[Hyperglycemia, morbidity and mortality in critically ill children: critical analysis based on a systematic review].
OBJECTIVE
This article focused on verifying if hyperglycemia in critically ill pediatric patients is a risk factor for increased morbidity and mortality and carried out a critical analysis of the articles in pediatrics and neonatology.


METHODS
A systematic review of literature was performed using Medline, Cochrane, Lilacs and Embase databases and references of articles. Articles written in Portuguese, English and Spanish were selected and the terms used in the search were hyperglycemia, intensive care units (pediatrics), hospitals, pediatrics and pediatric intensive care. Cohort studies, retrospective and prospective, were selected for analysis. The outcomes evaluated were mortality during pediatric intensive care unit (PICU) stay, mortality during hospital stay, length-of-stay in the PICU, mortality due to specific diseases, and risk of infection and time of mechanical ventilation.


RESULTS
During the study period 79 articles related to hyperglycemia in critically ill pediatric patients were selected; 15 (19%) were cohort studies (2 prospective and 13 retrospective) that were analyzed separately.


CONCLUSIONS
Analysis of these cohort studies supported the conclusion that hyperglycemia, isolated or persistent during stay in PICU, increases morbidity, mortality and length-of-stay in PICU of critically ill children. However, these studies disclosed methodological issues such as lack of protocols for glucose measurement, design (most of them retrospective cohorts) and many articles did not confirm hyperglycemia as a single predictor of morbidity and mortality in pediatrics; therefore further prospective studies are necessary.
Mekitarian Filho
Eduardo
E
Instituto da Criança Professor Pedro de Alcântara da Universidade de São Paulo, S. Paulo, Brazil. emf2002@uol.com.br
Carvalho
Werther Brunow de
WB
Troster
Eduardo Juan
EJ
D000293:Adolescent; D001930:Brain Injuries / Q000097:blood; D002056:Burns / Q000097:blood; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016638:Critical Illness / Q000145:classification / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D006943:Hyperglycemia / Q000150:complications*; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay / Q000706:statistics & numerical data; D009017:Morbidity; D012307:Risk Factors