Impact of Hyperglycemia Duration on Mortality and Ventilator Dependence in Neonatal Intensive Care Unit

Document Type: Original Article


1 Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 Department of Biology, Faculty of Sciences, Young Researchers and Elite Club, Islamic Azad University, Mashhad Branch, Mashhad, Iran


Background: Hyperglycemia is an independent risk factor for mortality in neonatal intensive care units (NICU).
Herein, we aimed to investigate the relationship of hyperglycemia duration with mortality and ventilator dependence in infants admitted to NICU.
Methods: In this original retrospective study, data was collected between October 2015 and December 2015 from NICU of Dr. Sheikh Children’s Hospital in Mashhad, Iran. The studied samples (n=112) were 0-3 month old infants who were admitted to this hospital and were followed up until discharge. Information related to blood sugar was collected based on the samples routinely taken using a glucometer every six hours and were recorded in each patient's blood sugar chart.
Results: Of the subjects, 46.4% (n=52) had blood sugar ≥ 126 mg/dl and 53.6% (n=60) had blood sugar ≤ 40-125
mg/dl. Mann-Whitney and logistic regression tests were used to analyze the data. In this study, we controlled the effect of confounding variables; a significant association was observed between mortality and duration of hyperglycemia (P=0.002). In addition, a significant association was observed between duration of hyperglycemia and ventilator dependence (P=0.02).
Conclusion: Our study showed that the duration of hyperglycemia is positively associated with mortality and
ventilator dependence in infants admitted to NICU.


1. Kyle UG, Coss Bu JA, Kennedy CE, Jefferson LS. Organ dysfunction is associated with hyperglycemia in critically ill children. Intensive Care Med. 2010; 36(2):312-20.

2. Klein GW, Hojsak JM, Schmeidler J, Rapaport R. Hyperglycemia and outcome in the pediatric intensive care unit. J Pediatr. 2008; 153(3):379-84.

3. Preissig CM, Rigby MR. A disparity between physician attitudes and practice regarding hyperglycemia in pediatric intensive care units in the United States: a survey on actual practice habits. Crit Care. 2010; 14(1):R11.

4. Patki VK, Chougule SB. Hyperglycemia in critically ill children. Indian J Crit Care Med. 2014; 18(1):8-13. 5. Poddar B. Treating hyperglycemia in the critically ill child: is there enough evidence? Indian Pediatr. 2011; 48(7):531-6.

6. Naranje KM, Poddar B, Bhriguvanshi A, Lal R, Azim A, Singh RK, Gurjar M, et al. Blood glucose variability and outcomes in critically ill children. Indian J Crit Care Med. 2017; 21(3):122-6.

7. Kao LS, Morris BH, Lally KP, Stewart CD, Huseby V, Kennedy KA. Hyperglycemia and morbidity and mortality in extremely low birth weight infants. J Perinatol. 2006; 26(12):730-6.

8. Hirshberg E, Lacroix J, Sward K, Willson D, Morris AH. Blood glucose control in critically ill adults and children: a survey on stated practice. Chest. 2008; 133(6):1328-35.

9. Nayak P, Lang H, Parslow R, Davies P, Morris K. Hyperglycemia and insulin therapy in the critically ill child. Pediatr Criti Care Med. 2009; 10(3):303-5.

10. Hall NJ, Peters M, Eaton S, Pierro A. Hyperglycemia is associated with increased morbidity and mortality rates in neonates with necrotizing enterocolitis. J Pediatr Surg. 2004; 39(6):898-901.

11. Vlasselaers D, Milants I, Desmet L, Wouters PJ, Vanhorebeek I, van den Heuvel I, et al. Intensive insulin therapy for patients in paediatric intensive care: a prospective, randomised controlled study. Lancet. 2009; 373(9663):547-56.

12. Lohman TG, Roche AF, Martorell R. Anthropometric standardization reference manual. Champaign, IL: Human Kinetics Books; 1988.

13. Moghissi ES, Korytkowski MT, DiNardo M, Einhorn D, Hellman R, Hirsch IB, et al. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Diabetes Care. 2009; 32(6): 1119-31.

14. Shaffner DH, Nichols DG. Rogers' textbook of pediatric intensive care. Philadelphia: Lippincott Williams & Wilkins; 2015.

15. Koletzko B, Goulet O, Hunt J, Krohn K, Shamir R; Parenteral Nutrition Guidelines Working Group, et al. 1. Guidelines on paediatric parenteral nutrition of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society for Clinical Nutrition and Metabolism (ESPEN), supported by the European Society of Paediatric Research (ESPR). J Pediatr Gastroenterol Nutr. 2005; 41(Suppl 4):S1-87.

16. Schlebusch H, Niesen M, Sorger M, Paffenholz I, Fahnenstich H. Blood sugar determinations in newborns: four instruments compared. Pediatr Pathol Lab Med. 1998; 18(1):41-8.

17. Srinivasan V, Spinella PC, Drott HR, Roth CL, Helfaer MA, Nadkarni V. Association of timing, duration, and intensity of hyperglycemia with intensive care unit mortality in critically ill children. Pediatr Crit Care Med. 2004; 5(4):329-36. 18. Branco RG, Tasker RC. Glycemic level in mechanically ventilated children with bronchiolitis. Pediatr Crit Care Med. 2007; 8(6):546-50.

19. Faustino EV, Apkon M. Persistent hyperglycemia in critically ill children. J Pediatr. 2005; 146(1):30-4. 20. Macrae D, Grieve R, Allen E, Sadique Z, Morris K, Pappachan J, et al. A randomized trial of hyperglycemic control in pediatric intensive care. N Engl J Med. 2014; 370(2):107-18.

21. McCowen KC, Malhotra A, Bistrian BR. Stressinduced hyperglycemia. Crit Care Clin. 2001; 17(1):107-24.

22. Shirzadeh L, Nasrfard S, Abdollahpour N, Khademi G, Sezavar M. Investigation of the relation between hyperglycemia and morbidity and mortality rates in critically Ill children in March 2013 to February 2014. Razavi Int J Med. 2016; 4(4):e40340.

23. Yung M, Wilkins B, Norton L, Slater A; Paediatric Study Group; Australian and New Zealand Intensive Care Society. Glucose Sugar control, organ failure, and mortality in pediatric intensive care. Pediatr Crit Care Med. 2008; 9(2):147-52.

24. Catre D, Lopes MF, Madrigal A, Oliveiros B, Viana JS, Cabrita AS. Early mortality after neonatal surgery: analysis of risk factors in an optimized health care system for the surgical newborn. Rev Bras Epidemiol. 2013; 16(4):943-52.

25. Hemachandra AH, Cowett RM. Neonatal hyperglycemia. Pediatr Rev. 1999; 20(7):16.

26. Wintergerst KA, Buckingham B, Gandrud L, Wong BJ, Kache S, Wilson DM. Association of hypoglycemia, hyperglycemia ,and sugar variability with morbidity and death in the pediatric intensive care unit. Pediatrics. 2006; 118(1):173-9.

27. Branco RG, Garcia PC, Piva JP, Casartelli CH, Seibel V, Tasker RC. Glucose level and risk of mortality in pediatric septic shock. Pediatr Crit Care Med. 2005; 6(4):470-2.

28. Li Y, Bai Z, Li M, Wang X, Pan J, Li X, et al. U-shaped relationship between early blood sugar and mortality in critically ill children. BMC Pediatr. 2015; 15(1):88.

29. Hirshberg E, Larsen G, Van Duker H. Alterations in sugar homeostasis in the pediatric intensive care unit: Hyperglycemia and sugar variability are associated with increased mortality and morbidity. Pediatr Crit Care Med. 2008; 9(4):361-6.

30. Yates AR, Dyke PC 2nd, Taeed R, Hoffman TM, Hayes J, Feltes TF. et al. Hyperglycemia is a marker for poor outcome in the postoperative pediatric cardiac patient. Pediatr Crit Care Med. 2006; 7(4):351-5.

31. Day KM, Haub N, Betts H, Inwald DP. Hyperglycemia is associated with morbidity in critically ill children with meningococcal sepsis. Pediatr Crit Care Med. 2008; 9(6):636-40.

32. Pollack MM, Wilkinson JD, Glass NL. Long-stay pediatric intensive care unit patients: outcome and resource utilization. Pediatrics. 1987; 80(6):855-60.

33. Wu Y, Pei J, Yang XD, Cheng ZD, Zhao YY, Xiang B.Hyperglycemia and its association with clinical outcomes for patients in the pediatric intensive care unit after abdominal surgery. J Pediatr Surg. 2013; 48(4):801-5.