Glucose management in the infant under six kilograms

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°C). Group 2 (n = 5) were infants undergoing low-flow bypass and profound hypothermia (20°C). Group 3 (n = 5) was comprised of infants undergoing total circulatory arrest and profound hypothermia (18°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 (65-110 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.

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