There is no consensus that hyperglycaemia is an independent predictor of morbidity-mortality in children. This retrospective observational study aimed to assess the association between abnormal perioperative glucose levels and adverse outcomes in infants receiving open-heart surgery with cardiopulmonary bypass. The records of a total of 233 infants who underwent cardiopulmonary bypass for a variety of congenital cardiac procedures between January and December 2010 were reviewed. The blood glucose levels, demographic and perioperative information were recorded. Patients who experienced complications (n=91) were compared with those who did not (n=142). We found both intraoperative and postoperative glucose levels increased compared to the preoperative values (P <0.001). Thirty patients (12.8%) experienced hyperglycaemia and 15 patients (6.4%) experienced at least one episode of hypoglycaemia during surgery. Within the first two days after surgery, 12 (5.2%) patients experienced hyperglycaemia and 32 (13.7%) became hypoglycaemic in the paediatric intensive care unit. However, the abnormal perioperative glucose levels were not associated with increased adverse outcomes. After adjusting for other potential variables, lower weight at surgery, longer surgery time and hospital length-of-stay are the independent predictors of morbidity-mortality. Our findings suggest that perioperative hyperglycaemia and mild transient hypoglycaemia do not appear to be detrimental to infants with congenital heart disease, although we did not assess neurological outcomes. Nevertheless, due to the limitations of the retrospective design of this study and its limited power, more thorough clinical randomised controlled trials are needed.

Introduction: Hydroxyethyl starch (HES) has been widely used for volume expansion, but its safety as priming fluid for cardiopulmonary bypass has been questioned recently. The aim of this meta-analysis is to compare the safety of albumin and hydroxyethyl starch as priming fluid for cardiopulmonary bypass.Methods: Pubmed, Embase database and Cochrane Library were searched for randomized controlled trials (RCTs) involving patients who received HES or albumin as priming fluid for cardiopulmonary bypass in cardiac surgery published up to October 2019. Two reviewers independently extracted the valid data, including the length of ICU stay, ventilator time, the length of hospital stay, crystal volume, fresh frozen plasma, platelet input, blood loss, blood platelet count. hemoglobin value, fibrin, APTT, PT, urea, creatinine and urine volume. Meta-analysis was performed with revman version 5.3. Results: Total 9 RCTs involving 452 patients were included in this meta-analysis. Compared with albumin, HES had similar effects on the length of ICU stay(MD = 0.70；95%CI：-0.14 to 1.55；P = 0.10；I2 = 89%);ventilation time(MD = 2.31 ;95%CI-3.93 to 8.55;P = 0.47,I2 = 60%); the length of hospital stay(MD = -0.31;95% CI:-2.00 to 1.37; P = 0.71 ;I2 = 0%); crystal volume(SMD = 0.26;95% CI:-0.09 to 0.61; P = 0.15;I2 = 0%); fresh frozen plasma(SMD = 0.25；95%CI：-0.08 to 0.59；P = 0.66；I2 =0%); platelet input(SMD =-0.17;95% Cl:-0.59 to 0.26;P =0.45;I2 = 0%);blood loss (SMD =0.31;95% Cl:-0.01 to 0.63;P = 0.06;I2 =29%);platelet count (SMD =-0.21;95% cl :-0.54 to 0.11; P = 0.20;I2 = 29% );hemoglobin value(SMD =0.1;95% CI: -0.15 to 0.36;P = 0.42; I2 = 0% ); fibrin (SMD =0.12;95% CI: -0.19 to 0.44 ; P = 0.45; I2 = 0% );APTT(MD =1.13;95% CI: -2.06 to 4.32 ; P = 0.49; I2 = 0%);PT(MD =0.10;95% CI: -0.21 to 0.40,P = 0.52; I2 = 0%);creatinine(SMD =0.09;95% CI: -0.32 to 0.50 ; P = 0.66; I2 = 51% );urine volume(SMD =0.11;95% CI: -0.26 to 0.48 ; P = 0.55; I2 = 43% ).but did not increase urea (SMD =-0.46;95% CI: -0.81 to -0.11; P = 0.01; I2 = 0%).Conclusions: HES was safe and effective compared to albumin as priming fluid for cardiopulmonary bypass because it did not affect renal function, coagulation function, liquid input, or the length of ICU stay and ventilation time of patients.