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Glucose management in the infant under six kilograms
1Division of Cardiopulmonary Surgery, Oregon Health Sciences University, Portland 97201, USA.
Insights
Hyperglycaemia (high blood glucose) is common in infants undergoing complex heart surgery with cardiopulmonary bypass (CPB) and hypothermia. Monitoring blood glucose during and after CPB is crucial for these young patients.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Pediatric Critical Care
Background:
- Complex congenital heart defects often require surgical intervention in infants.
- Cardiopulmonary bypass (CPB) with hypothermia is a common technique used during these surgeries.
- Hyperglycaemia can lead to adverse metabolic changes and potentially impact neurological outcomes.
Purpose of the Study:
- To evaluate the frequency of hyperglycaemia in very young children undergoing complex congenital heart defect repair.
- To assess the impact of different hypothermia and CPB strategies on blood glucose levels.
Main Methods:
- A retrospective, nonrandomized study involving three groups of infants (<6 kg) undergoing CPB.
- Group 1: Standard bypass, moderate hypothermia (26°C).
- Group 2: Low-flow bypass, profound hypothermia (20°C).
- Group 3: Total circulatory arrest, profound hypothermia (18°C).
- Blood glucose levels were measured preoperatively, during bypass, during rewarming, and 1-hour postoperatively.
Main Results:
- Group 1 maintained normal blood glucose levels throughout the study period.
- Groups 2 and 3 exhibited hyperglycaemic blood glucose levels during rewarming and 1-hour postoperatively.
- Specifically, Group 2 showed levels of 185 ± 17.2 mg/dl during rewarming and 168 ± 16.5 mg/dl postoperatively.
- Group 3 showed levels of 133 ± 29.4 mg/dl during rewarming and 130 ± 33.3 mg/dl postoperatively.
Conclusions:
- Infants undergoing complex congenital heart repair with CPB and profound hypothermia are at risk for developing hyperglycaemia.
- The findings suggest that blood glucose monitoring is essential during and after CPB in this vulnerable population.
- Further research may be warranted to explore the clinical implications and management strategies for perioperative hyperglycaemia in pediatric cardiac surgery.
Abstract:
A retrospective, nonrandomized study of blood glucose levels in very young children under 6 kg was undertaken. Each patient underwent the repair of complex congenital heart defects using hypothermia and nonpulsatile cardiopulmonary bypass (CPB). Hyperglycaemia may cause metabolic changes, resulting in reduced glucose transport and cerebral ischaemia. To evaluate the frequency of the occurrence of hyperglycaemia, samples were evaluated for glucose levels in three groups of patients. Group 1 (n = 5) consisted of infants undergoing standard bypass and moderate hypothermia (26 degrees C). Group 2 (n = 5) were infants undergoing low-flow bypass and profound hypothermia (20 degrees C). Group 3 (n = 5) was comprised of infants undergoing total circulatory arrest and profound hypothermia (18 degrees C). Glucose samples were taken preoperatively, during hypothermic bypass, during rewarming and 1-h postoperatively. In group 1, blood glucose levels remained within the normal range (65-100 mg/dl) throughout bypass and in the 1-h postoperative sample. In group 2, blood glucose levels remained within the normal range preoperatively and during the hypothermic bypass period. However, during the rewarming period, the glucose level rose to 185 +/- 17.2 mg/dl. The 1-h postoperative level was also increased to 168 +/- 16.5 mg/dl. Group 3, like group 2, showed that the preoperative and hypothermic glucose values were within the normal range and the rewarming, 133 +/- 29.4, and the 1 h, 130 +/- 33.3 mg/dl, glucose values were hyperglycaemic. This study indicates that blood glucose levels should be monitored routinely, both during and after CPB.