{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T07:08:30Z","timestamp":1780988910836,"version":"3.54.1"},"reference-count":13,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T00:00:00Z","timestamp":1774828800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T00:00:00Z","timestamp":1774828800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100019994","name":"Brisbane, Australia","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100019994","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Perioperative hypoglycemia during elective surgery may have serious consequences in neonates; however, infants under 12\u2009months of age have traditionally been assumed to be at lower risk of hypoglycemia and ketosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>The aim of this multi\u2010centre prospective observational study was to identify the incidence of hypoglycemia and ketosis in children aged 6\u201312\u2009months having elective surgery. Secondary aims were to identify factors associated with serum glucose concentrations and ketone concentrations at the beginning and end of anesthesia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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 &lt;\u20093.0\u2009mmol\/L and ketosis was defined as ketones being &gt;\u20090.6\u2009mmol\/L. Data on types of fluids given, fasting time for fluids, milks and solids, and vital signs were collected.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.22. There was also no evidence for a difference in serum glucose concentrations; RCH mean 4.6\u2009mmol\/L (SD 0.84), Queensland hospitals' mean 4.7\u2009mmol\/L (SD 0.83), differences in mean \u22120.07 (95% CI \u22120.35 to 0.20)\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.60. 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\u2009mmol\/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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The study showed that for young children undergoing elective surgery, there is a risk of hypoglycemia and ketosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pan.70153","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T12:11:55Z","timestamp":1774872715000},"page":"778-784","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Serum Glucose and Ketone Concentrations in Fasted Children Aged 6\u201312\u2009Months Having Elective Surgery"],"prefix":"10.1002","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1802-1112","authenticated-orcid":false,"given":"Abigail","family":"Wong","sequence":"first","affiliation":[{"name":"Gold Coast University Hospital  Gold Coast Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Ragg","sequence":"additional","affiliation":[{"name":"The Royal Children's Hospital  Parkville Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7050-7419","authenticated-orcid":false,"given":"Andrew","family":"Davidson","sequence":"additional","affiliation":[{"name":"Murdoch Children's Research Institute  Parkville Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzette","family":"Sheppard","sequence":"additional","affiliation":[{"name":"Murdoch Children's Research Institute  Parkville Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Hughes","sequence":"additional","affiliation":[{"name":"Office for Research Governance and Development Gold Coast University Hospital  Gold Coast Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,30]]},"reference":[{"issue":"4","key":"e_1_2_9_2_1","first-page":"A348","article-title":"Safe Perioperative Fasting: Implementation of Evidence\u2010Based Guidelines and an at Risk Checklist","volume":"21","author":"Young J.","year":"2006","journal-title":"Journal of Gastroenterology and Hepatology"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/EJA.0000000000000330"},{"key":"e_1_2_9_4_1","unstructured":"Safetots International \u201c10\u2010N\u2014Matrix for Safe Conduct of Anesthesia \u201dhttps:\/\/www.safetots.org\/10\u2010n\u2010quality\/."},{"key":"e_1_2_9_5_1","volume-title":"PG07(A) Guideline on Pre\u2010Anaesthesia Consultation and Patient Preparation Appendix\u00a012\u2009023","author":"The Australian and New Zealand College of Anaesthetists (ANZCA)","year":"2023"},{"key":"e_1_2_9_6_1","volume-title":"Fasting Guidelines","author":"Lady Cilento Children's Hospital","year":"2015"},{"key":"e_1_2_9_7_1","unstructured":"Royal College of Nursing \u201cPerioperative Fasting in Adults and Children an RCN Guideline for the Multidisciplinary Team \u201dhttps:\/\/www.rcn.org.uk."},{"key":"e_1_2_9_8_1","unstructured":"Royal Children's Hospital Melbourne Australia \u201cClinical Practice Guideline on Fasting \u201dhttps:\/\/www.rch.org.au\/clinicalguide\/index.cfm."},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000003773"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.14841"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/0310057X1604400116"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/EJA.0000000000001599"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pediatrneurol.2006.01.005"},{"key":"e_1_2_9_14_1","unstructured":"Scottish Hip Fracture Audit Sterring Group Practice Statement \u201cDeveloping \u2018SipTilSend\u2019 Policies for Hip Fracture Surgery 2021 \u201dDeveloping \u2018SipTilSend\u2019 Policies for Hip Fracture Surgery Version 1.1."}],"container-title":["Pediatric 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