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Hyperglycaemia after Stage I palliation does not adversely affect neurodevelopmental outcome at 1 year of age in patients with single-ventricle physiology

The Children's Hospital of Philadelphia, The University of Pennsylvania, Philadelphia, PA, USA

Received 1 September 2008; received in revised form 27 March 2009; accepted 2 April 2009.

^_* Corresponding author. Address: Department of Anesthesia and Critical Care Medicine, The Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Suite 6121, Philadelphia, PA 19104, USA. Tel.: +1 267 426 7937; fax: +1 215 590 2470. (Email: ballweg{at}email.chop.edu).

Objective: Hyperglycaemia has been associated with worse outcome following traumatic brain injury and cardiac surgery in adults. We have previously reported no relationship between early postoperative hyperglycaemia and worse neurodevelopmental outcome at 1 year following biventricular repair of congenital heart disease. It is not known if postoperative hyperglycaemia results in worse neurodevelopmental outcome after infant cardiac surgery for single-ventricle lesions. Methods: Secondary analysis of postoperative glucose levels in infants <6 months of age undergoing Stage I palliation for various forms of single ventricle with arch obstruction. The patients were enrolled in a prospective study of genetic polymorphisms and neurodevelopmental outcomes assessed at 1 year of age with the Bayley Scales of Infant Development-II yielding two indices: mental developmental index (MDI) and psychomotor developmental index (PDI). Results: Stage I palliation was performed on 162 infants with 13 hospital and 15 late deaths (17.3% 1-year mortality). Neurodevelopmental evaluation was performed in 89 of 134 (66.4%) survivors. Glucose levels at admission to the cardiac intensive care unit and during the first 48 postoperative hours were available for 85 of 89 (96%) patients. Mean admission glucose value was 274 ± 91 mg dl^–1; the maximum was 291 ± 90 mg dl^–1, with 69 of 85 (81%) patients having at least one glucose value >200 mg dl^–1. Only two patients had a value <50 mg dl^–1. Mean MDI and PDI scores were 88 ± 16 and 71 ± 18, respectively. There were no statistically significant correlations between initial, mean, minimum or maximum glucose measurements and MDI or PDI scores. Only delayed sternal closure resulted in a statistically significant relationship between initial, minimum and maximum glucose values within the context of a multivariate analysis of variance model. Conclusions: Hyperglycaemia following Stage I palliation in the neonatal period was not associated with lower MDI or PDI scores at 1 year of age.

Key Words: Congenital heart disease • Hyperglycaemia • Patient outcomes • Postoperative care