Abstract 18800: Feeding Modifies the Relationship Between Glucose Metabolism, Inflammation and Outcomes After Pediatric Heart Surgery
Introduction: We have previously shown that a low post-operative glucose:insulin ratio (GIR), which suggests insulin resistance, coupled with inflammation is associated with poor clinical outcomes in children following cardiac surgery. The purpose of this study was to determine if glucose infusion rate and enteral feeding alters this relationship and the association of these factors with morbidity following cardiopulmonary bypass (CPB).
Methods: Subjects included children, age 0-18y, undergoing cardiac surgery with CPB. Blood samples were collected at baseline and every 6 hours for up to 72 hours. Feeding regimens included NPO with glucose infusion, low volume feeds (<20mL/kg/day) and liberal feeding. Clinical outcomes were measured with a composite morbidity-mortality endpoint reflecting organ failure. Regression models adjusted for repeated measures were used to determine associations between GIR, inflammation and outcomes in those subjects who were NPO or on low volume feeds and those being fed more liberally.
Results: We studied 132 subjects with a median (IQR) age of 200 days (54, 1132) and weighing 6.79 kg (4.57, 14.7). The median (IQR) time of CPB and aortic cross clamp were 107 (71.5, 158) and 77 (54,112) minutes respectively. Median glucose infusion (IQR) rate was 1.44 (0.89-2.17) mg/kg/min. Most subjects (80%) had enteral feeds during the study, of which 29% were low volume feeds. Feeds were started on average at 30±16 hours post-surgery. A lower GIR was associated with increased TNF-alpha (EST: -0.066 (0.011)/0.1, p<0.001) and IL-6 (EST:-0.456 (0.127)/0.1, p=0.001. In children who were NPO or on low volume feeds, a low GIR was associated with increased IL-6 (EST: +0.215 (0.575)/0.1, p<0.001) and higher risk of reaching the composite morbidity outcome (OR: 1.24 (1.08-1.41), p=0.002). This relationship was not observed in subjects who were fed more liberally (EST: +0.198 (0.689), p=0.77).
Conclusion: A low GIR is associated with increased inflammation and worse outcomes in children who are NPO or are receiving only low volume feeds after CPB, but not in children receiving more liberal enteral feeds. This study suggests early feeding might be a way to modify outcomes after pediatric heart surgery.
- © 2012 by American Heart Association, Inc.