• Kerri L LaRovere, Lisa A Asaro, Kerry Coughlin-Wells, Vinay M Nadkarni, AgusMichael S DMSDDivision of Medicine Critical Care, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA., and Heart and Lung Failure—Pediatric Insulin Titration (HALF-PINT) Study Investigators.
• Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA.
• Pediatr Crit Care Me. 2025 Feb 5.

ObjectivesTo compare two blood glucose (BG) ranges in critically ill children with and without primary neurologic diagnoses in the Heart and Lung Failure-Pediatric Insulin Titration trial (HALF-PINT; ClinicalTrials.gov Identifier NCT01565941).DesignNon-prespecified post hoc analysis.SettingThirty-one PICUs in the United States, and one in Canada.PatientsNon-diabetic children enrolled from April 2012 to September 2016 with cardiovascular or respiratory failure and hyperglycemia. Patients in the neurologic subgroup had primary neurologic diagnoses on ICU admission.InterventionsPatients were randomized to insulin infusion to target lower-BG (80-110 mg/dL; 4.4-6.1 mmol/L) or higher-BG (150-180 mg/dL; 8.3-10 mmol/L).Measurements And Main ResultsPrimary diagnosis (neurologic vs. non-neurologic), daily BG and insulin values, outcomes (number of PICU-free days through day 28 and 1-y post-PICU discharge adaptive behavior composite score of Vineland Adaptive Behavior Scales, Second Edition). Of 698 patients analyzed, 64 (30 lower-BG target, 34 higher-BG target) had primary neurologic diagnoses and 634 (319 lower-BG target, 315 higher-BG target) had non-neurologic diagnoses. Within the neurologic subgroup, patients in the lower-BG targeting group had fewer ICU-free days compared with those in the higher-BG targeting group (median 8.5 vs. 21.1 d), whereas there was no difference between BG groups in the non-neurologic subgroup (20.5 vs. 19.3 d; interaction p = 0.02). One-year adaptive behavior composite score was less favorable for the lower-BG targeting group in those with neurologic diagnoses (mean 63.3 vs. 87.6), but no different in those with non-neurologic diagnoses (81.9 vs. 78.4; interaction p = 0.02). Lower-BG targeting was associated with more hypoglycemia (< 60 mg/dL) in both diagnostic subgroups, with no differential effect across subgroups (p = 0.47).ConclusionsIn this non-prespecified analysis of the HALF-PINT trial data, lower-BG targeting in hyperglycemic critically ill children with primary neurologic diagnoses was associated with unfavorable outcomes, while such BG targeting in those with non-neurologic diagnoses was not associated with adverse outcomes.Copyright © 2025 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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