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Updated: Jun 25, 2025
The Hypoxic Ischemic Encephalopathy Model of Perinatal Ischemia
Published on: November 19, 2008
Glucose instability and outcomes of neonates with hypoxic ischemic encephalopathy undergoing therapeutic hypothermia
Mahmoud A M Ali1, Mohsen A A Farghaly2, Injy El-Dib3
1West Virginia University School of Medicine, Department of Pediatrics, Morgantown, WV 26505, USA; MetroHealth Medical Center, Case Western Reserve University, Department of Pediatrics, Division of Neonatology, Cleveland, OH 44109, USA.
Insights
Blood glucose abnormalities in infants with hypoxic ischemic encephalopathy (HIE) treated with therapeutic hypothermia (TH) are linked to worse outcomes. Tightly controlling blood sugar is vital for better results in these vulnerable infants.
Area of Science:
- Neonatal neurology
- Pediatric endocrinology
- Critical care medicine
Background:
- Hypoxic ischemic encephalopathy (HIE) is a serious condition in newborns.
- Therapeutic hypothermia (TH) is a standard treatment for HIE.
- Glucose metabolism disturbances are common in HIE infants.
Purpose of the Study:
- To determine the frequency of glucose abnormalities in HIE infants receiving TH.
- To examine the relationship between glucose issues and infant outcomes.
- To assess the impact on brain imaging and neurodevelopmental results.
Main Methods:
- Retrospective review of glucose levels in HIE infants undergoing TH.
- Statistical analysis using Pearson's correlation.
- Assessment of neonatal brain MRI and neurodevelopmental outcomes at 12 and 24 months.
Main Results:
- 31% experienced hypoglycemia, 56% hyperglycemia, and 43% had combined episodes.
- Hyperglycemia and combined episodes correlated with increased mortality, seizures, and longer hospital stays.
- Both hypo- and hyperglycemia were linked to parenchymal hemorrhages; hypoglycemia to restricted diffusion, and hyperglycemia to cortical injuries.
- Each hour of abnormal glucose levels increased the risk of unfavorable outcomes by 5.2-5.8 times.
Conclusions:
- Blood glucose variations negatively impact HIE infants treated with TH.
- Effective glucose management is critical for improving neurodevelopmental outcomes in this population.
Background:
To investigate the prevalence and associated outcomes of glucose abnormalities in infants with hypoxic ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH).
Methods:
Glucose values were reviewed in all HIE infants. Pearson's correlation was used to assess the association of hypo- and hyperglycemic episodes with neonatal brain MRI and neurodevelopmental outcomes (NDO) at 12 & 24 months.
Results:
Of 153 infants included, 31, 56 and 43 had episodes of hypo-, hyperglycemia and combined, respectively. Hyperglycemia and combined hypo/hyper had higher mortality (p = 0.035), seizures (p = 0.009), and longer hospitalization (p = 0.023). Hypo- and hyperglycemia were associated with parenchymal hemorrhages (p = 0.028 & p = 0.027, respectively). Hypoglycemia was associated with restricted diffusion (p = 0.014), while hyperglycemia was associated with cortical injuries (p = 0.045). Each hour of hyper- or hypoglycemia was associated with 5.2-5.8 times unfavorable outcomes (p < 0.001).
Conclusion:
Blood glucose aberrations were detrimental in HIE infants treated with TH. Optimizing glucose management is crucial in this setting.
