title: Prevalence of dysglycemia and association with outcomes in pediatric extracorporeal membrane oxygenation.
abstract: OBJECTIVE
  To evaluate the relationship between glucose derangement, insulin administration, and mortality among children on extracorporeal membrane oxygenation.
  
  
  METHODS
  Retrospective cohort.
  
  
  METHODS
  Tertiary PICU.
  
  
  METHODS
  Two hundred nine children receiving extracorporeal membrane oxygenation, including 97 neonates.
  
  
  METHODS
  None.
  
  
  RESULTS
  Hyperglycemia and severe hyperglycemia were defined as a single blood glucose level greater than 15 mmol/L (270 mg/dL) and greater than 20 mmol/L (360 mg/dL), respectively. Hypoglycemia and severe hypoglycemia were defined as any single glucose level less than 3.3 mmol/L (60 mg/dL) and less than 2.2 mmol/L (40 mg/dL), respectively. A total of 15,912 glucose values were recorded. The median number of glucose values was 59 per patient, corresponding to a mean 0.53 ± 0.12 tests per hour. Sixty-nine patients (33.0%) without dysglycemia and who received no insulin were defined as the control group. Eighty-nine (42.6%) and 26 (12.4%) patients developed hyperglycemia and severe hyperglycemia, respectively. Sixty-three (30.1%) and 17 (8.1%) patients developed hypoglycemia and severe hypoglycemia, respectively. Sixty-one patients (29.2%) received IV insulin during extracorporeal membrane oxygenation. Both hyperglycemia and hypoglycemia were associated with increased mortality on extracorporeal membrane oxygenation (46% and 48%, respectively, vs 29% of controls; p = 0.03). However, after adjusting for severity of illness and extracorporeal membrane oxygenation complications, abnormal glucose levels were not independently related to mortality.
  
  
  CONCLUSIONS
  Dysglycemia in children on extracorporeal membrane oxygenation was common but not independently associated with increased mortality. The optimal glucose range for this high-risk population requires further investigation.
authors.affiliation: 1Paediatric Intensive Care Unit, The Royal Children's Hospital, Melbourne, VIC, Australia. 2Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China. 3Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia. 4Cardiothoracic Intensive Care Unit, National University Health System, Singapore. 5School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
authors.forename: Song
authors.initials: S
authors.lastname: Lou
authors.forename: Graeme
authors.initials: G
authors.lastname: MacLaren
authors.forename: Eldho
authors.initials: E
authors.lastname: Paul
authors.forename: Derek
authors.initials: D
authors.lastname: Best
authors.forename: Carmel
authors.initials: C
authors.lastname: Delzoppo
authors.forename: Warwick
authors.initials: W
authors.lastname: Butt
mesh_terms: D001786:Blood Glucose / Q000187:drug effects*; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D007003:Hypoglycemia / Q000453:epidemiology* / Q000401:mortality; D007223:Infant; D007231:Infant, Newborn; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D015278:Intensive Care Units, Pediatric; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007328:Insulin