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Published on: June 11, 2012
Long-Term Outcomes of Hyperglycemic Preterm Infants Randomized to Tight Glycemic Control
Anna Catherine Tottman1, Jane Marie Alsweiler2, Frank Harry Bloomfield1
1Liggins Institute, University of Auckland, Auckland, New Zealand.
Insights
Tight glycemic control in newborns with hyperglycemia does not impact neurodevelopmental outcomes at school age. However, it did result in reduced height but increased lean mass and lower fasting glucose levels.
Area of Science:
- Neonatal Medicine
- Pediatric Endocrinology
- Developmental Pediatrics
Background:
- Neonatal hyperglycemia is common in very low birth weight infants.
- The long-term effects of glycemic control strategies on neurodevelopment and growth are not fully understood.
Purpose of the Study:
- To investigate if tight glycemic control in neonates with hyperglycemia affects neurodevelopment, growth, and metabolism at school age.
- To compare outcomes at 7 years corrected age between infants randomized to tight versus standard glycemic control.
Main Methods:
- A randomized trial involving very low birth weight infants with neonatal hyperglycemia.
- Assessment at 7 years corrected age included neurodevelopmental tests, growth measures, body composition analysis (DXA), and glucose-tolerance tests.
- Primary outcome was survival without neurodevelopmental impairment.
Main Results:
- No significant difference in survival without neurodevelopmental impairment between tight and standard glycemic control groups (37%).
- Children in the tight control group were shorter (P<.05) but had greater height-adjusted lean mass (P<.01) and lower fasting glucose (P<.05) at age 7.
- No differences in weight, head circumference, other body composition, or insulin-glucose metabolism measures were observed.
Conclusions:
- Tight glycemic control for neonatal hyperglycemia does not alter survival without neurodevelopmental impairment at school age.
- This strategy leads to reduced height, increased lean mass, and lower fasting blood glucose concentrations in school-aged children.
- Further research may be needed to understand the long-term implications of these metabolic and growth changes.
Objective:
To determine whether tight glycemic control of neonatal hyperglycemia changes neurodevelopment, growth, and metabolism at school age.
Study Design:
Children born very low birth weight and randomized as hyperglycemic neonates to a trial of tight vs standard glycemic control were assessed at 7 years corrected age, including Wechsler Intelligence Scale for Children Fourth Edition, Movement Assessment Battery for Children 2, visual and neurologic examinations, growth measures, dual X-ray absorptiometry, and frequently sampled intravenous glucose tolerance test. The primary outcome was survival without neurodevelopmental impairment at age 7 years. Outcomes were compared using linear regression, adjusted for sex, small for gestational age, birth plurality, and the clustering of twins. Data are reported as number (%) or mean (SD).
Results:
Of the 88 infants randomized, 11 (13%) had died and 57 (74% of eligible children) were assessed at corrected age 7 years. Survival without neurodevelopmental impairment occurred in 25 of 68 children (37%), with no significant difference between tight (14 of 35; 40%) and standard (11 of 33; 33%) glycemic control groups (P = .60). Children in the tight group were shorter than those in the standard group (121.3 [6.3] cm vs 125.1 [5.4] cm; P < .05), but had similar weight and head circumference. Children in the tight group had greater height-adjusted lean mass (18.7 [0.3] vs 17.6 [0.2] kg; P < .01) and lower fasting glucose concentrations (84.6 [6.30] vs 90.0 [5.6] mg⋅dL-1; P < .05), but no other differences in measures of body composition or insulin-glucose metabolism.
Conclusion:
Tight glycemic control for neonatal hyperglycemia does not change survival without neurodevelopmental impairment, but reduces height, increases height-adjusted lean mass, and reduces fasting blood glucose concentrations at school age.
Trial Registration:
ACTRN: 12606000270516.
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