Factors associated with hyperglycemia and low insulin levels in children undergoing cardiac surgery with cardiopulmonary bypass who received a single high dose of methylprednisolone

Abstract

OBJECTIVES:Administering steroids before cardiopulmonary bypass in pediatric heart surgery modulates systemic inflammatory response syndrome and improves postoperative recovery. However, the use of steroids aggravates hyperglycemia, which is associated with a poor prognosis. Adult patients with systemic inflammatory response syndrome usually evolve with hyperglycemia and high insulin levels, whereas >90% of pediatric patients exhibit hyperglycemia and low insulin levels. This study aims to determine: A) the metabolic and inflammatory factors that are associated with hyperglycemia and low insulin levels in children who underwent cardiac surgery with cardiopulmonary bypass and who received a single high dose of methylprednisolone and B) the best predictors of insulin variation using a mathematical model.METHODS:This preliminary study recruited 20 children who underwent heart surgery with cardiopulmonary bypass and received methylprednisolone (30 mg/kg) immediately after anesthesia. Among the 20 patients initially recruited, one was excluded because of the absence of hyperglycemia and lower insulin levels after surgery. However, these abnormalities were confirmed in the remaining 19 children. The C-peptide, CRP, IL-6, and adrenomedullin levels were measured before surgery, immediately after cardiopulmonary bypass, and on the first, second, and third days after cardiac surgery.RESULTS:IL-6, CRP, and adrenomedullin increments were observed, whereas the C-peptide levels remained within reference intervals.CONCLUSION:The multiple regression model demonstrated that in addition to age and glycemia (two well-known factors that are directly involved in glucose metabolism), adrenomedullin and IL-6 levels were independent factors associated with lower insulin concentrations. These four parameters were responsible for 64.7% of the observed insulin variances. In addition, the fact that C-peptide levels did not fall together with insulin could have grounded the medical decision not to administer insulin to patients.

Short Course of Systemic Corticosteroids in Wheezy Children: Still an Open Question

“…Changes in blood glucose levels were not significant, but there was one case of hyperglycemia (> 11.1 mmol/L) in the intervention group after the first day of treatment. More significant cases of hyperglycemia were observed in previous studies [20,21]. Systemic GCS administration should be considered as a risk factor for children with diabetes with hyperglycemia, even if prescribed as a short course.…”

Benefits of spinal anesthesia for urologic surgery in the youngest of patients

“…However, corticosteroids are not without adverse effects; treatment of bronchopulmonary dysplasia with corticosteroids in the neonatal period has been associated with complications such as infection, hyperglycemia, hypertension, gastrointestinal bleeding, and poor neurodevelopment [12]. Although few studies have been conducted to evaluate the effect of a single dose of corticosteroids, neonates undergoing open heart surgery who receive a single dose of methylprednisone to decrease systemic inflammation have been found to have significantly higher rates of postoperative hyperglycemia, which has been associated with poor postoperative outcomes [13].…”

Metabolic Uncoupling Following Cardiopulmonary Bypass

“…Hyperglycemia in the ICU is a multifactorial process, resulting in part from the physiologic stress response from surgery or critical illness. Intraoperative steroid administration, a commonplace practice in pediatric cardiac surgery to address bypass‐related inflammation, contributes directly to hyperglycemia and perhaps to mitochondrial dysfunction . The impact of hyperglycemia has been studied meticulously in children recovering from cardiac surgery.…”