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Early blood glucose profile and neurodevelopmental outcome at two years in neonatal hypoxic-ischaemic encephalopathy
Montasser Nadeem1, Deirdre M Murray, Geraldine B Boylan
1Neonatal Intensive Care Unit, Cork University Maternity Hospital, Cork, Ireland.
Insights
Early hypoglycemia in newborns with hypoxic-ischaemic encephalopathy (HIE) is linked to adverse neurodevelopmental outcomes. Blood glucose levels in these infants vary significantly within 72 hours of birth, despite management protocols.
Area of Science:
- Neonatal Medicine
- Pediatric Neurology
- Endocrinology
Background:
- Hypoxic-ischaemic encephalopathy (HIE) is a major cause of neonatal brain injury.
- Blood glucose dysregulation is common in infants with HIE.
- Understanding glucose profiles is crucial for predicting neurodevelopmental outcomes.
Purpose of the Study:
- To investigate the blood glucose profile in term infants with HIE.
- To determine the association between blood glucose levels and neurodevelopmental outcomes at 24 months.
Main Methods:
- Collected blood glucose data from 52 term infants with HIE within 72 hours of birth.
- Defined hypoglycemia (< 46.8 mg/dL) and hyperglycemia (> 150 mg/dL).
- Correlated glucose levels with neurodevelopmental assessments at 24 months.
Main Results:
- Most blood samples (83.8%) were normoglycemic; however, hypoglycemia and hyperglycemia were frequent in the remaining samples.
- Early hypoglycemia (0-6 hours) was associated with adverse outcomes (OR = 5.8), though not statistically significant after adjusting for HIE severity.
- Late hypoglycemia and any hyperglycemia were not significantly associated with adverse outcomes.
Conclusions:
- Blood glucose levels in infants with HIE exhibit wide variability within 72 hours post-birth.
- Early-onset hypoglycemia (0-6 hours) is linked to severe HIE and adverse neurodevelopmental outcomes.
- Current management protocols may not fully normalize glucose profiles in HIE infants.
Background:
To examine the blood glucose profile and the relationship between blood glucose levels and neurodevelopmental outcome in term infants with hypoxic-ischaemic encephalopathy.
Methods:
Blood glucose values within 72 hours of birth were collected from 52 term infants with hypoxic-ischaemic encephalopathy. Hypoglycaemia [< 46.8 mg/dL (2.6 mmol/L)] and hyperglycaemia [> 150 mg/dL (8.3 mmol/L)] were correlated to neurodevelopmental outcome at 24 months of age.
Results:
Four fifths of the 468 blood samples were in the normoglycaemic range (392/468:83.8%). Of the remaining 76 samples, 51.3% were in the hypoglycaemic range and (48.7%) were hyperglycaemic. A quarter of the hypoglycaemic samples (28.2%:11/39) and a third of the hyperglycaemic samples (32.4%:12/37) were recorded within the first 30 minutes of life. Mean (SD) blood glucose values did not differ between infants with normal and abnormal outcomes [4.89(2.28) mmol/L and 5.02(2.35) mmol/L, p value = 0.15] respectively. In term infants with hypoxic-ischaemic encephalopathy, early hypoglycaemia (between 0-6 hours of life) was associated with adverse outcome at 24 months of age [OR = 5.8, CI = 1.04-32)]. On multivariate analysis to adjust for grade of HIE this association was not statistically significant. Late hypoglycaemia (6-72 hours of life) was not associated with abnormal outcome [OR = 0.22, CI (0.04-1.14)]. The occurrence of hyperglycaemia was not associated with adverse outcome.
Conclusion:
During the first 72 hours of life, blood glucose profile in infants with hypoxic-ischaemic encephalopathy varies widely despite a management protocol. Early hypoglycaemia (0-6 hours of life) was associated with severe HIE, and thereby; adverse outcome.
