Tight Glycemic Control After Pediatric Cardiac Surgery in High-Risk Patient Populations: A Secondary Analysis of the Safe Pediatric Euglycemia After Cardiac Surgery Trial

Study Questions:

Are specific subgroups of pediatric patients undergoing cardiac surgery more likely to benefit from a strategy of tight glycemic control postoperatively?

Methods:

A post-hoc exploratory analysis was performed of 980 children, ages 0-36 months, enrolled in the SPECS (Safe Pediatric Euglycemia After Cardiac Surgery) trial. Patients had been randomized either to tight glycemic control (TGC) with goal glucose range of 80-110 mg/dl or to standard therapy (STD).

Results:

Post-hoc analysis demonstrated differential response to the intervention based on age. In subjects ≤60 days old, the rate of infections was 13.5 per 1,000 cardiac intensive care unit (CICU) days in the TGC group as compared with 3.7 per 1,000 CICU days in the STD group (p = 0.01). For subjects >60 days old, the rate of infections was lower in the TGC group, with a rate of 5.0 infections per 1,000 CICU days as compared with 14.1 infections per 1,000 CICU days in the STD group (p = 0.02).

Conclusions:

Tight glycemic control might limit the risk of infection in children >60 days old undergoing cardiac surgery. Further study, including meta-analyses of past and ongoing trials, is required prior to a change in clinical practice.

Perspective:

The randomized, controlled SPECS trial did not demonstrate benefit of tight glycemic control (targeting normoglycemia with glucose range of 80-110 mg/dl) in pediatric patients undergoing cardiac surgery. This post-hoc subgroup analysis suggests possible benefit for older patients (>60 days old), and confirms lack of benefit and possible harm for neonates with tight control. Further study is required, particularly of this older group, and verifications of the ‘cutoff age’ of 60 days at which benefit was suggested. It is speculated that older patients may not have had the benefits of maternally acquired, antibody-mediated immunity, increasing the likelihood of benefit from tight glycemic control. Additionally, the neonates may be at greater risk for protocol-associated hypoglycemia and anemia, necessitating transfusion.

Clinical Topics: Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Cardiac Surgery and CHD & Pediatrics, CHD & Pediatrics and Interventions, CHD & Pediatrics and Prevention

Keywords: Child, Infant, Newborn, Intensive Care Units, Blood Glucose, Cardiac Surgical Procedures, Hypoglycemia


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