Glucose-to-lactate ratio in infants with hypoxic-ischemic encephalopathy treated with hypothermia

Carlo Dani ¹, Giulia Remaschi ², Elia Benelli ²

⁰Department of Neurosciences, Psychology, Drug Research, and Child Health, University of Florence, Florence, Italy; Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy.

Early Human Development +

|

December 13, 2025

View abstract on PubMed

Summary

Blood glucose and lactate levels at 24 hours of therapeutic hypothermia (TH), along with MRI scores, predict neurodevelopmental outcomes in infants with hypoxic-ischemic encephalopathy (HIE). The glucose-to-lactate ratio did not show predictive value.

Area Of Science

Neonatal neurology
Biomarkers in infant brain injury
Neurodevelopmental outcomes

Background

Infants with hypoxic-ischemic encephalopathy (HIE) treated with therapeutic hypothermia (TH) have variable neurodevelopmental outcomes.
Previous studies suggested glucose-to-lactate ratio and blood glucose/lactate levels predict outcomes.

Purpose Of The Study

To confirm or refute the correlation between glucose-to-lactate ratio, glucose and lactate blood values, and neuroimaging with neurodevelopmental outcomes in HIE infants treated with TH.

Main Methods

Retrospective study of 48 infants with HIE treated with TH.
Recorded glucose-to-lactate ratio, glucose, and lactate levels before and during TH.
Assessed outcomes using aEEG, cerebral MRI, and Bayley-III scales at corrected age.

Main Results

Logistic regression showed glucose and lactate levels at 24h of TH were positively correlated with unfavorable outcomes (P=0.027 and P=0.041, respectively).
MRI scores were also positively correlated with unfavorable outcomes (P=0.037).
Glucose-to-lactate ratio did not predict neurodevelopmental outcome.

Conclusions

Glucose-to-lactate ratio is not a reliable predictor of neurodevelopmental outcome in HIE infants receiving TH.
Blood glucose and lactate levels at 24h of TH and cerebral MRI findings are associated with an increased risk of unfavorable outcomes.
Further research is needed to explore other potential biomarkers for predicting outcomes in HIE.

Keywords:

Glucose Glucose-to-lactate ratio Hypoxic ischemic encephalopathy Lactate Magnetic resonance imaging