Document Detail


Increased calcium supplementation is associated with morbidity and mortality in the infant postoperative cardiac patient.
MedLine Citation:
PMID:  17417127     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The purpose of this study was to assess the association of calcium replacement therapy with morbidity and mortality in infants after cardiac surgery involving cardiopulmonary bypass. DESIGN: Retrospective chart review. SETTING: The cardiac intensive care unit at a tertiary care children's hospital. PATIENTS: Infants undergoing cardiac surgery involving cardiopulmonary bypass between October 2002 and August 2004. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Total calcium replacement (mg/kg calcium chloride given) for the first 72 postoperative hours was measured. Morbidity and mortality data were collected. The total volume of blood products given during the first 72 hrs was recorded. Infants with confirmed chromosomal deletions at the 22q11 locus were noted. Correlation and logistic regression analyses were used to generate odds ratios and 95% confidence intervals, with p < .05 being significant. One hundred seventy-one infants met inclusion criteria. Age was 4 +/- 3 months and weight was 4.9 +/- 1.7 kg at surgery. Six infants had deletions of chromosome 22q11. Infants who weighed less required more calcium replacement (r = -.28, p < .001). Greater calcium replacement correlated with a longer intensive care unit length of stay (r = .27, p < .001) and a longer total hospital length of stay (r = .23, p = .002). Greater calcium replacement was significantly associated with morbidity (liver dysfunction [odds ratio, 3.9; confidence interval, 2.1-7.3; p < .001], central nervous system complication [odds ratio, 1.8; confidence interval, 1.1-3.0; p = .02], infection [odds ratio, 1.5; confidence interval, 1.0-2.2; p < .04], extracorporeal membrane oxygenation [odds ratio, 5.0; confidence interval, 2.3-10.6; p < .001]) and mortality (odds ratio, 5.8; confidence interval, 5.8-5.9; p < .001). Greater calcium replacement was not associated with renal insufficiency (odds ratio, 1.5; confidence interval, 0.9-2.3; p = .07). Infants with >1 sd above the mean of total calcium replacement received on average fewer blood products than the total study population. CONCLUSIONS: Greater calcium replacement is associated with increasing morbidity and mortality. Further investigation of the etiology and therapy of hypocalcemia in this population is warranted.
Authors:
Peter C Dyke; Andrew R Yates; Clifford L Cua; Timothy M Hoffman; John Hayes; Timothy F Feltes; Michelle A Springer; Roozbeh Taeed
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies     Volume:  8     ISSN:  1529-7535     ISO Abbreviation:  Pediatr Crit Care Med     Publication Date:  2007 May 
Date Detail:
Created Date:  2007-05-14     Completed Date:  2007-07-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100954653     Medline TA:  Pediatr Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  254-7     Citation Subset:  IM    
Affiliation:
Department of Pediatrics, The Ohio State Unviersity, and Columbus Children's Hospital, The Heart Center, Columbus, OH 43205-2696, USA. lpdyke@gmail.com
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MeSH Terms
Descriptor/Qualifier:
Calcium
Cardiopulmonary Bypass / adverse effects
Dietary Supplements / adverse effects*
Female
Heart Diseases / epidemiology*,  mortality,  surgery
Humans
Infant
Infant, Newborn
Male
Postoperative Period
Retrospective Studies
Chemical
Reg. No./Substance:
7440-70-2/Calcium
Comments/Corrections
Comment In:
Pediatr Crit Care Med. 2007 May;8(3):300-1   [PMID:  17496519 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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