Intraoperative Dextrose Rate during Exploratory Laparotomies in Neonates and the Incidence of Postoperative Hyperglycemia

INTRODUCTION Compared to the older pediatric population, neonates have greater perioperative morbidity and mortality. Difficulty with glucose regulation may be a contributing modifiable risk factor during perioperative anesthetic management. To mitigate the risk of hyperglycemia in neonates, some providers empirically halve the preoperative rate of dextrose containing infusions during surgery.

AIMS The objective of this study is to assess the association between halving the preoperative maintenance dextrose rate and postoperative euglycemia in neonatal intensive care unit patients undergoing exploratory laparotomies.

METHODS Neonatal intensive care unit patients who underwent exploratory laparotomy under general anesthesia from 1/1/2014 to 11/21/2019 were included in this analysis. Hyperglycemia and hypoglycemia were defined as>150 mg/dL and<46 mg/dL. A calculated dextrose ratio was utilized to categorize patients into full and half intraoperative dextrose rate cohorts. Univariate analyses were performed with Fisher’s exact test, Wilcoxon rank sum test, or Spearman’s correlation. Multivariable analyses with regression models were conducted after graphical evaluation of a predetermined set of independent variables.

RESULTS 107 patients were included in the full dextrose rate cohort and 96 patients in the half dextrose rate cohort with post-operative hyperglycemia occurring in 47 and 28 patients, respectively. On univariate analysis, halving the preoperative dextrose rate was associated with decreased postoperative hyperglycemia (odds ratio 0.53; 95% CI: 0.28-0.98; p=0.041). This association continued in the regression model (adjusted odds ratio 0.49; 95% CI: 0.25-0.80; p=0.008) after controlling for preoperative dextrose rate, preoperative serum glucose, preoperative pH, surgical duration, post-menstrual age at surgery, and presence of necrotizing enterocolitis. Only one patient was hypoglycemic postoperatively and they were in the full dextrose cohort.

CONCLUSION Halving of preoperative dextrose rates intraoperatively during exploratory laparotomy in neonatal intensive care unit patients was associated with a decreased risk of postoperative hyperglycemia without substantially increasing the occurrence of postoperative hypoglycemia. The practice of halving preoperative dextrose rates may be an effective empirical approach for intraoperative glucose management in the high-risk neonatal population when glucose monitoring is challenging.