title: The association of age, illness severity, and glycemic status in a pediatric intensive care unit.
abstract: OBJECTIVE
  Tight glycemic control in critically ill children is controversial. The benefits of controlling hyperglycemia may be offset by the risk of hypoglycemia on the immature brain. Both age and severity of illness may influence the risks and benefits of tight glycemic control. We hypothesize that rates of hypoglycemia (blood glucose <60 mg/dL) and hyperglycemia (blood glucose >150 mg/dL) in children will correlate with age and illness severity.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Thirty-two-bed university-affiliated pediatric intensive care unit.
  
  
  METHODS
  Children <19 yrs old admitted between January and September 2006.
  
  
  METHODS
  None.
  
  
  RESULTS
  We recorded all blood glucose measurements for up to 10 days of each pediatric intensive care unit visit and assessed rates of hypoglycemia and hyperglycemia based on age, medical vs. surgical therapy, length of stay, therapeutic intervention (Therapeutic Intervention Scoring System), and illness severity (Pediatric Risk of Mortality III). A total of 8853 blood glucose values in 616 patients were recorded. Spontaneous hypoglycemia was noted in 18.8% of patients <1 yr compared with 5.1% to 11.3% of patients in older age groups. Hyperglycemia occurred in 47% of patients <1 yr, which increased to 58.9% in patients 13-18 yrs. Rates of hypoglycemia were not affected by medical/surgical status. Surgical patients had an increased risk of hyperglycemia. Rates of hypo- and hyperglycemia increased with higher Pediatric Risk of Mortality III, Therapeutic Intervention Scoring System, length of stay, and days of mechanical ventilation. Increased rates of hypo-/hyperglycemia were observed in patients who died.
  
  
  CONCLUSIONS
  The youngest patients are at higher risk for spontaneous hypoglycemia, whereas hyperglycemia occurs more often in the older ages. Higher rates of hypo-/hyperglycemia were noted in sicker patients and in those requiring more therapeutic interventions. Our results suggest that special consideration should be given to the safety of the youngest patients given their higher risk of hypoglycemia if an investigation of tight glycemic control is performed.
authors.affiliation: Division of Pediatric Critical Care, Columbia University, College of Physicians and Surgeons, New York, NY, USA. ko2006@columbia.edu
authors.forename: Kristin L
authors.initials: KL
authors.lastname: Ognibene
authors.forename: David K
authors.initials: DK
authors.lastname: Vawdrey
authors.forename: Katherine V
authors.initials: KV
authors.lastname: Biagas
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001786:Blood Glucose / Q000032:analysis*; D002648:Child; D002675:Child, Preschool; D005260:Female; D038321:Glycemic Index; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D008485:Medical Audit; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D001786:Blood Glucose