Temporal Trends of Blood Glucose in Children with Cerebral Malaria
Kennedy M Chastang1, Rami Imam2, Meredith G Sherman3
1Howard University, Washington, District of Columbia.
Insights
Hypoglycemia in pediatric cerebral malaria (CM) is linked to death. Monitoring blood glucose for 48 hours post-admission is recommended for children with CM, especially if low blood sugar is detected early.
Area of Science:
- Pediatric Infectious Diseases
- Neuroscience
- Metabolic Disorders
Background:
- Hypoglycemia (blood glucose < 2.2 mmol/L) is a critical complication in pediatric cerebral malaria (CM).
- The optimal duration for glucose monitoring in CM patients remains undetermined.
- Early detection and management of hypoglycemia are crucial for improving outcomes.
Purpose of the Study:
- To evaluate the association between hypoglycemia and mortality or neurological disability in children with CM.
- To determine the optimal duration for routine blood glucose monitoring in pediatric CM patients.
Main Methods:
- A retrospective analysis of data from 1,674 hospitalized Malawian children with CM.
- Assessment of hypoglycemia at admission and at 6-hour intervals post-admission.
- Evaluation of the association between hypoglycemia and clinical outcomes, including death and neurological sequelae.
Main Results:
- Hypoglycemia at admission significantly increased the odds of death (OR 2.87) and neurological sequelae in survivors (OR 3.21).
- New-onset hypoglycemia at 6 hours post-admission was strongly associated with increased mortality (OR 7.27).
- Most new hypoglycemia episodes (94.7%) occurred within 24 hours; persistent or recurrent low blood sugar was observed up to 42 hours.
Conclusions:
- Hypoglycemia at admission or 6 hours post-admission is a strong predictor of mortality in pediatric CM.
- Continuous blood glucose monitoring for at least 24 hours post-admission is recommended for all CM patients.
- Patients with detected hypoglycemia within the first 24 hours require extended monitoring for up to 48 hours post-admission.
Abstract:
Hypoglycemia, defined as a blood glucose < 2.2 mmol/L, is associated with death in pediatric cerebral malaria (CM). The optimal duration of glucose monitoring in CM is unknown. We collected data from 1,674 hospitalized Malawian children with CM to evaluate the association between hypoglycemia and death or neurologic disability in survivors. We assessed the optimal duration of routine periodic measurements of blood glucose. Children with hypoglycemia at admission had a 2.87-fold higher odds (95% CI: 1.35-6.09) of death and, if they survived, a 3.21-fold greater odds (95% CI: 1.51-6.86) of sequelae at hospital discharge. If hypoglycemia was detected at 6 hours but not at admission, there was a 7.27-fold higher odds of death (95% CI: 1.85-8.56). The presence of newly developed hypoglycemia after admission was not independently associated with neurological sequelae in CM survivors. Among all new episodes of blood sugar below a treatment threshold of 3.0 mmol/L, 94.7% occurred within 24 hours of admission. In those with blood sugar below 3.0 mmol/L in the first 24 hours, low blood sugar persisted or recurred for up to 42 hours. Hypoglycemia at admission or 6 hours afterward is strongly associated with mortality in CM. Children with CM should have 24 hours of post-admission blood glucose measurements. If a blood glucose less than the treatment threshold of 3.0 mmol/L is not detected, routine assessments may cease. Children who have blood sugar values below the treatment threshold detected within the first 24 hours should continue to have periodic glucose measurements for 48 hours post-admission.
