Fuente: "milk OR dairy products" Paediatr Anaesth. 2026 Mar 30. doi: 10.1002/pan.70153. Online ahead of print.ABSTRACTBACKGROUND: Perioperative hypoglycemia during elective surgery may have serious consequences in neonates; however, infants under 12 months of age have traditionally been assumed to be at lower risk of hypoglycemia and ketosis.AIMS: The aim of this multi-centre prospective observational study was to identify the incidence of hypoglycemia and ketosis in children aged 6-12 months having elective surgery. Secondary aims were to identify factors associated with serum glucose concentrations and ketone concentrations at the beginning and end of anesthesia.METHODS: Serum glucose and ketone concentrations were tested at the induction of anesthesia and at the end of anesthesia. For this study, hypoglycemia was defined as glucose < 3.0 mmol/L and ketosis was defined as ketones being > 0.6 mmol/L. Data on types of fluids given, fasting time for fluids, milks and solids, and vital signs were collected.RESULTS: The study enrolled 158 participants between 2019 and 2021 at three tertiary pediatric hospitals in Australia. There were 6 cases of hypoglycemia (3.8%) recorded at induction of anesthesia with only 1 at the end of the case. At induction, 54 (34.6%) patients were ketotic with 76 ketotic (48.7%) at the end of the procedure. At induction there was no evidence for a difference between states with differing fasting guidelines in the incidence of hypoglycemia; The Royal Children's Hospital (RCH) 4 (4.1%), Queensland hospitals 2 (3.6%) risk ratio 1.13, and no evidence for a difference in ketosis; RCH 31 (32%), Queensland hospitals 18 (47.4%) risk ratio 0.76, 95% CI 0.45 to 1.17, p = 0.22. There was also no evidence for a difference in serum glucose concentrations; RCH mean 4.6 mmol/L (SD 0.84), Queensland hospitals' mean 4.7 mmol/L (SD 0.83), differences in mean -0.07 (95% CI -0.35 to 0.20) p = 0.60. However, there was evidence for a difference in ketones with median at RCH at 0.4 (IQR 0.2,0.7), Queensland at 0.6 mmol/L (IQR 0.3,0.9) however it is clinically insignificant. Serum glucose and ketone concentrations are related to milk fasting time. Increasing milk fasting times increases ketone concentrations and decreases serum glucose concentrations.CONCLUSIONS: The study showed that for young children undergoing elective surgery, there is a risk of hypoglycemia and ketosis.PMID:41910193 | DOI:10.1002/pan.70153