Glucose-to-lactate ratio and neurodevelopment in infants with hypoxic-ischemic encephalopathy: an observational study

Area of Science:

• Neonatal Medicine
• Neuroscience
• Metabolic Research

Background:

• Glucose and lactate are critical metabolic fuels in neonatal hypoglycemia.
• Their concentrations may impact neurodevelopmental outcomes in infants with hypoxic-ischemic encephalopathy (HIE).

Purpose of the Study:

• To evaluate glucose and lactate kinetics during therapeutic hypothermia (TH) in infants with HIE.
• To determine the relationship between these metabolic parameters and long-term neurodevelopmental outcomes.

Main Methods:

• Measured glucose and lactate concentrations before and during TH (days 2 and 3) in infants with varying HIE severity.
• Assessed neurodevelopment at 2 years, categorizing participants into favorable (FO) and unfavorable (UFO) outcome groups.
• Analyzed the glucose-to-lactate ratio as a predictor of metabolic outcome, adjusting for clinical and metabolic variables.

Main Results:

• Severe hypoglycemia and hyperglycemia were observed in 18% and 36% of FO and UFO groups, respectively.
• The glucose-to-lactate ratio on day 1 was the strongest predictor of unfavorable metabolic outcome (OR 3.27, p=0.032).
• Eighty-eight infants were evaluated at follow-up, with 34 in the FO group and 54 in the UFO group.

Conclusions:

• The glucose-to-lactate ratio on day 1 may serve as a new risk marker for infants with HIE undergoing TH.
• This finding highlights the importance of metabolic monitoring during TH for predicting neurodevelopmental trajectories.