Risk factors for intraoperative hypoglycemia in children: a retrospective observational cohort study

  • Lori Q. RieggerEmail author
  • Aleda M. Leis
  • Shobha Malviya
  • Kevin K. Tremper
Reports of Original Investigations



Intraoperative hypoglycemia can result in devastating neurologic injury if not promptly diagnosed and treated. Few studies have defined risk factors for intraoperative hypoglycemia. The authors sought to characterize children with intraoperative hypoglycemia and determine independent risk factors.


This retrospective observational single-institution study included all patients < 18 yr of age undergoing an anesthetic from January 1 2012 to December 31 2016. The primary outcome was blood glucose < 3.3 mmol·L−1 (60 mg·dl−1). Data collected included patient characteristics, comorbidities, and intraoperative factors. A multivariable logistic regression model was used to identify independent predictors of intraoperative hypoglycemia.


Blood glucose was measured in 7,715 of 73,592 cases with 271 (3.5%) having a glucose < 3.3 mmol·L−1 (60 mg·dl−1). Young age, weight for age < 5th percentile, developmental delay, presence of a gastric or jejunal tube, and abdominal surgery were identified as independent predictors for intraoperative hypoglycemia. Eighty percent of hypoglycemia cases occurred in children < three years of age and in children < 15 kg.


Young age, weight for age < 5th percentile, developmental delay, having a gastric or jejunal tube, and abdominal surgery were independent risk factors for intraoperative hypoglycemia in children. Frequent monitoring of blood glucose and judicious isotonic dextrose administration may be warranted in these children.

Facteurs de risque d’hypoglycémie peropératoire chez l’enfant : une étude de cohorte observationnelle rétrospective



L’hypoglycémie peropératoire peut entraîner des lésions neurologiques catastrophiques si elle n’est pas diagnostiquée et traitée rapidement. Très peu d’études ont défini les facteurs de risque d’hypoglycémie peropératoire. Les auteurs ont essayé de caractériser les enfants atteints d’hypoglycémie peropératoire et de déterminer les facteurs de risque indépendants.


Cette étude observationnelle rétrospective monocentrique a inclus tous les patients < 18 ans subissant une anesthésie entre le 1er janvier 2012 et le 31 décembre 2016. Le critère d’évaluation principal était une glycémie < 3,3 mmol·L−1 (60 mg·dl−1). Les données colligées comprenaient les caractéristiques des patients, les comorbidités et les facteurs peropératoires. Un modèle de régression logistique multivariée a été utilisé pour identifier les prédicteurs indépendants d’hypoglycémie peropératoire.


La glycémie a été mesurée dans 7715 des 73 592 cas, et 271 cas (3,5 %) ont eu un taux de glycémie < 3,3 mmol·L−1 (60 mg·dl−1). Un jeune âge, un poids < 5e percentile pour l’âge, un retard de développement, la présence d’une sonde gastrique ou jéjunale, et une chirurgie abdominale ont été identifiés comme des prédicteurs indépendants d’hypoglycémie peropératoire. Quatre-vingts pour cent des cas d’hypoglycémie sont survenus chez des enfants < trois ans et chez des enfants < 15 kg.


Un jeune âge, un poids < 5e percentile pour l’âge, un retard de développement, la présence d’une sonde gastrique ou jéjunale, et une chirurgie abdominale sont des facteurs de risque indépendants d’hypoglycémie peropératoire chez les enfants. Le monitorage fréquent de la glycémie et l’administration judicieuse de solution dextrosée isotonique pourraient être justifiés chez ces enfants.


Financial support and sponsorship

This work was supported by the University of Michigan Department of Anesthesiology, Ann Arbor, Michigan, USA.

Conflicts of interest

Lori Q. Riegger, Aleda M. Leis, Shobha Malviya have no conflict of interests. Kevin K. Tremper is the founder and equity holder in AlertWatch, a quality/safety decision support software company.

Author contributions

Lori Q. Riegger contributed to the study design, data collection, data analysis and interpretation, and writing and editing the manuscript. Aleda M. Leis contributed to the study design, data collection, statistical and data analysis and interpretation, and writing and editing the manuscript. Shobha Malviya contributed to the study design, data analysis, interpretation of data, and writing and editing the manuscript. Kevin K. Tremper contributed to the study design, data interpretation, and editing the manuscript.

Editorial responsibility

This submission was handled by Dr. Philip M. Jones, Associate Editor, Canadian Journal of Anesthesia.


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Copyright information

© Canadian Anesthesiologists' Society 2019

Authors and Affiliations

  1. 1.Department of AnesthesiologyUniversity of Michigan Health SystemAnn ArborUSA

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