Abnormal Blood Glucose as a Prognostic Factor for Adverse Clinical Outcome in Children Admitted to the Paediatric Emergency Unit at Komfo Anokye Teaching Hospital, Kumasi, Ghana

Abstract

Dysglycaemia (hyper- or hypoglycaemia) in critically ill children has been associated with poor outcome. We compared the clinical outcomes in children admitted to Pediatric Emergency Unit (PEU) at Komfo Anokye Teaching Hospital (KATH) for acute medical conditions and presenting with euglycaemia or dysglycaemia. This is a prospective case matching cohort study. Eight hundred subjects aged between 3 and 144 months were screened out of whom 430 (215 with euglycaemia and 215 with dysglycaemia) were enrolled. The median age was 24 months (range: 3–144 months). In the dysglycaemia group, 28 (13%) subjects had hypoglycemia and 187 (87%) had hyperglycemia. Overall, there were 128 complications in 116 subjects. The number of subjects with complications was significantly higher in dysglycaemia group (n = 99, 46%) compared to euglycaemia group (n = 17, 8%) (P < 0.001). Forty subjects died out of whom 30 had dysglycaemia (P = 0.001). Subjects with dysglycaemia were 3 times (95% CI: 1.5–6.0) more likely to die and 4.8 times (95% CI: 3.1–7.5) more likely to develop complications (P = 0.001). Dysglycaemia is associated with increased morbidity and mortality in children with acute medical conditions and should lead to intensive management of the underlying condition.

Psychometric Properties of the Autoquestionnaire Qualité De Vie Enfant Imagé (AUQEI) Applied to Children with Cerebral Palsy

“…The QL studies among children with incapacitating diseases such as CP [ 4 ] present limitations with regard to responses obtained directly from the patients and there is often a need to rely on a representative [ 5 ]-[ 7 ]. Although this means of obtaining data is indispensable in situations of greater cognitive impairment, it makes QL assessments more subjective [ 8 ].…”

Hypoglycaemia in children: Review of the literature

“…More recent studies done in paediatric emergency admissions of some West African countries equally documented the occurrence of hypoglycaemia. 22-24. Prevalence rates of 6.4% in Ile-Ife by Elusiyan et al 22 and 5.6% in Lagos by Oyenusi et al 23 both in Nigeria and a rate of 13% by Ameyaw et al 24 in Kumasi, Ghana respectively were reported. Other studies such as that done by Osier et al 25 reported a prevalence of 7.3% among paediatric admissions in Kenya while a prevalence rate of 18.6% was documented by Wintergerst et al 26 among patients admitted to a paediatric intensive care unit of a tertiary hospital in California, United States.…”

“…A strong association between hypoglycaemia and increased mortality and morbidity has been documented by several authors 3,[22][23][24][25][26]82 . Hypoglycaemia appears to be a function of the severity of illness in childhood and more severely ill children will be more likely to die than less severely ill ones.…”

“…This could be due to the hypoglycaemic activity of onions 68,69 and garlic 70 contained in the mixture. [22][23][24][25] Other cause include side effects of drugs or drug overdosages, use of traditional concoctions as mentioned earlier amongst others. Hyperinsulinism, secondary to therapy of diabetes or islet cell adenoma is also an important cause of hypoglycaemia.…”

“…It is also referred to as ketotic hypoglycaemia of infancy and classically manifest between the ages of 18 months and 5 years and may remit spontaneously before the age of 10 years 74 . Typical history is of a child who may miss a meal due to Another benefit of bedside determination of blood glucose is to prevent hyperglycaemia which may be caused by unnecessary glucose administration to children that are normoglycaemic or may even be hyperglycaemic 24,25,79,80 .…”