Neurophysiological changes associated with dysglycemia in term neonates with neonatal encephalopathy

To investigate the relationship between hypo/hyperglycemia and EEG measures in term neonates with neonatal encephalopathy (NE) treated with therapeutic hypothermia (TH).

Ninety-six neonates underwent concurrent continuous glucose monitoring (CGM) and EEG for 48 h within the first 72 h of life. Five-minute epochs of hypoglycemia (≤2.6 mmol/L; ≤47 mg/dL) and hyperglycemia (>10.1 mmol/L; >182 mg/dL) were identified. Continuous EEG data was segmented into 5-min epochs corresponding to 5-min CGM data. Visual EEG background score and 22 computational EEG measures were estimated and their relationship to dysglycemia was assessed after adjusting for hypoxia-ischemia severity and multiple testing.

Among the 96 neonates, 12 had hypoglycemia, 16 had hyperglycemia, including 1 with both during the recording period. In the adjusted analyses, hyperglycemic epochs were associated with worse visual background scores (1.2, 95 %CI 0.51-1.89, q = 0.003) and 11 computational EEG measures. In contrast, hypoglycemic epochs were not associated with a significant change in visual background scores (-0.28, 95 %CI -0.66 - -0.10, q = 0.549), and were only associated with one computational EEG measure.

Hyperglycemia is temporally associated with changes in brain function in term neonates with NE treated with TH.

This temporal relationship suggests high glucose levels may contribute directly to brain injury after NE.