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Updated: Jun 13, 2026
The Hypoxic Ischemic Encephalopathy Model of Perinatal Ischemia
Published on: November 19, 2008
Glucose-to-lactate ratio in infants with hypoxic-ischemic encephalopathy treated with hypothermia
Carlo Dani1, Giulia Remaschi2, Elia Benelli2
1Department of Neurosciences, Psychology, Drug Research, and Child Health, University of Florence, Florence, Italy; Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy.
Insights
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.
Background:
Glucose-to-lactate ratio and abnormal values of glucose and lactate blood values, as well as neuroimaging, have been reported to predict neurodevelopmental outcome in infants with hypoxic-ischemic encephalopathy (HIE) treated with therapeutic hypothermia (TH). Our aim was to confirm or confute these correlations.
Methods:
We retrospectively studied 48 late preterm and term infants, 31 with favourable and 17 with unfavourable outcome. Glucose-to-lactate ratio, glucose and lactate values were recorded before and during TH. They were studied with aEEG, cerebral magnetic resonance imaging (MRI), and the Bayley-III scales for assessing psychomotor development at 24 ± 2 months corrected age.
Results:
Logistic regression analysis demonstrated that glucose (OR 30.219, 95 % Cl 1.473-62.069, P = 0.027) and lactate (OR 1.923, 95 % Cl 1.027-3.601, P = 0.041) blood level at 24 h of TH and MRI score (OR 2.668 95 % Cl 1.060-6.713. P = 0.037) were positively correlated with unfavourable outcome.
Conclusions:
Glucose-to-lactate ratio did not predict neurodevelopmental outcome in infants with HIE treated with TH. Further investigation is needed to explore the prognostic significance of this biomarker. Glycemia and lactate blood levels measured at 24 h of TH, as well as cerebral MRI, are positively correlated with an increasing risk of unfavourable outcome.
