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Impact of hypoglycaemia on neurodevelopmental outcomes in hypoxic ischaemic encephalopathy: a retrospective cohort
Jason Khay Ghim Tan1,2, Corrado Minutillo1,2, Judy McMichael2,3
1Neonatal Intensive Care Unit, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.
Insights
Recurrent low blood glucose levels (BGLs) in infants with hypoxic ischaemic encephalopathy (HIE) treated with therapeutic hypothermia (TH) are linked to worse neurodevelopmental outcomes. Early detection and management of hypoglycemia are crucial for improving infant health.
Area of Science:
- Neonatal neurology
- Pediatric critical care
- Metabolic disorders in newborns
Background:
- Infant hypoglycemia (low blood glucose levels) can negatively impact neurodevelopment.
- The association between hypoglycemia and neurodevelopmental outcomes in infants with hypoxic ischaemic encephalopathy (HIE) receiving therapeutic hypothermia (TH) requires further investigation.
- Optimal blood glucose level (BGL) targets for HIE infants undergoing TH are not well-defined.
Purpose of the Study:
- To investigate the relationship between hypoglycemia and neurodevelopmental outcomes in neonates with HIE treated with TH.
- To examine the impact of different BGL thresholds (2.6 and 3.0 mmol/L) on these outcomes.
Main Methods:
- A retrospective cohort study was conducted involving infants with HIE treated with TH.
- Neurodevelopmental data up to two years of age were collected using the Bayley Scales of Infant Development, third edition (BSID-III).
- Multivariable logistic regression models were used to analyze the association between hypoglycemia and neurodevelopmental outcomes.
Main Results:
- Hypoglycemia (BGL < 2.6 mmol/L) occurred in 31% of infants, with 9% experiencing recurrent episodes.
- Recurrent hypoglycemia (< 2.6 mmol/L) was significantly associated with lower BSID-III cognitive, language, and socioemotional scores.
- Recurrent hypoglycemia (< 2.6 mmol/L) increased the odds of death or disability (aOR 8.15). Recurrent hypoglycemia (< 3.0 mmol/L) within 12 hours was linked to severe disability in survivors (aOR 11.13).
Conclusions:
- Early recurrent hypoglycemia in neonates undergoing TH for HIE is associated with a higher risk of death or severe disability.
- Further prospective studies are necessary to establish ideal target BGLs for this vulnerable infant population.
Background:
Low blood glucose levels (BGLs) in infants are known to adversely affect neurodevelopmental outcomes. However, this risk is not well explored in infants with hypoxic ischaemic encephalopathy (HIE) that receive therapeutic hypothermia (TH). Additionally, little information is available on the optimal BGLs to target in infants with HIE.
Aim:
To explore the association between hypoglycaemia and neurodevelopmental outcomes at different BGL thresholds (2.6 and 3.0 mmol/L) in neonates with HIE treated with TH.
Methods:
Retrospective cohort study. Clinical information and 2-year neurodevelopmental data using Bayley Scales of Infant Development, third edition (BSID-III) and disabilities were recorded for infants born in Western Australia with HIE and treated with TH between February 2008 and February 2012. Multivariable logistic regression models explored the association between hypoglycaemia and neurodevelopmental outcomes.
Results:
122 infants underwent a total of 1616 BGL estimations before and during 72 hours of TH. Hypoglycaemia (BGL<2.6 mmol/L) occurred in 38/122 (31%) infants and 11/122 (9%) had recurrent hypoglycaemia (three or more episodes). Infants with recurrent hypoglycaemia (<2.6 mmol/L) had significantly lower mean BSID-III cognitive, language and socioemotional subscale scores. On multivariable analysis, recurrent hypoglycaemia (<2.6 mmol/L) was associated with increased odds of death or disability (adjusted OR 8.15; 95% CI 1.31 to 50.58; p=0.024). Recurrent hypoglycaemia (<3.0 mmol/L) during the first 12 hours of life was also associated with severe disability among survivors (adjusted OR 11.13; 95% CI 2.06 to 59.89; p=0.005).
Conclusions:
Early recurrent hypoglycaemia was associated with increased risk of death or severe disability in neonates undergoing TH for HIE. Prospective studies are needed to identify the ideal target BGL in this population.
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