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. 2011 Oct;159(4):597-601.e1.
doi: 10.1016/j.jpeds.2011.03.049. Epub 2011 May 17.

Postoperative surveillance and detection of postprandial hypoglycemia after fundoplasty in children

Andrew C Calabria  1 , Paul R Gallagher, Rebecca Simmons, Thane Blinman, Diva D De León
Affiliations

Postoperative surveillance and detection of postprandial hypoglycemia after fundoplasty in children

Andrew C Calabria et al. J Pediatr. 2011 Oct.

Abstract

Objective: To evaluate the prevalence of postprandial hypoglycemia (PPH) after fundoplasty after the initiation of a universal postoperative glucose surveillance plan in the neonatal intensive care unit (NICU).

Study design: This was a retrospective chart review of children (newborn to 18 years) who underwent fundoplasty at The Children's Hospital of Philadelphia during the 2-year-period after the launch of a surveillance protocol in the NICU and other units. The rate of screening, frequency of PPH (postprandial blood glucose <60 mg/dL [3.3 mmol/L] on 2 occasions), frequency of postprandial hyperglycemia preceding PPH, timing of PPH presentation, and related symptoms were evaluated.

Results: A total of 285 children were included (n = 64 in the NICU; n = 221 in other units). Of the children screened in all units, 24.0% showed evidence of PPH, compared with 1.3% of unscreened children. Hyperglycemia preceded PPH in 67.7% (21/31) of all screened children. Within the NICU, most children had PPH within 1 week, but only 53.3% exhibited symptoms of dumping syndrome.

Conclusions: This study supports the use of universal postoperative blood glucose surveillance in identifying PPH in children after fundoplasty. Earlier identification of PPH would lead to earlier treatment and minimize the effects of unidentified hypoglycemic events.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Breakdown of subjects after fundoplasty based on hospital unit, screening status, and PPH. Subjects in the NICU underwent postoperative glucose surveillance for the first 72 hours after full feedings were reached, whereas other units did not routinely monitor blood glucose levels unless requested by the surgeon.
Figure 2
Figure 2
Cumulative frequency of PPH cases in the NICU (n = 15) based on the day PPH was detected after reaching full feedings. The majority of cases were detected by 1 week after reaching full feeds (66.7% by 3 days, 86.7% by 7 days), and all cases were detected within 10 days.
See this image and copyright information in PMC

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