Disturbance of glucose homeostasis after pediatric cardiac surgery

Abstract

This study aimed to evaluate the time course of perioperative blood glucose levels of children undergoing cardiac surgery for congenital heart disease in relation to endogenous stress hormones, inflammatory mediators, and exogenous factors such as caloric intake and glucocorticoid use. The study prospectively included 49 children undergoing cardiac surgery. Blood glucose levels, hormonal alterations, and inflammatory responses were investigated before and at the end of surgery, then 12 and 24 h afterward. In general, blood glucose levels were highest at the end of surgery. Hyperglycemia, defined as a glucose level higher than 8.3 mmol/l (>150 mg/dl) was present in 52% of the children at the end of surgery. Spontaneous normalization of blood glucose occurred in 94% of the children within 24 h. During surgery, glucocorticoids were administered to 65% of the children, and this was the main factor associated with hyperglycemia at the end of surgery (determined by univariate analysis of variance). Hyperglycemia disappeared spontaneously without insulin therapy after 12-24 h for the majority of the children. Postoperative morbidity was low in the study group, so the presumed positive effects of glucocorticoids seemed to outweigh the adverse effects of iatrogenic hyperglycemia.

Fig. 1

Time course of blood levels of glucose (a), insulin (b), insulin–glucose ratios (c), and cortisol (d) at the start of surgery, at the end of surgery, and 12 and 24 h after surgery for patients treated with and those treated without glucocorticoids. Box–whisker plots: the boxes indicate the 25th to the 75th percentiles with the median, and the attached whiskers indicate the complete range with the exclusion of outliers (open circle) and extremes (*)