Current Practices in Hyperglycemia Management in Neonatal Encephalopathy: A Treatment of Hyperglycemia in Neonatal...

Neonatal encephalopathy (NE) is a condition with significant morbidity and mortality, and these neonates are at high risk for glucose disturbances. Growing evidence links hyperglycemia to brain injury independent of NE, yet long-term outcomes data to inform clinical management remain scarce. This study aimed to describe current definitions, detection methods, and management strategies for hyperglycemia in neonates with NE undergoing therapeutic hypothermia (TH).

We conducted a cross-sectional survey of 49 Level IV neonatal intensive care units (NICUs) participating in the Children's Hospitals Neonatal Consortium (CHNC) to evaluate center-specific practices for managing hyperglycemia in patients with NE undergoing TH. Individual respondent data were analyzed as the unit of observation using descriptive statistics.

Forty-two of 49 centers responded (86% center response rate), yielding 53 individual completed surveys, with 10 centers contributing multiple responses (range 1-3 per center). The median threshold for hyperglycemia was 180 mg/dL (interquartile range, IQR: 160-200). Glucose monitoring frequency ranged from 1 to 6 hours during TH. Point-of-care glucose monitoring was used by 51 respondents (96%); 2 respondents (4%) reported using continuous glucose monitoring in non-research clinical care. Most respondents (48/53, 91%) reported reducing glucose delivery as the initial intervention for hyperglycemia, followed by insulin initiation if hyperglycemia persisted. The lowest median (range) glucose infusion rate used was 4 (3-5) mg/kg/min. Most respondents expressed concern about the adverse effects of untreated hyperglycemia (68%), though a substantial proportion (53%) also believed treatment itself could pose risks.

Substantial practice variability exists despite shared expertise in defining, monitoring, and managing hyperglycemia in neonates with NE undergoing TH. Although most centers use similar thresholds and stepwise approaches, monitoring strategies vary widely. The coexistence of concern about untreated hyperglycemia (68%) and apprehension about treatment risks (53%) reflects clinical equipoise. These findings underscore the urgent need for prospective studies and evidence-based guidelines to inform best practices in this vulnerable population.

· Hyperglycemia thresholds vary widely, and glucose monitoring frequency is inconsistent.. · Many clinicians do not follow the ESPGHAN recommendations for glucose management.. · Guidelines for managing hyperglycemia in NE are lacking..