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Targeting Glycemic Control After Pediatric Cardiac Surgery: The Influence of Age on Insulin Requirement.
Pediatr Crit Care Med. 2015 Nov; 16(9):853-8.PC

Abstract

OBJECTIVE

Factors influencing the development of hyperglycemia and pattern of insulin requirement in children undergoing cardiac surgery are poorly understood. This study investigated the impact of age on the pattern of hyperglycemia and insulin requirement in children after cardiac surgery.

DESIGN

Cohort study, based on a prospectively collected dataset for patients enrolled into the Control of Hyperglycemia in Pediatric Intensive Care trial.

SETTING

A 24-bedded multidisciplinary PICU.

PATIENTS

Children randomized to the tight glycemic control arm (target blood glucose, 4-7 mmol/L [72-126 mg/dL]) of the Control of Hyperglycemia in Pediatric Intensive Care trial following cardiac surgery. Children were categorized into four age groups (neonate, 1-30 d; infant, 31-365 d; young child, 1-5 yr; older child, 5-16 yr) for analyses of patterns of hyperglycemia and insulin requirement over the 12-hour period following initiation of insulin.

INTERVENTIONS

Insulin titration was performed based on blood glucose value and rate of change of blood glucose using an algorithm developed for the Control of Hyperglycemia in Pediatric Intensive Care trial.

MEASUREMENTS AND MAIN RESULTS

Of 92 children, 72 children (78%) randomized to the tight glycemic control group developed hyperglycemia (blood glucose, > 7 mmol/L [126 mg/dL]) and received insulin. Older age was associated with higher blood glucose and a higher insulin dose per kilogram over the first 3 hours of the study period (p ≤ 0.02). Cumulative insulin dose was significantly higher in older children (median, 1.3 U/kg [range, 0.2-5.75]) compared with other age groups (neonate, 0.37 [0.05-2.2]; infant, 0.45 [0.05-2.2]; young child, 0.35 [0.05-0.81]) (p = 0.004). Age group, rather than body mass index, carbohydrate intake, or cardiac surgery variables, was the only variable (coefficient: 1.14 ± 0.3; p < 0.001) associated with cumulative insulin dose on multivariate analysis.

CONCLUSIONS

When tight glycemic control is targeted in children who have undergone cardiac surgery, children in the older child age group (5-16 yr) require insulin at significantly higher doses. Further study is needed to understand the mechanisms involved.

Authors+Show Affiliations

1PICU, Birmingham Children's Hospital, Birmingham, United Kingdom. 2PICU, Leeds Children's Hospital, Leeds, United Kingdom. 3University of Birmingham, Birmingham, United Kingdom.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26218256

Citation

Kanthimathinathan, Hari Krishnan, et al. "Targeting Glycemic Control After Pediatric Cardiac Surgery: the Influence of Age On Insulin Requirement." 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. 16, no. 9, 2015, pp. 853-8.
Kanthimathinathan HK, Sundararajan SB, Laker S, et al. Targeting Glycemic Control After Pediatric Cardiac Surgery: The Influence of Age on Insulin Requirement. Pediatr Crit Care Med. 2015;16(9):853-8.
Kanthimathinathan, H. K., Sundararajan, S. B., Laker, S., Scholefield, B. R., & Morris, K. P. (2015). Targeting Glycemic Control After Pediatric Cardiac Surgery: The Influence of Age on Insulin Requirement. Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 16(9), 853-8. https://doi.org/10.1097/PCC.0000000000000479
Kanthimathinathan HK, et al. Targeting Glycemic Control After Pediatric Cardiac Surgery: the Influence of Age On Insulin Requirement. Pediatr Crit Care Med. 2015;16(9):853-8. PubMed PMID: 26218256.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Targeting Glycemic Control After Pediatric Cardiac Surgery: The Influence of Age on Insulin Requirement. AU - Kanthimathinathan,Hari Krishnan, AU - Sundararajan,Santosh B, AU - Laker,Simon, AU - Scholefield,Barney R, AU - Morris,Kevin P, PY - 2015/7/29/entrez PY - 2015/7/29/pubmed PY - 2016/8/19/medline SP - 853 EP - 8 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 - 16 IS - 9 N2 - OBJECTIVE: Factors influencing the development of hyperglycemia and pattern of insulin requirement in children undergoing cardiac surgery are poorly understood. This study investigated the impact of age on the pattern of hyperglycemia and insulin requirement in children after cardiac surgery. DESIGN: Cohort study, based on a prospectively collected dataset for patients enrolled into the Control of Hyperglycemia in Pediatric Intensive Care trial. SETTING: A 24-bedded multidisciplinary PICU. PATIENTS: Children randomized to the tight glycemic control arm (target blood glucose, 4-7 mmol/L [72-126 mg/dL]) of the Control of Hyperglycemia in Pediatric Intensive Care trial following cardiac surgery. Children were categorized into four age groups (neonate, 1-30 d; infant, 31-365 d; young child, 1-5 yr; older child, 5-16 yr) for analyses of patterns of hyperglycemia and insulin requirement over the 12-hour period following initiation of insulin. INTERVENTIONS: Insulin titration was performed based on blood glucose value and rate of change of blood glucose using an algorithm developed for the Control of Hyperglycemia in Pediatric Intensive Care trial. MEASUREMENTS AND MAIN RESULTS: Of 92 children, 72 children (78%) randomized to the tight glycemic control group developed hyperglycemia (blood glucose, > 7 mmol/L [126 mg/dL]) and received insulin. Older age was associated with higher blood glucose and a higher insulin dose per kilogram over the first 3 hours of the study period (p ≤ 0.02). Cumulative insulin dose was significantly higher in older children (median, 1.3 U/kg [range, 0.2-5.75]) compared with other age groups (neonate, 0.37 [0.05-2.2]; infant, 0.45 [0.05-2.2]; young child, 0.35 [0.05-0.81]) (p = 0.004). Age group, rather than body mass index, carbohydrate intake, or cardiac surgery variables, was the only variable (coefficient: 1.14 ± 0.3; p < 0.001) associated with cumulative insulin dose on multivariate analysis. CONCLUSIONS: When tight glycemic control is targeted in children who have undergone cardiac surgery, children in the older child age group (5-16 yr) require insulin at significantly higher doses. Further study is needed to understand the mechanisms involved. SN - 1529-7535 UR - https://www.unboundmedicine.com/medline/citation/26218256/Targeting_Glycemic_Control_After_Pediatric_Cardiac_Surgery:_The_Influence_of_Age_on_Insulin_Requirement_ L2 - https://doi.org/10.1097/PCC.0000000000000479 DB - PRIME DP - Unbound Medicine ER -