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Outcomes of very preterm infants with neonatal hyperglycaemia: a systematic review and meta-analysis

Chandra Prakash Rath1,2, Madhusudhan Shivamallappa1,2, Saravanan Muthusamy1,2

  • 1Neonatology, King Edward Memorial Hospital for Women, Subiaco, Western Australia, Australia.

Archives of Disease in Childhood. Fetal and Neonatal Edition
|July 31, 2021
PubMed

Insights

Hyperglycaemia in very preterm infants is linked to increased mortality and severe complications like intraventricular hemorrhage and retinopathy of prematurity. Longer duration of high blood sugar worsens these adverse outcomes.

Area of Science:

  • Neonatal Medicine
  • Endocrinology
  • Perinatal Epidemiology

Background:

  • Hyperglycaemia is a common metabolic disturbance in very preterm infants.
  • The association between hyperglycaemia and adverse outcomes in this vulnerable population requires further clarification.

Purpose of the Study:

  • To systematically review and meta-analyze the association between hyperglycaemia and adverse outcomes in very preterm infants (<32 weeks or <1500 g).

Main Methods:

  • Systematic review and meta-analysis of 46 studies including 34,527 infants.
  • Data pooled using random-effects models for adjusted and unadjusted odds ratios (ORs).
  • Subgroup analysis conducted based on study design (cohort and case-control).

Main Results:

  • Unadjusted analysis indicated significant associations between hyperglycaemia and mortality, intraventricular haemorrhage (IVH), retinopathy of prematurity (ROP), sepsis, chronic lung disease, and disability.
  • Adjusted analysis revealed significant associations only for mortality (aOR 2.37), any-grade IVH (aOR 2.60), and any-stage ROP (aOR 3.70).
  • Higher glucose levels (>10 mmol/L) and longer duration of hyperglycaemia were associated with increased odds of mortality and adverse outcomes, respectively. GRADE of evidence was 'Low' or 'Very low'.

Conclusions:

  • Hyperglycaemia in very preterm infants is associated with increased odds of mortality, any-grade IVH, and any-stage ROP.
  • The lack of adjusted ORs in many studies limits definitive conclusions.
  • Further research with robust adjusted analyses is warranted.
Abstract

Keywords:
endocrinologymortalityneonatology

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