1. The document discusses glycemic control in neonates after congenital cardiac surgeries. It covers factors that can lead to hyperglycemia or hypoglycemia post-surgery like medications, stress, and temperature changes during procedures. 2. Continuous glucose monitoring is recommended to monitor glucose levels and prevent hypoglycemia in babies on continuous insulin therapy. Signs of hypoglycemia include hypotonia, poor feeding, and seizures in very severe cases. 3. Management involves early feeding, glucose supplementation either orally or intravenously, and drugs like dextrose and glucagon in case of hypoglycemia. Overall prevention is better than treatment and careful monitoring and patient-tailored care is emphasized

1. GLYCEMIC CONTROL IN
POST CONGENITAL CARDIAC
SURGERIES IN NEONATES
PRESENTED BY
PRASANTH.K
NURSING OFFICER, CTVS ICU , AIIMS,
NEWDELHI
MSC IN CARDIOVASCULAR AND THORACIC
SCIENCE NURSING (Narayana Hrudayalaya College
of Nursing Bangalore)

2. 1. BACK GROUND AND
EPIDEMIOLOGY
• Hyperglycemia is common in nondiabetic
critically ill patients admitted to adult and
pediatric intensive care units (ICUs).

3. FACTORS AFFECTING INTRA
OPERATIVE GLUCOSE CONTROL

4. • Cardiopulmonary pump (CPB) prime fluid
composition
• Temperature while on CPB
• Medications such as catecholamines and
glucocorticoids.

5. • Glucose withdrawal during pediatric cardiac
surgery induces threatening hypoglycemia
during the prebypass period, and moderate
intraoperative glucose administration (2.5
mg/kg/min) is not responsible for major
hyperglycemia.

6. • Intraoperative glucose control has a significant
impact on postoperative outcomes.
• No optimal intraoperative or immediate
postoperative insulin regimen has been
identified.

7. PREDISPOSING FACTORS

8. PREDISPOSING FACTORS
• Stress hyperglycemia is mainly caused by six
events:
• Severe trauma
• Bleeding
• Hypothermia
• Septicemia
• Severe burns
• Great-magnitude surgeries

9. PHYSIOLOGY BEHIND HYPERGLYCEMIA
POST CARDIAC SURGERY IN PEDIATRIC
POPULATION

10. • In cardiac surgery, hyperglycemia is a common
occurrence in patients with and without
diabetes.
• For many years, stress-induced hyperglycemia
was considered an adaptive and beneficial
response of the organism.

11. • Stress hyperglycemia is defined as an
elevation of plasma glucose levels (above 126
mg/dl in fasting condition or 200 mg/dl at any
time) in critically ill or hospitalized patients,
with or without history of diabetes.

12. • Stress hyperglycemia is caused mainly by the
effects of counter-regulatory hormones
(catecholamines, growth hormone, and
cortisol) and by depletion of the functional
reserve of the beta-cells in the Langerhans
islets of the pancreas.

13. • Previously diagnosed with Diabetes Mellitus

14. Acute pain
Which inhibits the suppression of endogenous
glucose by insulin; in addition, it releases diverse
acute-stress hormones that contribute
hyperglycemia, such as cortisol, glucagon,
growth hormone, etc.

15. Exogenous factors
Hypothermia, especially present in coronary
bypass surgery due to cardioplegic solutions,
provokes hyperglycemia by inhibiting the
negative-feedback of the insulin response
Desaturation and arterial hypoxemia, increase a
sympathetic autonomous response that favors
glucagon release by an alpha-receptor action.

16. • Many drugs commonly used with inpatient
care might modify glucose metabolism. Some
of them are well known as ‘diabetogenic’
medications such as glucocorticoids and
opiates.

17. • Every synthetic catecholamine or
catecholamine-agonist or blocker (such as
epinephrine, norepinephrine, salbutamol,
metoprolol, propanolol) and tricyclic
antidepressants, might elevate glucose levels

20. • In children undergoing complex congenital
heart surgery, the optimal postoperative
glucose range may be 110 to 126 mg/dL

21. • An intravenous infusion of regular human
insulin at the lowest dose necessary to
achieve normoglycemia (defined as a blood
glucose level of 80 to 110 mg per deciliter [4.4
to 6.1 mmol per liter]).

22. CGM – continuous glucose monitoring
• CGM is a way to measure glucose levels in
real-time throughout the day and night.
• Microdialysis system

23. LEVEL OF
HYPOGLYCEMIA
BLOOD
GLUCOSE LEVEL
SERIOUSNESS
1. SEVERE
HYPOGLYCEMIA
<40 MG PER
DECILITER
SERIOUS
2. MILD
HYPOGLYCEMIA
50 TO 59 MG
PER DECILITER /
2.8 TO 3.3
MMOL PER
LITER
MODERATELY
SERIOUS
3. MODERATE
HYPOGLYCEMIA
40 TO 49 MG
PER DECILITER
/2.2 TO 2.7
MMOL PER
LITER
NO SERIOUS

24. • 1. Babies on continuous insulin therapy
• Monitor for hypoglycemic signs and symptoms
• Intermittent glucose monitoring/continuous
with the help of a CGM device
• Care of monitoring devise – check and change
the position of probe on skin
• Preserve sterile field under and around (use of
drape) on the devise connected on central
lines.

25. HYPOGLYCEMIA
• Neonatal hypoglycemia, defined as a plasma
glucose level of less than 30 mg/dL (1.65
mmol/L) in the first 24 hours of life and less
than 45 mg/dL (2.5 mmol/L)

27. EARLY RECOGNITION
Signs and symptoms
• Infants in the first or second day of life may be asymptomatic or
may have life-threatening central nervous system (CNS) and
cardiopulmonary disturbances. Symptoms can include the
following:
• Hypotonia
• Lethargy, apathy
• Poor feeding
• Jitteriness, seizures
• Congestive heart failure
• Cyanosis
• Apnea
• Hypothermia

28. Clinical manifestations of
hypoglycorrhachia or neuroglycopenia
• Headache
• Mental confusion, staring, behavioral changes,
difficulty concentrating
• Visual disturbances (eg, decreased acuity, diplopia)
• Dysarthria
• Seizures
• Ataxia, somnolence, coma
• Stroke (hemiplegia, aphasia), paresthesias, dizziness,
amnesia, decerebrate or decorticate posturing

29. MANAGEMENT
PREVENTIVE MANAGEMENT
• Early feeding :EBM, substitutes
• Other natural fruit juices

30. MEDICAL MANAGEMENT
• Oral
• RT
• IV
• Drugs
– Dextrose
– glucagon

31. Post cardiac surgery
• Babies on continuous insulin therapy
• Monitor for hypoglycemic signs and symptoms
• Intermittent glucose monitoring/continuous
with the help of a CGM device
• Care of monitoring devise – check and change
the position of probe on skin
• Preserve sterile field under and around (use of
drape) on the devise connected on central
lines.

32. CONCLUSION
• Prevention better than managing
• Assess in totality
• Monitor regularly
• Cautious use of drugs
• Optimization of catecholamines.
• Patient tailored treatment