Risk factors for intraoperative hypoglycemia in children: a retrospective observational cohort study
Lori Q Riegger1, Aleda M Leis2, Shobha Malviya2
1Department of Anesthesiology, University of Michigan Health System, 4-911 Mott Hospital SPC 4245, 1540 E. Hospital Dr, Ann Arbor, MI, 48109-4245, USA. riegger@umich.edu.
Insights
Young children, especially those with developmental delays or undergoing abdominal surgery, face higher risks of intraoperative hypoglycemia. Prompt blood glucose monitoring and dextrose administration are crucial for these pediatric patients.
Area of Science:
- Pediatric Anesthesiology
- Critical Care Medicine
- Clinical Risk Management
Background:
- Intraoperative hypoglycemia poses a significant risk of neurological damage in children.
- Limited research exists on identifying specific risk factors for this condition in pediatric populations.
Purpose of the Study:
- To identify and characterize independent risk factors associated with intraoperative hypoglycemia in children.
- To inform preventative strategies and management protocols for pediatric surgical patients.
Main Methods:
- Retrospective observational study of pediatric patients (<18 years) undergoing anesthesia between 2012 and 2016.
- Defined primary outcome as blood glucose < 3.3 mmol·L⁻¹ (60 mg·dl⁻¹).
- Utilized multivariable logistic regression to identify independent predictors of hypoglycemia.
Main Results:
- 3.5% of 73,592 cases (271 patients) experienced intraoperative hypoglycemia.
- Independent risk factors identified: young age, low weight-for-age percentile, developmental delay, gastric/jejunal tube presence, and abdominal surgery.
- 80% of hypoglycemia events occurred in children under three years old or weighing less than 15 kg.
Conclusions:
- Young age, developmental delay, specific medical devices (gastric/jejunal tubes), and abdominal surgery are significant risk factors for intraoperative hypoglycemia in children.
- Suggests increased vigilance with frequent blood glucose monitoring and proactive dextrose administration for high-risk pediatric surgical patients.
Purpose:
Intraoperative hypoglycemia can result in devastating neurologic injury if not promptly diagnosed and treated. Few studies have defined risk factors for intraoperative hypoglycemia. The authors sought to characterize children with intraoperative hypoglycemia and determine independent risk factors.
Methods:
This retrospective observational single-institution study included all patients < 18 yr of age undergoing an anesthetic from January 1 2012 to December 31 2016. The primary outcome was blood glucose < 3.3 mmol·L-1 (60 mg·dl-1). Data collected included patient characteristics, comorbidities, and intraoperative factors. A multivariable logistic regression model was used to identify independent predictors of intraoperative hypoglycemia.
Results:
Blood glucose was measured in 7,715 of 73,592 cases with 271 (3.5%) having a glucose < 3.3 mmol·L-1 (60 mg·dl-1). Young age, weight for age < 5th percentile, developmental delay, presence of a gastric or jejunal tube, and abdominal surgery were identified as independent predictors for intraoperative hypoglycemia. Eighty percent of hypoglycemia cases occurred in children < three years of age and in children < 15 kg.
Conclusion:
Young age, weight for age < 5th percentile, developmental delay, having a gastric or jejunal tube, and abdominal surgery were independent risk factors for intraoperative hypoglycemia in children. Frequent monitoring of blood glucose and judicious isotonic dextrose administration may be warranted in these children.
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