Dr Sanklecha has raised some valid points in his communication [1]; nevertheless, I would like to put these in their right perspective.

First of all, 17.5% to 70% of patients in the various studies included in the review [2] were post-operative/surgical. In the only prospective randomised controlled study of tight glycemic control in children by Vlasselaers, et al. [3], 600 out of 700 (85.7%) patients were post-operative cardiac surgical, high risk surgical or those with trauma. Further, in a retrospective study in 177 post-operative (cardiac surgery) children admitted to a PICU, non-survivors had higher peak glucose levels (389.3 ± 162 mg/dL vs 162± 106.3 mg/dL) and longer duration of hyperglycemia (3.06 ± 1.67 vs 2.11 ± 0.92 days) during the first 5 post operative days, compared to survivors [4].

In the absence of any scientific studies, it would be difficult to substantiate the author’s observation that post-operative hyperglycemia is not necessarily indicative of a poor outcome. Though hyperglycemia may not directly be associated with mortality, significant increase in morbidity such as, increase in duration of ventilation, higher wound infection rates and increase in length of ICU/hospital stay is possible. However, it is pertinent to mention here that some studies have shown that early post-operative hyperglycemia (within first 24-48 hours) is not associated with a worse outcome [4,5]. To conclusively determine whether post-operative hyperglycemia is indeed asso-ciated with a worse outcome, we await the results of an ongoing trial in post-operative cardiac surgical children [6].

Secondly, the evidence is now moving in favour of a modest glucose target of 110-150 mg% rather than strict normoglycemia [2]. There is no doubt that targeting strict normoglycemia definitely increases the risk of hypoglycemia. The same has been emphasized in other studies too [4].

Finally, I have no doubt that insulin infusion to correct hyperglycemia, especially in our children where malnutrition is rampant, cannot be taken lightly. This can only be embarked upon once the nursing personnel are trained, adequate nutrition is provided and locally feasible protocols are devised.

1. Sanklecha M. Hyperglycemia in the PICU: Tread with caution. Indian Pediatr. 2011;48:824.

2. Poddar B. Treating hyperglycemia in the critically ill child: Is there enough evidence? Indian Pediatr. 2011;48:531-6.

3. Vlasselaers D, Milants I, Desmet L, Wouters PJ, Vanhorebeek I, van den Heuvel I, et al. Intensive insulin therapy for patients in paediatric intensive care: a prospective, randomized controlled study. Lancet. 2009;373:547-56.

4. Ulate KP, Falcao GCL, Bielefeld MR, Morales JM, Rotta AT. Strict glycemic targets need not be so strict: A more permissive glycemic range for critically ill children. Pediatrics. 2008;e898-904.

5. Yung M, Wilkins B, Norton L, Slater A. Glucose control, organ failure, and mortality in pediatric intensive care. Pediatr Crit Care Med. 2008;9:147-52.

6. Maintaining normal blood sugar levels in children undergoing heart surgery to reduce the risk of infections and improve recovery (The SPECS study). http://clinicaltrials.gov/ct2/show/NCT00443599. Accessed on October 10, 2010.