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Disturbance of glucose homeostasis after pediatric cardiac surgery

Jennifer J Verhoeven1, Anita C S Hokken-Koelega, Marieke den Brinker

  • 1Intensive Care, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands. j.j.verhoeven@erasmusmc.nl

Pediatric Cardiology
|November 18, 2010
PubMed

Insights

Perioperative hyperglycemia is common in children undergoing cardiac surgery, often linked to glucocorticoid use. Blood glucose levels typically normalize within 24 hours without insulin, suggesting benefits may outweigh risks.

Area of Science:

  • Pediatric Cardiology
  • Endocrinology
  • Critical Care Medicine

Background:

  • Congenital heart disease (CHD) necessitates complex cardiac surgeries in children.
  • Perioperative glycemic control is crucial but challenging in pediatric cardiac surgery.
  • Understanding factors influencing blood glucose levels is vital for optimizing patient outcomes.

Purpose of the Study:

  • To investigate the temporal patterns of blood glucose in pediatric cardiac surgery patients.
  • To correlate glucose levels with stress hormones, inflammatory markers, and exogenous factors.
  • To assess the incidence and resolution of hyperglycemia and its management.

Main Methods:

  • Prospective study of 49 children undergoing cardiac surgery for CHD.
  • Monitoring of blood glucose, stress hormones, and inflammatory mediators preoperatively and at 12, 24 hours postoperatively.
  • Analysis of exogenous factors including caloric intake and glucocorticoid administration.

Main Results:

  • Blood glucose levels peaked at the end of surgery, with 52% of children experiencing hyperglycemia (>8.3 mmol/l).
  • Glucocorticoid administration was significantly associated with end-of-surgery hyperglycemia.
  • Spontaneous blood glucose normalization occurred within 24 hours in 94% of patients without insulin therapy.

Conclusions:

  • Transient perioperative hyperglycemia is frequent in pediatric cardiac surgery but generally resolves spontaneously.
  • Glucocorticoid use is a primary driver of this hyperglycemia.
  • The benefits of perioperative glucocorticoids may outweigh the risks of iatrogenic hyperglycemia in this population, given low morbidity.

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