Long-Term Neurobehavioral and Quality of Life Outcomes of Critically Ill Children after Glycemic Control - 20/02/20

Doi : 10.1016/j.jpeds.2019.10.055

Katherine V. Biagas, MD ^1,^⁎ , Veronica J. Hinton, PhD ², Natalie R. Hasbani, MPH ³, Peter M. Luckett, MD ⁴, David Wypij, MD ³, Vinay M. Nadkarni, MD ⁵, Michael S.D. Agus, MD ⁶
on behalf of the
HALF-PINT trial study investigators^{^∗}
List of the HALF-PINT trial study investigators is available at www.jpeds.com (Appendix).
Vijay Srinivasan, MD, Peter M. Mourani, MD, Ranjit Chima, MD, Neal J. Thomas, MD, MS, Simon Li, MD, MPH, Alan Pinto, MD, Christopher Newth, MD, FRCPC, Amanda Hassinger, MD, MS, Kris Bysani, MD, Kyle J. Rehder, MD, Edward Vincent Faustino, MD, MHS, Sarah Kandil, MD, Eliotte Hirshberg, MD, Kupper Wintergerst, MD, Adam Schwarz, MD, Dayanand Bagdure, MD, Lauren Marsillio, MD, Natalie Cvijanovich, MD, Nga Pham, MD, Michael Quasney, MD, Heidi Flori, MD, Myke Federman, MD, Sholeen Nett, MD, Neethi Pinto, MD, MS, Shirley Viteri, MD, James Schneider, MD, Shivanand Medar, MD, Anil Sapru, MD, Patrick McQuillen, MD, Christopher Babbitt, MD, John C. Lin, MD, Philippe Jouvet, MD, Ofer Yanay, MD, Christine Allen, MD, Lisa Asaro, MS, Kerry Coughlin-Wells, RN, MPH, Jaclyn French, Aruna Natarajan, MD, PhD

the PALISI Network
¹ Department of Pediatrics, Stony Brook Children's Hospital and the Renaissance School of Medicine, Stony Brook, NY
² Department of Psychology, Queens College and the Graduate Center of the City University of New York, New York, NY
³ Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA
⁴ Department of Pediatrics, University of Texas Southwestern Medical Center and Children's Health, Dallas, TX
⁵ Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, PA
⁶ Division of Medical Critical Care, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA

^∗Reprint requests: Katherine V. Biagas, MD, Division of Pediatric Critical Care Medicine, 101 Nicolls Rd, HSC T11-040, Stony Brook, NY 11794.Division of Pediatric Critical Care Medicine101 Nicolls RdHSC T11-040Stony BrookNY11794

Abstract

Objectives

To investigate adaptive skills, behavior, and quality health-related quality of life in children from 32 centers enrolling in the Heart And Lung Failure-Pediatric INsulin Titration randomized controlled trial.

Study design

This prospective longitudinal cohort study compared the effect of 2 tight glycemic control ranges (lower target, 80-100 mg/dL vs higher target, 150-180 mg/dL) 1-year neurobehavioral and health-related quality of life outcomes. Subjects had confirmed hyperglycemia and cardiac and/or respiratory failure. Patients aged 2-16 years old enrolled between April 2012 and September 2016 were studied at 1 year after intensive care discharge. The primary outcome, adaptive skills, was assessed using the Vineland Adaptive Behavior Scale. Behavior and health-related quality of life outcomes were assessed as secondary outcomes using the Pediatric Quality of Life and Child Behavior Checklist at baseline and 1-year follow-up. Group differences were evaluated using regression models adjusting for age category, baseline overall performance, and risk of mortality.

Results

Of 369 eligible children, 358 survived after hospital discharge and 214 (60%) completed follow-up. One-year Vineland Adaptive Behavior Scale-II composite scores were not different (mean ± SD, 79.9 ± 25.5 vs 79.4 ± 26.9, lower vs higher target; P = .20). Improvement in Pediatric Quality of Life total health from baseline was greater in the higher target group (adjusted mean difference, 8.2; 95% CI, 1.1-15.3; P = .02).

Conclusions

One-year adaptive behavior in critically ill children with lower vs higher target glycemic control did not differ. The higher target group demonstrated improvement from baseline in overall health. This study affirms the lack of benefit of lower glucose targeting.

Trial registration

ClinicalTrials.gov: NCT01565941.

Le texte complet de cet article est disponible en PDF.

Abbreviations : CBCL, HALF-PINT, HRQoL, PedsQL, PICU, POPC, VABS-II

Plan

Baseline Neurobehavioral and HRQoL Status

One-Year Neurobehavioral and HRQoL Status

Status by Hypoglycemia Experience

Discussion

Data Statement

	Supported by the National Heart, Lung, and Blood Institute (U01HL107681 [to M.A. and V.N.]) and (U01HL108028 [to D.W.]) and the National Center for Advancing Translational Sciences (UL1TR001873 [to K.B.]), and by endowed chairs (to M.A. and V.N.). The authors declare no conflicts of interests.
	Portions of this study were presented at the Pediatric Academic Societies annual meeting, May 5-8, 2018, Toronto, Canada.

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Long-Term Neurobehavioral and Quality of Life Outcomes of Critically Ill Children after Glycemic Control - 20/02/20

Abstract

Objectives

Study design

Results

Conclusions

Trial registration

Plan

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