Pediatrics resident - Neonatology fellow metrohealth medical cener North Olmsted, Ohio, United States
Background: Blood glucose aberrations is not uncommon in neonates with Hypoxic Ischemic Encephalopathy (HIE) undergoing therapeutic hypothermia (TH). The relationship between serum glucose abnormalities, duration of such abnormalities, and neurological outcomes deserve further studying. Objective: 1) to investigate the prevalence of glucose abnormalities, 2) to determine the association between glucose aberrations and brain MRI findings, and 3) to compare neurodevelopmental outcomes in HIE infants undergoing TH with and without glucose abnormalities. Design/Methods: We retrospectively reviewed blood glucose measurements in 4 hour-blocks during the first 5 days of life. Hypoglycemia was defined as a glucose level < 40 mg/dl, < 45 mg/dl, and < 60 mg/dl at age 0-4 hours, 5-48 hours, and >48 hours respectively. Hyperglycemia was defined as a glucose level >150 mg/dl. Results: Of 153 infants included, 31 (20%) had at least one episode of hypoglycemia, 56 (37%) had at least one episode of hyperglycemia, and 43 (28%) had episodes of hypoglycemia and hyperglycemia. Infants with hyperglycemia and those with mixed glucose derangements have higher incidence of mortality (p=0.035), seizure (p=0.009), and longer hospital stay (p=0.023). MRI showed a high incidence of parenchymal hemorrhage among patients with hypoglycemic events (p=0.028) and those with hyperglycemic events (p=0.027). Patients with hypoglycemia had higher MRI findings of restricted diffusion/stroke (p=0.014), while patients with hyperglycemia events had higher findings of cortical injury (p=0.045). The relationship between glucose abnormalities and neurological outcomes was duration dependent; each one-hour longer of hyperglycemia or hypoglycemia was independently associated with 5.2-5.8 times worse MRI findings and neurodevelopmental outcomes than the control group (p< 0.001).
Conclusion(s): Blood glucose aberrations were common in infants with HIE treated with TH. Longer duration of hypo and hyperglycemia was associated with worse MRI findings and neurodevelopmental outcomes. Optimum blood sugar management is crucial in this setting.
.png)
.png)
.png)