Alteration of Homeostasis: Prevalence, Effect of Therapy and Outcome in Pediatric Intensive Care Unit at a Tertiary Care Centre

Sushma Save, Maaz Ahmed, Anandini Suri
2016 International Journal of Contemporary Medical Research   unpublished
Many factors influence outcome in children admitted to the Pediatric Intensive Care Unit (PICU), including hyperglycemia, hypoglycemia and glucose variability. We conducted a study to determine the prevalence of hyperglycemia, hypoglycaemia and glucose variability in children admitted to the PICU and their association with mortality and morbidity. Material and methods: A prospective observational study was conducted over an 18-month period in the PICU of a teaching public hospital in Mumbai.
more » ... children aged 29days to12years admitted to the PICU were enrolled in the study. Hyperglycemia, hypoglycemia and glucose variability were recorded. Insulin by infusion was given for children with hyperglycemia. The outcome measures were recorded in terms of duration of PICU, discharge and death. Results: A total of 113 eligible patients wh o were enrolled in the study. Hyperglycemia was significantly associated with increasing length of PICU stay (χ 2 , p=0.045). Hypoglycemia was not associated with significant mortality (p value 0.66)or increase in length of stay (p= 0.351). Increased glucose variability was associated with increased morbidity in terms of length of IPCU stay (χ 2 , p=0.005, p=0.038; standard deviation and coefficient of variance respectively). Insulin infusion was used in children with hyperglycemia (p = 0.025) associated with mortality. Conclusion: Our study also confirms to the existing evidence that hyperglycemia and glucose variability prolongs the length of PICU stay. Hence we suggest a closer watch on blood glucose variability. Though our study shows increased mortality in children in whom insulin infusion was started; more data and large randomised control trials are required to evaluate the effect of tight glycemic control on critically ill children.