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Safe and effective use of a glycemic control protocol for neonates in a cardiac ICU.
Pediatr Crit Care Med. 2013 Mar; 14(3):284-9.PC

Abstract

OBJECTIVE

To investigate the safety and efficacy of a hyperglycemia protocol in neonates with critical cardiac illness. Neonates are often regarded as high risk for hypoglycemia while receiving continuous insulin infusions and thus have been excluded from some clinical trials.

DESIGN

A retrospective review.

SETTING

A pediatric cardiac ICU in a tertiary academic center.

INTERVENTIONS

Neonates with critical cardiac illness who developed hyperglycemia were placed on an insulin-hyperglycemia protocol at the attending physician's discretion. Insulin infusions were titrated based on frequent blood glucose monitoring.

MEASUREMENTS

Critical illness hyperglycemia was defined as a blood glucose less than 140 mg/dL. Hypoglycemia was defined as moderate (≤ 60 mg/dL) or severe (≤ 40 mg/dL). Initiating blood glucose, lowest blood glucose during insulin infusion, doses of insulin, duration of insulin, and time to blood glucose greater than 140 mg/dL were evaluated.

MAIN RESULTS

A total of 44 patients were placed on the protocol between January 2009 and October 2011. The majority of insulin infusions were initiated in the early postoperative period (33 of 44, 75%). Moderate hypoglycemia occurred in two patients (4.5%), with blood glucose levels of 49 and 53 mg/dL. No episodes of severe hypoglycemia occurred. A total of 345 discrete blood glucose levels were analyzed; two of these being greater than 60 mg/dL (0.58%). Mean blood glucose prior to starting insulin was 252 ± 45 mg/dL and time until euglycemia was 6.1 ± 3.9 hours. The mean duration of insulin infusion was 24.6 ± 38.7 hours, mean peak dose was 0.10 ± 0.05 units/kg/hour, and mean insulin dose was 0.06 ± 0.02 units/kg/hour. For postoperative patients, mean time after bypass until onset of hyperglycemia was 2.2 ± 2.6 hours.

CONCLUSIONS

A glycemic control protocol can safely and effectively be applied to neonates with critical cardiac disease. Neonates with critical cardiac illness should be included in clinical trials evaluating the benefits of glycemic control.

Authors+Show Affiliations

Division of Pediatric Cardiology, Department of Pediatrics, Emory University School of Medicine/Children's Healthcare of Atlanta, Atlanta, GA, USA. chebson@emory.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

23392366

Citation

Hebson, Camden L., et al. "Safe and Effective Use of a Glycemic Control Protocol for Neonates in a Cardiac ICU." Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, vol. 14, no. 3, 2013, pp. 284-9.
Hebson CL, Chanani NK, Rigby MR, et al. Safe and effective use of a glycemic control protocol for neonates in a cardiac ICU. Pediatr Crit Care Med. 2013;14(3):284-9.
Hebson, C. L., Chanani, N. K., Rigby, M. R., Wolf, M. J., Deshpande, S. R., Montegna, L. M., & Maher, K. O. (2013). Safe and effective use of a glycemic control protocol for neonates in a cardiac ICU. Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 14(3), 284-9. https://doi.org/10.1097/PCC.0b013e31827200de
Hebson CL, et al. Safe and Effective Use of a Glycemic Control Protocol for Neonates in a Cardiac ICU. Pediatr Crit Care Med. 2013;14(3):284-9. PubMed PMID: 23392366.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Safe and effective use of a glycemic control protocol for neonates in a cardiac ICU. AU - Hebson,Camden L, AU - Chanani,Nikhil K, AU - Rigby,Mark R, AU - Wolf,Michael J, AU - Deshpande,Shriprasad R, AU - Montegna,Leticia M, AU - Maher,Kevin O, PY - 2013/2/9/entrez PY - 2013/2/9/pubmed PY - 2013/8/27/medline SP - 284 EP - 9 JF - Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies JO - Pediatr Crit Care Med VL - 14 IS - 3 N2 - OBJECTIVE: To investigate the safety and efficacy of a hyperglycemia protocol in neonates with critical cardiac illness. Neonates are often regarded as high risk for hypoglycemia while receiving continuous insulin infusions and thus have been excluded from some clinical trials. DESIGN: A retrospective review. SETTING: A pediatric cardiac ICU in a tertiary academic center. INTERVENTIONS: Neonates with critical cardiac illness who developed hyperglycemia were placed on an insulin-hyperglycemia protocol at the attending physician's discretion. Insulin infusions were titrated based on frequent blood glucose monitoring. MEASUREMENTS: Critical illness hyperglycemia was defined as a blood glucose less than 140 mg/dL. Hypoglycemia was defined as moderate (≤ 60 mg/dL) or severe (≤ 40 mg/dL). Initiating blood glucose, lowest blood glucose during insulin infusion, doses of insulin, duration of insulin, and time to blood glucose greater than 140 mg/dL were evaluated. MAIN RESULTS: A total of 44 patients were placed on the protocol between January 2009 and October 2011. The majority of insulin infusions were initiated in the early postoperative period (33 of 44, 75%). Moderate hypoglycemia occurred in two patients (4.5%), with blood glucose levels of 49 and 53 mg/dL. No episodes of severe hypoglycemia occurred. A total of 345 discrete blood glucose levels were analyzed; two of these being greater than 60 mg/dL (0.58%). Mean blood glucose prior to starting insulin was 252 ± 45 mg/dL and time until euglycemia was 6.1 ± 3.9 hours. The mean duration of insulin infusion was 24.6 ± 38.7 hours, mean peak dose was 0.10 ± 0.05 units/kg/hour, and mean insulin dose was 0.06 ± 0.02 units/kg/hour. For postoperative patients, mean time after bypass until onset of hyperglycemia was 2.2 ± 2.6 hours. CONCLUSIONS: A glycemic control protocol can safely and effectively be applied to neonates with critical cardiac disease. Neonates with critical cardiac illness should be included in clinical trials evaluating the benefits of glycemic control. SN - 1529-7535 UR - https://www.unboundmedicine.com/medline/citation/23392366/Safe_and_effective_use_of_a_glycemic_control_protocol_for_neonates_in_a_cardiac_ICU_ L2 - https://doi.org/10.1097/PCC.0b013e31827200de DB - PRIME DP - Unbound Medicine ER -