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The association of age, illness severity, and glycemic status in a pediatric intensive care unit
Kristin L Ognibene1, David K Vawdrey, Katherine V Biagas
1Division of Pediatric Critical Care, Columbia University, College of Physicians and Surgeons, New York, NY, USA. ko2006@columbia.edu
Insights
Critically ill children face risks from tight glycemic control. Younger children are more prone to hypoglycemia, while older children experience more hyperglycemia, especially if severely ill.
Area of Science:
- Pediatric critical care medicine
- Endocrinology
- Metabolic disorders
Background:
- Tight glycemic control in critically ill children is debated due to potential risks of hypoglycemia.
- The immature brain's vulnerability to hypoglycemia necessitates careful consideration of glycemic targets.
- Age and illness severity may modulate the risks and benefits of glycemic control.
Purpose of the Study:
- To investigate the correlation between age, illness severity, and the rates of hypoglycemia and hyperglycemia in pediatric intensive care unit (PICU) patients.
- To inform the safe implementation of glycemic control strategies in pediatric critical care.
Main Methods:
- Retrospective chart review of blood glucose measurements in a university-affiliated PICU.
- Inclusion of 616 children under 19 years old admitted between January and September 2006.
- Analysis of 8853 blood glucose values, assessing hypoglycemia (<60 mg/dL) and hyperglycemia (>150 mg/dL) rates.
Main Results:
- Infants (<1 year) had higher rates of spontaneous hypoglycemia (18.8%) compared to older children.
- Hyperglycemia rates increased with age, affecting 47% of infants and 58.9% of adolescents (13-18 years).
- Hypoglycemia and hyperglycemia rates correlated with increased illness severity (Pediatric Risk of Mortality III), higher Therapeutic Intervention Scoring System scores, longer stays, and mechanical ventilation, with higher rates in non-survivors.
Conclusions:
- Younger children (<1 year) are at a greater risk for hypoglycemia, while older children face higher hyperglycemia risks.
- Sicker children and those requiring more interventions exhibit increased rates of both hypoglycemia and hyperglycemia.
- Special attention to hypoglycemia risk in the youngest patients is crucial when considering tight glycemic control in pediatric critical care.
Objective:
Tight glycemic control in critically ill children is controversial. The benefits of controlling hyperglycemia may be offset by the risk of hypoglycemia on the immature brain. Both age and severity of illness may influence the risks and benefits of tight glycemic control. We hypothesize that rates of hypoglycemia (blood glucose <60 mg/dL) and hyperglycemia (blood glucose >150 mg/dL) in children will correlate with age and illness severity.
Design:
Retrospective chart review.
Setting:
Thirty-two-bed university-affiliated pediatric intensive care unit.
Patients:
Children <19 yrs old admitted between January and September 2006.
Interventions:
None.
Measurements And Main Results:
We recorded all blood glucose measurements for up to 10 days of each pediatric intensive care unit visit and assessed rates of hypoglycemia and hyperglycemia based on age, medical vs. surgical therapy, length of stay, therapeutic intervention (Therapeutic Intervention Scoring System), and illness severity (Pediatric Risk of Mortality III). A total of 8853 blood glucose values in 616 patients were recorded. Spontaneous hypoglycemia was noted in 18.8% of patients <1 yr compared with 5.1% to 11.3% of patients in older age groups. Hyperglycemia occurred in 47% of patients <1 yr, which increased to 58.9% in patients 13-18 yrs. Rates of hypoglycemia were not affected by medical/surgical status. Surgical patients had an increased risk of hyperglycemia. Rates of hypo- and hyperglycemia increased with higher Pediatric Risk of Mortality III, Therapeutic Intervention Scoring System, length of stay, and days of mechanical ventilation. Increased rates of hypo-/hyperglycemia were observed in patients who died.
Conclusions:
The youngest patients are at higher risk for spontaneous hypoglycemia, whereas hyperglycemia occurs more often in the older ages. Higher rates of hypo-/hyperglycemia were noted in sicker patients and in those requiring more therapeutic interventions. Our results suggest that special consideration should be given to the safety of the youngest patients given their higher risk of hypoglycemia if an investigation of tight glycemic control is performed.
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