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Tight glucose control did not impair neurocognitive development in children
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In previous studies, tight glucose control use in children in the ICU has been associated with potentially long-term negative effects on neurocognitive development. However, researchers in Belgium have released new data suggesting otherwise.
From October 2004 to December 2007, Dieter Mesotten, MD, PhD, and colleagues conducted a prospective, randomized controlled study investigating the use of tight glucose control (TGC) in 700 patients aged 16 years or younger. The patients had all been admitted to the pediatric ICU of the University Hospitals in Leuven, Belgium, during this time period.
Patients were randomly assigned to two groups: TGC (n=349), with insulin infusions of 50 mg/dL to 80 mg/dL in infants (aged <1 year) and 70 mg/dL to 100 mg/dL in patients aged 1 to 16 years; and usual care (UC; n=351), with insulin infusion starting when blood glucose levels rose above 215 mg/dL twice, and stopped when blood glucose levels fell to 180 mg/dL, the researchers wrote.
Mesotten and colleagues conducted intelligence and neurodevelopmental tests that accounted for visual-motor integration, attention, motor coordination, and executive functions, memory and behavior.
Four years after being randomly assigned, 569 patients remained available for follow-up, researchers wrote.
They found that TGC used in the ICU did not result in a decrease of IQ scores (P=.73), or neurocognitive testing (P=.72).
According to data, visual-motor integration and memory were not different between groups. Additionally, TGC improved motor coordination from 9% to 20% (P≤.03) and cognitive flexibility (19%; P=.02).
“Most neurocognitive outcomes revealed no significant differences, whereas patients who experienced TGC-induced hypoglycemia performed better for cognitive flexibility than matched patients in the UC group (P=.04),” the researchers wrote.
In an accompanying editorial, Robert C. Tasker, MBBS, MD, of the department of neurology and anesthesia at Harvard Medical School and the department of anesthesiology, perioperative pain medicine at Boston Children’s Hospital, said hyperglycemia is not the root of the problem. However, being admitted for cardiac critical care is the real focus. Tasker also wrote that Mesotten and colleagues presented a unique data set that should not be overlooked.
“Future studies should build on these findings to address additional questions, such as is the global neurocognitive deficit a reflection of premorbid state and genetic disease?” Tasker wrote. “If this is the case, perhaps there is little that can be achieved except for improving the practice of intensive care.”
Disclosure: Lagae has served as board member and received consultancy fees from Viropharma and Cyberonics. He has also received payment for lectures from Eisai and UCB. Tasker has been a co-investigator for the CHiP study. All other researchers have no relevant financial disclosures.
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