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Early Blood Glucose Level Post-Admission Correlates with the Outcomes and Oxidative Stress in Neonatal
Inn-Chi Lee1,2, Jiann-Jou Yang2,3, Ying-Ming Liou4,5
1Division of Pediatric Neurology, Department of Pediatrics, Chung Shan Medical University Hospital, Taichung 40201, Taiwan.
Insights
Neonatal hypoxic-ischemic encephalopathy (HIE) outcomes are linked to initial blood glucose levels. Both high and low glucose levels correlate with poorer clinical, brain lesion, and neurodevelopmental outcomes in HIE infants.
Area of Science:
- Neonatal Medicine
- Neurology
- Endocrinology
Background:
- Neonatal hypoxic-ischemic encephalopathy (HIE) is a severe condition linked to oxidative stress.
- Antioxidant defense systems play a role in HIE pathogenesis.
- The impact of initial serum glucose levels on HIE outcomes requires further investigation.
Purpose of the Study:
- To investigate the association between first serum blood glucose levels and clinical outcomes in neonatal HIE.
- To determine the correlation between glucose levels and brain lesions, hearing impairment, and neurodevelopmental outcomes in HIE.
- To identify initial glucose levels as a potential biomarker for predicting HIE severity and prognosis.
Main Methods:
- Seventy-four neonatal HIE patients were categorized into three groups based on initial glucose levels: hypoglycemia (<60 mg/dL), normoglycemia (60-149 mg/dL), and hyperglycemia (≥150 mg/dL).
- Clinical staging, brain parenchymal lesions (MRI), hearing impairment, and neurodevelopmental outcomes were assessed.
- Statistical analyses, including Pearson's test, were used to evaluate correlations between glucose levels and various outcome measures.
Main Results:
- Abnormal glucose levels (hypoglycemia and hyperglycemia) were associated with significantly poorer clinical stage, brain parenchymal lesions, and neurodevelopmental outcomes.
- Hyperglycemia (group 3) showed a higher incidence of hearing impairment and more thalamus and basal ganglion lesions compared to hypoglycemia (group 1) and normoglycemia (group 2).
- Initial glucose levels significantly correlated with clinical staging, brain lesions, hearing impairment, and neurodevelopmental outcomes.
Conclusions:
- The first blood glucose level is a crucial biomarker for predicting clinical staging, MRI findings, and hearing and neurodevelopmental outcomes in neonatal HIE.
- Hyperglycemia in HIE is linked to a higher risk of specific brain lesions (thalamus, basal ganglia, brain stem) compared to hypoglycemia.
- Both hyperglycemia and hypoglycemia are associated with adverse outcomes in neonatal HIE, highlighting the importance of glucose monitoring and management.
Abstract:
The antioxidant defense system is involved in the pathogenesis of neonatal hypoxic-ischemic encephalopathy (HIE). To analyze the relationship between first serum blood glucose levels and outcomes in neonatal HIE, seventy-four patients were divided, based on the first glucose level, into group 1 (>0 mg/dL and <60 mg/dL, n =11), group 2 (≥60 mg/dL and <150 mg/dL, n = 49), and group 3 (≥150 mg/dL, n = 14). Abnormal glucose levels had poor outcomes among three groups in terms of the clinical stage (p = 0.001), brain parenchymal lesion (p = 0.004), and neurodevelopmental outcomes (p = 0.029). Hearing impairment was more common in group 3 than in group 1 (p = 0.062) and group 2 (p = 0.010). The MRI findings of group 3 exhibited more thalamus and basal ganglion lesions than those of group 1 (p = 0.012). The glucose level was significantly correlated with clinical staging (p< 0.001), parenchymal brain lesions (p = 0.044), hearing impairment (p = 0.003), and neurodevelopmental outcomes (p = 0.005) by Pearson's test. The first blood glucose level in neonatal HIE is an important biomarker for clinical staging, MRI findings, as well as hearing and neurodevelopment outcomes. Hyperglycemic patients had a higher odds ratio for thalamus, basal ganglia, and brain stem lesions than hypoglycemic patients with white matter and focal ischemic injury. Hyperglycemia can be due to prolonged or intermittent hypoxia and can be associated with poor outcomes.
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