Hyperglycemia is associated with increased morbidity and mortality rates in neonates with necrotizing enterocolitis

Presented at the 55th Annual Meeting of the Section on Surgery of the American Academy of Pediatrics, New Orleans, Louisiana, October 31-November 2, 2003.
https://doi.org/10.1016/j.jpedsurg.2004.02.005Get rights and content

Abstract

Background purpose

An association between hyperglycaemia and poor outcome has been reported in critically ill adults and children. The authors investigated the incidence of hyperglycemia in infants with necrotizing enterocolitis (NEC) and the relationship between glucose levels and outcome in these infants.

Methods

All glucose measurements (n = 6508) in 95 neonates with confirmed NEC admitted to the surgical intensive care unit (ICU) were reviewed. Maximum glucose concentration during admission (Gmax) was determined for each infant and correlated with outcome. Eleven infants in whom treatment was withdrawn within 24 hours owing to unsalvageable panintestinal NEC were excluded from the analysis.

Results

Glucose levels ranged from 0.5 to 35.0 mmol/L and 69% of infants became hyperglycemic (>8 mmol/L) during their admission. Thirty-two infants died. Mortality rate tended to be higher in infants with Gmax greater than 11.9 mmol/L compared with those with Gmax less than 11.9 mmol/L, and late (>10 days admission) mortality rate was significantly higher in these infants (29% v, 2%; P = .0009). Median length of stay was 9.3 days. Linear regression analysis indicated that Gmax was significantly related to length of stay (P < .0001).

Conclusions

Hyperglycemia is common in infants with NEC admitted to the ICU and is associated with an increase in late mortality and longer intensive care stay. Aggressive glycemic control may improve outcome in this group of infants.

Section snippets

Materials and methods

The study was approved by our institutional research ethics committee. The subjects for this review were 95 consecutive neonates with confirmed NEC (Bell stage II or III9) admitted to the surgical intensive care unit (ICU) over a 5-year period. All infants were transferred in to our ICU from referring hospitals, and no infants were inborn. All blood glucose measurements (n = 6,508) taken from these neonates were retrieved from a departmental clinical database (CareVue, Philips Medical Systems,

Results

The demographic details of the 95 infants with a confirmed diagnosis of NEC are summarized in Table 1. Of these, 2 had 2 episodes of NEC, and 1 had 3 episodes. Each admission episode was considered separately resulting in a total of 99 admission episodes. Outcome was discharge in 67 episodes (66%) and death in the remaining 32 (34%). Sixty-eight infants required surgery during the course of their ICU admission for acute NEC. Of these, 11 infants were found to have panintestinal NEC at

Discussion

We have identified a high incidence of hyperglycaemia in infants with NEC, a finding that has not been reported previously. Associated with hyperglycemia is an increase in late mortality and a tendency for longer ICU stay. Although longer ICU stay may simply increase the chance of hyperglycemia occurring, this association between hyperglycemia and poor outcome has been reported in critically ill adult patients and more recently in a pediatric intensive care unit setting.10

The nature of the

References (15)

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    In neonatal intensive care hyperglycaemia is a common complication of prematurity [1,2], and has been associated with worsened outcomes [2–4].

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