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Tight glycaemic control cuts paediatric intensive care stays

The length of time critically ill children spend in hospital could be slashed by changing the way paediatric intensive care units control blood sugar levels, according to UK researchers.

The UK-wide CHiP trial was led by clinicians from the children’s intensive care at the Royal Brompton and Harefield Foundation Trust.

It looked at different ways of tackling “stress hyperglycaemia” – resulting from severe illness or major surgery – among 1,369 children at 13 children’s intensive care units.

The trial, published today in the New England Journal of Medicine, compared the effects of allowing the natural rise in blood glucose to occur with controlling the rise using insulin to maintain normal glucose levels.

During one-year follow-up, researchers found a significant difference between the two treatment groups in children who had not undergone heart surgery.

Tight glycaemic control resulted in an average length of hospital stay of 31 days, which was 13.5 days less than the 44.5 days for children whose glucose levels were allowed to rise naturally.

However, no such benefits were seen for children who had undergone heart surgery.

Study author Dr Duncan Macrae, from the Royal Brompton, said the findings had “important implications for the way blood glucose levels are managed in very sick children”.

“Evidence from this study suggests those caring for very sick children, who have not undergone heart surgery, should consider controlling blood glucose levels more closely during intensive care.”

The authors calculate that a policy of tight glycemic control could reduce costs by about £10,000 per child, potentially saving the NHS in England and Wales up to £12m each year.

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