Tight glycemic control does not reduce infection rate after pediatric cardiac surgery

By Sarah Guy, medwireNews Reporter

Implementing tight glycemic control after surgery with cardiopulmonary bypass does not reduce the rate of healthcare-associated infections (HAIs) among pediatric patients, compared with standard care in the intensive care unit (ICU), show US study results.

The finding is in contrast to findings in adult patients, where such a regimen has emerged as a potential approach to reduce morbidity in cardiac and surgical populations, explain the researchers.

Instead, while normoglycemia was achieved earlier in the pediatric patients with tight glycemic control compared with their peers given standard care, infection rate, mortality rate, length of hospital stay, and measures of organ failure did not differ significantly.

"Children have often had to accept medicines and treatments based on what is known to work in adults, but treatments that benefit adults do not necessarily benefit children," said Michael Lauer, from the National Institutes of Health National Heart, Lung, and Blood Institute, Bethesda, Maryland (which supported the study), in a press statement.

Michael Agus (Harvard Medical School, Boston, Massachusetts) and colleagues randomly assigned 490 children aged 0 to 30 months to tight glycemic control - using an insulin-dosing algorithm to target a blood glucose level of 80-100 mg/dL - and 490 children to standard care in the ICU, where they had no target range for blood glucose management.

In all, 97% of children had at least one postsurgery glucose measurement above 110 mg/dL, report the researchers, with severe hypoglycemia (<40 mg/dL) seen in 3% and 1% of the tight glycemic control group and standard care group, respectively.

The per-protocol analysis showed a nonsignificant HAI rate of 8.6 per 1000 patient-days in the glycemic-control group, and 9.9 per 1000 patient-days in the standard ICU care group, giving a nonsignificant risk reduction of 12% for those under tight glycemic control.

This nonsignificant association was true for all infections examined: pneumonia, bloodstream, urinary tract, and surgical-site infections.

Furthermore, Agus and team report no significant differences in any other outcomes assessed, although time to normoglycemia was significantly shorter in the glycemic control versus standard care group, at 6 versus 16 hours.

"Whether there are age-related differences in the biologic sequelae of hyperglycemia in pediatric and adult populations of cardiac surgical patients is unknown," the team concludes in The New England Journal of Medicine.

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