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Published on: October 28, 2022
Hypoglycaemia and hyperglycaemia in neonatal encephalopathy: a systematic review and meta-analysis
Simona Puzone1, Mario Diplomatico2, Elisabetta Caredda1
1Department of Neonatal Intensive Care, University of Campania Luigi Vanvitelli, Naples, Italy.
Insights
Neonatal hypoglycemia and hyperglycemia increase the risk of death or neurodevelopmental issues in infants with neonatal encephalopathy (NE). Optimal metabolic management is crucial for these high-risk infants.
Area of Science:
- Neonatal medicine
- Neuroscience
- Metabolic disorders
Background:
- Neonatal encephalopathy (NE) is a serious condition in newborns.
- Glucose homeostasis disturbances, specifically hypoglycemia and hyperglycemia, are common in neonates.
- The long-term neurological impact of these metabolic issues in NE infants remains unclear.
Approach:
- A systematic review and meta-analysis were conducted.
- Searched major databases (PubMed, Embase, Web of Science) for relevant studies.
- Assessed risk of bias and quality of evidence, performing meta-analysis on 12 included studies.
Key Points:
- Neonatal hypoglycemia was associated with higher odds of neurodevelopmental impairment or death (OR=2.17).
- Neonatal hyperglycemia was linked to increased risk of death or neurodisability (OR=3.07).
- Findings were consistent in subgroup analyses of infants receiving therapeutic hypothermia.
Conclusions:
- Neonatal hypoglycemia and hyperglycemia are associated with adverse long-term neurodevelopmental outcomes in infants with NE.
- Further research with long-term follow-up is essential.
- Optimizing metabolic management is critical for improving outcomes in this vulnerable population.
Importance:
Although hypoglycaemia and hyperglycaemia represent the most common metabolic problem in neonates, there is still uncertainty regarding the effects of glucose homoeostasis on the neurological outcomes of infants with neonatal encephalopathy (NE).
Objective:
To systematically investigate the association between neonatal hypoglycaemia and hyperglycaemia with adverse outcome in children who suffered from NE.
Study Selection:
We searched Pubmed, Embase and Web of Science databases to identify studies which reported prespecified outcomes and compared infants with NE who had been exposed to neonatal hypoglycaemia or hyperglycaemia with infants not exposed.
Data Analysis:
We assessed the risk of bias (ROBINS-I), quality of evidence (Grading of Recommendations, Assessment, Development and Evaluation (GRADE)) for each of the studies. RevMan was used for meta-analysis (inverse variance, fixed effects).
Main Outcome:
Death or neurodevelopmental outcomes at 18 months of age or later.
Results:
82 studies were screened, 28 reviewed in full and 12 included. Children who were exposed to neonatal hypoglycaemia had higher odds of neurodevelopmental impairment or death (6 studies, 685 infants; 40.6% vs 25.4%; OR=2.17, 95% CI 1.46 to 3.25; p=0.0001). Neonatal exposure to hyperglycaemia was associated with death or neurodisability at 18 months or later (7 studies, 807 infants; 46.1% vs 28.0%; OR=3.07, 95% CI 2.17 to 4.35; p<0.00001). These findings were confirmed in the subgroup analysis, which included only the infants who underwent therapeutic hypothermia.
Conclusions:
These data suggest that neonatal hypoglycaemia and hyperglycaemia may be associated with the neurodevelopmental outcome later on in infants with NE. Further studies with long-term follow-up are needed to optimise the metabolic management of these high-risk infants.
Prospero Registration Number:
CRD42022368870.
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