title: Tight glycemic control after pediatric cardiac surgery in high-risk patient populations: a secondary analysis of the safe pediatric euglycemia after cardiac surgery trial.
abstract: BACKGROUND
  Our previous randomized, clinical trial showed that postoperative tight glycemic control (TGC) for children undergoing cardiac surgery did not reduce the rate of health care-associated infections compared with standard care (STD). Heterogeneity of treatment effect may exist within this population.
  
  
  RESULTS
  We performed a post hoc exploratory analysis of 980 children from birth to 36 months of age at the time of cardiac surgery who were randomized to postoperative TGC or STD in the intensive care unit. Significant interactions were observed between treatment group and both neonate (age ≤30 days; P=0.03) and intraoperative glucocorticoid exposure (P=0.03) on the risk of infection. The rate and incidence of infections in subjects ≤60 days old were significantly increased in the TGC compared with the STD group (rate: 13.5 versus 3.7 infections per 1000 cardiac intensive care unit days, P=0.01; incidence: 13% versus 4%, P=0.02), whereas infections among those >60 days of age were significantly reduced in the TGC compared with the STD group (rate: 5.0 versus 14.1 infections per 1000 cardiac intensive care unit days, P=0.02; incidence: 2% versus 5%, P=0.03); the interaction of treatment group by age subgroup was highly significant (P=0.001). Multivariable logistic regression controlling for the main effects revealed that previous cardiac surgery, chromosomal anomaly, and delayed sternal closure were independently associated with increased risk of infection.
  
  
  CONCLUSIONS
  This exploratory analysis demonstrated that TGC may lower the risk of infection in children >60 days of age at the time of cardiac surgery compared with children receiving STD. Meta-analyses of past and ongoing clinical trials are necessary to confirm these findings before clinical practice is altered.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov. Unique identifier: NCT00443599.
authors.affiliation: From the Division of Medicine Critical Care (M.S.D.A., G.M.S., J.L.A., M.S.) and Department of Cardiology (L.A.A., D.W.), Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Biostatistics, Harvard School of Public Health, Boston, MA (D.W.); and Division of Pediatric Cardiology, C.S. Mott Children's Hospital and University of Michigan Medical School, Ann Arbor (M.G.G.). michael.agus@childrens.harvard.edu.
authors.forename: Michael S D
authors.initials: MS
authors.lastname: Agus
authors.affiliation: From the Division of Medicine Critical Care (M.S.D.A., G.M.S., J.L.A., M.S.) and Department of Cardiology (L.A.A., D.W.), Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Biostatistics, Harvard School of Public Health, Boston, MA (D.W.); and Division of Pediatric Cardiology, C.S. Mott Children's Hospital and University of Michigan Medical School, Ann Arbor (M.G.G.).
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Asaro
authors.affiliation: From the Division of Medicine Critical Care (M.S.D.A., G.M.S., J.L.A., M.S.) and Department of Cardiology (L.A.A., D.W.), Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Biostatistics, Harvard School of Public Health, Boston, MA (D.W.); and Division of Pediatric Cardiology, C.S. Mott Children's Hospital and University of Michigan Medical School, Ann Arbor (M.G.G.).
authors.forename: Garry M
authors.initials: GM
authors.lastname: Steil
authors.affiliation: From the Division of Medicine Critical Care (M.S.D.A., G.M.S., J.L.A., M.S.) and Department of Cardiology (L.A.A., D.W.), Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Biostatistics, Harvard School of Public Health, Boston, MA (D.W.); and Division of Pediatric Cardiology, C.S. Mott Children's Hospital and University of Michigan Medical School, Ann Arbor (M.G.G.).
authors.forename: Jamin L
authors.initials: JL
authors.lastname: Alexander
authors.affiliation: From the Division of Medicine Critical Care (M.S.D.A., G.M.S., J.L.A., M.S.) and Department of Cardiology (L.A.A., D.W.), Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Biostatistics, Harvard School of Public Health, Boston, MA (D.W.); and Division of Pediatric Cardiology, C.S. Mott Children's Hospital and University of Michigan Medical School, Ann Arbor (M.G.G.).
authors.forename: Melanie
authors.initials: M
authors.lastname: Silverman
authors.affiliation: From the Division of Medicine Critical Care (M.S.D.A., G.M.S., J.L.A., M.S.) and Department of Cardiology (L.A.A., D.W.), Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Biostatistics, Harvard School of Public Health, Boston, MA (D.W.); and Division of Pediatric Cardiology, C.S. Mott Children's Hospital and University of Michigan Medical School, Ann Arbor (M.G.G.).
authors.forename: David
authors.initials: D
authors.lastname: Wypij
authors.affiliation: From the Division of Medicine Critical Care (M.S.D.A., G.M.S., J.L.A., M.S.) and Department of Cardiology (L.A.A., D.W.), Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Biostatistics, Harvard School of Public Health, Boston, MA (D.W.); and Division of Pediatric Cardiology, C.S. Mott Children's Hospital and University of Michigan Medical School, Ann Arbor (M.G.G.).
authors.forename: Michael G
authors.initials: MG
authors.lastname: Gaies
mesh_terms: D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D002675:Child, Preschool; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007239:Infections / Q000453:epidemiology; D007328:Insulin / Q000494:pharmacology / Q000627:therapeutic use*; D015278:Intensive Care Units, Pediatric; D011184:Postoperative Period; D013903:Thoracic Surgery; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: blood glucose; critical care; heart diseases; hyperglycemia; pediatrics