mg/dL (Group 2).
  • Group 1 infants had significantly higher rates of any adverse event (P=.001) and renal insufficiency (P<.001).
  • Hyperglycemia (Group 2) was not associated with increased adverse events; tight control (Group 1) was an independent predictor of adverse events (P=.004).

Conclusions:

  • Hyperglycemia does not appear detrimental in postoperative infants with congenital heart disease.
  • Infants maintaining glucose levels between 80-110 mg/dL were at increased risk for adverse events.
  • The optimal glycemic profile for postoperative infants undergoing cardiac surgery requires further definition.
Abstract

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