CLINICS 2011;66(9):1637-1640 RAPID COMMUNICATION DOI:10.1590/S1807-59322011000900022 Hyperglycemia and postoperative outcomes in pediatric neurosurgery Eduardo Mekitarian Filho,I Werther Brunow de Carvalho,II Se´ rgio Cavalheiro,III Nelson Kazunobu Horigoshi,IV Norberto Antonio Freddi,V Gil Kruppa VieiraVI I Pediatrics and Sciences Applied to Pediatrics, Universidade Federal de S a˜o Paulo (UNIFESP), Pediatric Emergency Department, University Hospital of Universidade de S a˜o Paulo (USP) and Admissions Unit of Hospital Israelita Albert Einstein, Pediatric Intensivist, Santa Catarina Hospital, Sa˜ o Paulo/SP, Brazil. II Neonatology and Intensive Care, Department of Pediatrics, School of Medicine, USP. Head of Pediatric ICU, Santa Catarina Hospital, Sa˜ o Paulo/SP, Brazil. III Neurosurgery, UNIFESP, S a˜o Paulo/SP, Brazil. IV Attending Physician, Pediatric ICU of Santa Catarina Hospital, Sa˜ o Paulo/SP, Brazil. V Sciences, USP. Pediatrician, Hospital Israelita Albert Einstein. Head of Pediatric ICU, Santa Catarina Hospital, Sa˜ o Paulo/SP, Brazil. VI University Hospital, University of S a˜o Paulo/SP, Brazil. Email: emf2002@uol.com.br Tel.: 55 11 3091 9333/9451 INTRODUCTION Recent studies in adults have demonstrated the deleter- ious effects of hyperglycemia in intensive care patients and its substantial impact on crucial outcomes such as mortality. As a result, there is an increasing interest in the impact of this complication on the outcomes of critical illness in children.1 Hyperglycemia is prevalent among critically ill children and may be associated with poor outcomes and higher morbidity during hospitalization.2 Few prospective studies have analyzed the occurrence of hyperglycemia and the use of intensive insulin therapy in critically ill children. A recent single-center trial demonstrated the efficacy and safety of an insulin therapy protocol. The trial results indicated improved survival rates among the patients who received the treatment.3 A clear association between hyperglycemia and poorer outcomes has been demonstrated in some specific clinical situations, such as septic shock, cardiac surgery, and traumatic brain injury.4-7 However, hyperglycemia has yet to be fully studied in the context of pediatric surgery, and no pediatric neurosurgical studies have analyzed the associa- tion between hyperglycemia, morbidity, and mortality. This study evaluated the postoperative glucose levels of children who underwent neurosurgeries for different indications and analyzed the association of these levels with lengths of mechanical ventilation, intensive care, and hospital stay. MATERIAL AND METHODS The study was conducted in the Pediatric Intensive Care Unit (PICU) of Santa Catarina Hospital, Sao Paulo, Brazil, a tertiary multidisciplinary hospital with 16 PICU beds. This retrospective cohort study evaluated all patients admitted to the PICU who underwent neurosurgical procedures from May 2004 to May 2009. Both plasma and capillary blood Copyright 2011 CLINICS – This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non- commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 1637 glucose values were collected from patients during their stay in the PICU and during their stay in the pediatric ward after transfer from the PICU. Hyperglycemia was defined as a blood glucose level $150 mg/dL. The three outcomes evaluated in the study were the durations of mechanical ventilation, PICU, and hospital stay. Hyperglycemia was studied along with other likely risk factors in these patients, such as fever, laryngitis, infection, hypothermia, packed red blood cells, and hormonal disorders. First, a univariate analysis was performed to identify the main risk factors associated with the three outcomes, and the statistically relevant risk factors were separated and analyzed in a multivariate analysis. The level of significance was set at 5%. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) 18.0 (Chicago, Illinois). The study was approved by the Ethics in Research Committee of the institution where it was conducted. RESULTS The charts of 198 patients were analyzed during the study. The most frequent surgeries were brain tumor resection (37.4%), craniosynostosis (31.3%), ventriculoper- itoneal shunting (16.7%), craniotomy for craniofacial dysos- tosis (4.5%), spinal arthrodesis (4%), epilepsy surgery (2%), and brain revascularization for Moyamoya disease (1.5%). A total of 139 glucose measurements were recorded for the patients included in the study. Hyperglycemia was diagnosed in 62.6% of the patients. The patient glucose level upon admission to the PICU and the highest glucose level noted in the first 24 hours post-admission were recorded. The mean glucose level was recorded following the 24-hour measurement. The results of the glucose measurements according to surgical diagnosis are listed in Table 1. A univariate analysis identified a positive association between hyperglycemia and a prolonged duration of PICU stay (3.88 days vs. 2.46 days, p = 0.042). However, hypergly- cemia was not associated with prolonged hospitalization or the duration of mechanical ventilation required (Table 2). The multivariate analysis did not identify any positive associations between hyperglycemia and any of the three outcomes studied (Table 3).