Background: Neonates undergoing major surgery experience a significant stress response, yet the clinical impact of perioperative hyperglycemia in this population prior to contemporary tight glycemic control protocols was unclear. This study aimed to prospectively investigate the association between perioperative hyperglycemia and a composite outcome of major morbidity/mortality. Methods: In this prospective observational cohort study conducted in 2008, we enrolled neonates (≥35 weeks gestation) scheduled for major abdominal laparotomy. Blood glucose was measured at standardized perioperative time points. Hyperglycemia was defined as any value >150 mg/dL (8.3 mmol/L) intraoperatively or within 12 hours postoperatively. The primary outcome was a composite of in-hospital mortality, culture-proven sepsis, surgical site infection, or anastomotic leak. Multivariable logistic regression adjusted for preoperative risk. Results: Of 86 neonates enrolled, 49 (57.0%) developed perioperative hyperglycemia. The composite primary outcome occurred in 26/49 (53.1%) neonates with hyperglycemia compared to 8/37 (21.6%) normoglycemic neonates (p=0.003). Hyperglycemic neonates had significantly higher peak glucose levels (mean 182.4 ± 31.2 mg/dL vs. 118.6 ± 21.4 mg/dL, p<0.001). After adjustment for birth weight and preoperative PRISM score, hyperglycemia remained independently associated with the composite outcome (adjusted Odds Ratio 3.4, 95% CI: 1.3–8.9; p=0.012). Conclusion: Perioperative hyperglycemia, defined by a threshold of 150 mg/dL, was common and independently associated with a greater than three-fold increased risk of major morbidity or mortality in surgical neonates. These findings from 2008 highlight the potential significance of glucose dysregulation as an important risk factor in neonatal perioperative care.

Neonate; Hyperglycemia; Abdominal Surgery; Postoperative Complications; Anesthesia; Outcomes.