Abstract 19383: Impact of Tight Glycemic Control on the Neurodevelopmental Outcomes at One Year of Age of Children with Congenital Heart Disease
Background: While postoperative tight glycemic control (TGC) may reduce morbidity in certain subgroups of children undergoing cardiac surgery, its association with later neurodevelopmental outcomes is not well-characterized. Both hypoglycemia and hyperglycemia impact brain development after pediatric cardiac surgery. The aim of this study was to assess the association of post-operative TGC in children undergoing cardiac surgery with neurodevelopmental outcomes at one year of age.
Methods: A two-center, prospective, randomized trial of TGC vs. standard care (STD) was conducted in 980 children with congenital heart disease, from 0 to 36 months of age, undergoing cardiopulmonary bypass surgery. Subjects were eligible for one-year follow-up evaluations if they were less than one year of age when enrolled in the trial and were born after March 1, 2008 (N=681). In-person testing was conducted using the Bayley Scales of Infant Development, Third Edition (BSID-III). Parents completed the Adaptive Behavior Assessment System, Second Edition (ABAS-II) to assess adaptive functioning.
Results: Of 681 eligible patients, 200 patients (TGC=100, STD=100) returned for neurodevelopmental testing and 166 parents completed the ABAS-II. Mean age at testing was 13 months (TGC 13.2±1.8, STD 13.3±1.8). Nineteen percent of children assigned to TGC and 15% assigned to STD had a known genetic anomaly. For the remaining 166 patients without a known genetic anomaly, cognitive composite scores (103.9±12.8 in the combined groups) on the BSID-III fell in the Average range while language (97.0±12.1) and motor (92.2±14.2) composite scores and overall adaptive functioning on the ABAS-II [(Global Adaptive Composite (GAC) 91.5±14.0] were significantly lower than population norms (p<0.001). On the ABAS-II, 28% of the patients had concerns (scores< 1 SD below the mean) in the health & safety domain, 35% in the motor domain and 47% in the self-care domain. No significant treatment group differences were found in the BSID-III [cognitive (p=0.60), language (p=0.66), or motor (p=0.29)] or ABAS-II [GAC (p=0.15)] composite scores.
Conclusion: For children undergoing congenital heart surgery, post-operative TGC is not associated with neurodevelopmental outcomes at one year of age.
Author Disclosures: A. Sadhwani: None. L. Asaro: None. C. Goldberg: None. J. Ware: None. J. Butcher: None. D. Wypij: None. M. Gaies: None. C. Smith: None. J. Alexander: None. M. Agus: None.
- © 2014 by American Heart Association, Inc.