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Original Articles: Cardiovascular

Hyperglycemia After Infant Cardiac Surgery Does Not Adversely Impact Neurodevelopmental Outcome

^a Division of Pediatric Cardiology, The Cardiac Center at The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
^c Division of General Pediatrics, The Cardiac Center at The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
^d Division of Psychology, The Cardiac Center at The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
^e Division of Genetics, The Cardiac Center at The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
^f Division of Neurology, The Cardiac Center at The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
^g Division of Cardiothoracic Anesthesiology, The Cardiac Center at The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
^h Division of Cardiothoracic Surgery, The Cardiac Center at The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
^b Division of Biostatistics and Data Management Core, The Cardiac Center at The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania

Accepted for publication June 5, 2007.

^_* Address correspondence to Dr Ballweg, Division of Pediatric Cardiology, The Children’s Hospital of Philadelphia, 34th and Civic Center Blvd, Suite 6121, Philadelphia, PA 19104 (Email: ballweg{at}email.chop.edu).

Presented at the Poster Session of the Forty-third Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 29–31, 2007.

Background: Hyperglycemia has been associated with worse outcome after traumatic brain injury and cardiac surgery in adults. It is not known whether postoperative hyperglycemia results in worse neurodevelopmental outcome after infant cardiac surgery.

Methods: Secondary analysis of postoperative glucose levels was performed in infants younger than 6 months of age enrolled in a prospective study of genetic polymorphisms and neurodevelopmental outcomes who were undergoing repair of two-ventricle cardiac defects. Neurodevelopmental outcomes at 1 year of age were assessed with the Bayley Scales of Infant Development-II, yielding two indices: Mental Developmental Index and Psychomotor Developmental Index.

Results: Surgical repair was performed in 247 infants with 1 in-hospital and 3 late deaths. Neurodevelopmental evaluation was performed in 188 of 243 (77%) survivors. Glucose levels at cardiac intensive care unit admission and during the first 48 postoperative hours were available for 180 of 188 patients. Mean admission glucose was 328 ± 106 mg/dL; maximum glucose was 340 ± 109 mg/dL. At least one glucose was greater than 200 mg/dL in 160 of 180 patients, and 49 of 180 patients (27%) had a glucose greater than 400 mg/dL. Only 1 patient had a glucose less than 50 mg/dL. Female sex (p = 0.02), but no other patient or operative variable, was associated with higher glucose levels. Mean Mental Developmental Index and Psychomotor Developmental Index were 90.6 ± 14.9 and 81.6 ± 17.2, respectively. Hyperglycemia was not associated with lower Mental Developmental Index and Psychomotor Developmental Index scores for the entire cohort or for neonates alone.

Conclusions: Hyperglycemia is common early after infant cardiac surgery, but is not associated with worse neurodevelopmental outcome at 1 year of age.