Skip to main content Accessibility help

Hyperglycaemia is negatively associated with systemic and cerebral oxygen transport in neonates after the Norwood procedure

  • Gencheng Zhang (a1), Sally Cai (a2) and Jia Li (a2)



Hyperglycaemia has been identified as a risk factor for adverse outcomes in critically ill patients, including those who have undergone cardiopulmonary bypass. Tight glucose control with insulin therapy has been shown to improve outcomes, but is not common practice for children following cardiopulmonary bypass. We examined the relationship between blood glucose level and systemic and cerebral oxygen transport in a uniform group of neonates after the Norwood procedure.


Systemic oxygen consumption was measured using respiratory mass spectrometry in 17 neonates for 72 hours postoperatively. Cardiac output, systemic and total pulmonary vascular resistances – including the Blalock–Taussig shunt, systemic oxygen delivery and oxygen extraction ratio, as well as arterial lactate and glucose, were measured at 2- to 4-hour intervals. Cerebral oxygen saturation was measured by near-infrared spectroscopy.


Blood glucose levels ranged from 2.8 to 24.6 millimoles per litre. Elevated glucose level showed a significant negative correlation with cardiac output (p = 0.02) and cerebral oxygen saturation (p = 0.03), and a positive correlation with oxygen extraction ratio (p = 0.03). It tended to correlate positively with systemic vascular resistance (p = 0.09) and negatively with oxygen delivery (p = 0.09), but did not correlate with oxygen consumption (p = 0.13).


Hyperglycaemia is negatively associated with systemic haemodynamics, oxygen transport, and cerebral oxygenation status in neonates after the Norwood procedure. Further study is warranted to examine tight glucose control with insulin therapy on postoperative systemic and cerebral oxygen transport and functional outcomes in neonates after cardiopulmonary bypass.


Corresponding author

Correspondence to: Dr J. Li, MD, PhD, Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, 8440-112 Street, Edmonton, Alberta, Canada T6G 2B7. Tel: +780 492 8463; Fax: +780 407 3954; E-mail:


Hide All
1. Anand, KJ, Brown, MJ, Bloom, SR, Aynsley-Green, A. Studies on the hormonal regulation of fuel metabolism in the human newborn infant undergoing anaesthesia and surgery. Horm Res 1985; 22: 115128.
2. Ellger, B, Debaveye, Y, Vanhorebeek, I, et al. Survival benefits of intensive insulin therapy in critical illness: impact of maintaining normoglycemia versus glycemia-independent actions of insulin. Diabetes 2006; 55: 10961105.
3. Gandhi, GY, Nuttall, GA, Abel, MD, et al. Intraoperative hyperglycemia and perioperative outcomes in cardiac surgery patients. Mayo Clin Proc 2005; 80: 862866.
4. 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: 470472.
5. Hays, SP, Smith, EO, Sunehag, AL. Hyperglycemia is a risk factor for early death and morbidity in extremely low birth-weight infants. Pediatrics 2006; 118: 18111818.
6. Van den Berghe, G, Wilmer, A, Hermans, G, et al. Intensive insulin therapy in the medical ICU. N Engl J Med 2006; 354: 449461.
7. van den Berghe, G, Wouters, P, Weekers, F, et al. Intensive insulin therapy in the critically ill patients. N Engl J Med 2001; 345: 13591367.
8. Vlasselaers, D, Milants, I, Desmet, L, et al. Intensive insulin therapy for patients in paediatric intensive care: a prospective, randomised controlled study. Lancet 2009; 373: 547556.
9. Finfer, S, Chittock, DR, Su, SY, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med 2009; 360: 12831297.
10. Polito, A, Thiagarajan, RR, Laussen, PC, et al. Association between intraoperative and early postoperative glucose levels and adverse outcomes after complex congenital heart surgery. Circulation 2008; 118: 22352242.
11. Yates, AR, Dyke, PC II, Taeed, R, et al. Hyperglycemia is a marker for poor outcome in the postoperative pediatric cardiac patient. Pediatr Crit Care Med 2006; 7: 351355.
12. Ulate, KP, Lima Falcao, GC, Bielefeld, MR, Morales, JM, Rotta, AT. Strict glycemic targets need not be so strict: a more permissive glycemic range for critically ill children. Pediatrics 2008; 122: e898e904.
13. Ballweg, JA, Wernovsky, G, Ittenbach, RF, et al. Hyperglycemia after infant cardiac surgery does not adversely impact neurodevelopmental outcome. Ann Thorac Surg 2007; 84: 20522058.
14. Li, J, Zhang, G, McCrindle, BW, et al. Profiles of hemodynamics and oxygen transport derived by using continuous measured oxygen consumption after the Norwood procedure. J Thorac Cardiovasc Surg 2007; 133: 441448.
15. Li, J, Zhang, G, Holtby, H, et al. The influence of systemic hemodynamics and oxygen transport on cerebral oxygen saturation in neonates after the Norwood procedure. J Thorac Cardiovasc Surg 2008; 135: 8390, 90.e81–82.
16. Li, J, Zhang, G, Holtby, H, et al. Adverse effects of dopamine on systemic hemodynamic status and oxygen transport in neonates after the Norwood procedure. J Am Coll Cardiol 2006; 48: 18591864.
17. Li, J, Redington, AN. Unique technique for assessing the effects of CO2 on oxygen transport variables. Int J Intensive Care 2006; 13: 169175.
18. Van den Berghe, G. How does blood glucose control with insulin save lives in intensive care? J Clin Invest 2004; 114: 11871195.
19. Ceriello, A, Quagliaro, L, D'Amico, M, et al. Acute hyperglycemia induces nitrotyrosine formation and apoptosis in perfused heart from rat. Diabetes 2002; 51: 10761082.
20. Giugliano, D, Marfella, R, Coppola, L, et al. Vascular effects of acute hyperglycemia in humans are reversed by l-arginine. Evidence for reduced availability of nitric oxide during hyperglycemia. Circulation 1997; 95: 17831790.
21. Vanhorebeek, I, De Vos, R, Mesotten, D, Wouters, PJ, De Wolf-Peeters, C, Van den Berghe, G. Protection of hepatocyte mitochondrial ultrastructure and function by strict blood glucose control with insulin in critically ill patients. Lancet 2005; 365: 5359.
22. Ste-Marie, L, Hazell, AS, Bemeur, C, Butterworth, R, Montgomery, J. Immunohistochemical detection of inducible nitric oxide synthase, nitrotyrosine and manganese superoxide dismutase following hyperglycemic focal cerebral ischemia. Brain Res 2001; 918: 1019.
23. Dietrich, WD, Alonso, O, Busto, R. Moderate hyperglycemia worsens acute blood–brain barrier injury after forebrain ischemia in rats. Stroke 1993; 24: 111116.
24. Puskas, F, Grocott, HP, White, WD, Mathew, JP, Newman, MF, Bar-Yosef, S. Intraoperative hyperglycemia and cognitive decline after CABG. Ann Thorac Surg 2007; 84: 14671473.
25. Wernovsky, G. Current insights regarding neurological and developmental abnormalities in children and young adults with complex congenital cardiac disease. Cardiol Young 2006; 16 (Suppl 1): 92104.



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed