深刻な病気と厳格な血糖コントロールによる治療から4年後の子供の神経認知発達:ランダム化制御試験

Dieter Mesotten¹, Marijke Gielen, Caroline Sterken

¹Department of Intensive Care Medicine, Catholic University of Leuven, Leuven, Belgium.

JAMA

|October 27, 2012

まとめ

小児重症病棟での厳格なグルコースコントロール (TGC) は,長期的な神経発達を害しませんでした. このアプローチは低血糖症を増加させる一方で,子どもの知性や全体的な成績に悪影響を及ぼさなかった.

科学分野:

小児重症治療医療は,小児重症治療医療である.
神経発達に関する結果
グルコース管理について

背景:

小児集中治療における厳格なグルコースコントロール (TGC) は,罹病率と死亡率を低下させ,低血糖症を増加させた.
高血糖症と低血糖症の両方が発達中の脳に与える潜在的な悪影響について懸念がありました.

研究の目的:

ICUでTGCで治療された子供の長期的な神経発達のアウトカムを評価する.
TGCの短期的な利点を検証し,潜在的な害を排除する.

主な方法:

700人の小児ICU患者を対象とした将来性,ランダム化制御試験です.
3年後の長期フォローアップでは,知能 (IQ),視覚運動統合,注意力,運動調整,実行機能,記憶,行動の評価が行われました.
健康な兄弟姉妹と無縁の子供との比較.

主要な成果:

TGCは,フルスケールIQスコアに影響したり,悪い結果 (死亡または重度の障害) の発生率を増やしたりしませんでした.
TGCと通常ケア (UC) グループ間の知能,視覚運動統合,または記憶の違いは観察されなかった.
TGCは,運動調整と認知の柔軟性を大幅に改善しました.

結論:

ICUでTGCを投与された子どもたちは,UCを投与された子どもと比較して,フォローアップ時に知能の測定値が悪くなかった.
TGCによって誘発された短期的な低血糖症は,有害な神経認知的結果と関連しませんでした.

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