Department of Pediatrics, Leiden University Medical Center, The Netherlands.
BMC Pediatr. 2010 Jul 20;10:52. doi: 10.1186/1471-2431-10-52.
Hyperglycemia in premature infants is associated with increased morbidity and mortality, but data on long-term outcome are limited. We investigated the effects of neonatal hyperglycemia (blood glucose > or = 10 mmol/l, treated with insulin for > or = 12 hours) on growth and neurobehavioral outcome at 2 years of age.
Retrospective follow-up study at 2 years of age among 859 infants < or =32 weeks of gestation admitted to a tertiary neonatal center between January 2002 and December 2006. Thirty-three survivors treated with insulin for hyperglycemia and 63 matched controls without hyperglycemia were evaluated at a corrected age of 2 years. Outcome measures consisted of growth (weight, length, and head circumference) and neurological and behavioural development.
66/859 (8%) infants < or = 32 weeks of gestation developed hyperglycemia. Mortality during admission was 27/66 (41%) in the hyperglycemia group versus 62/793 (8%) in those without hyperglycemia (p < 0.001). Mortality was higher in infants with hyperglycemia with a birth weight < or =1,000 gram (p = 0.005) and/or gestational age of 24-28 weeks (p = 0.009) than in control infants without hyperglycemia. Sepsis was more prominent in infants with hyperglycemia and a birth weight of >1,000 gram (p = 0.002) and/or gestational age of 29-32 weeks (p = 0.009) than in control infants without hyperglycemia. Growth at 2 years of age was similar, but neurological and behavioural development was more frequently abnormal among those with neonatal hyperglycemia (p = 0.036 and 0.021 respectively).
Mortality was higher in very preterm infants with hyperglycemia treated with insulin during the neonatal period. At 2 years of age survivors showed normal growth, but a higher incidence of neurological and behavioural problems. Better strategies to manage hyperglycemia may improve outcome of very preterm infants.
早产儿高血糖与发病率和死亡率增加有关，但长期预后数据有限。我们研究了新生儿高血糖（血糖＞或=10mmol/L，用胰岛素治疗＞或=12 小时）对 2 岁时生长和神经行为结局的影响。
2002 年 1 月至 2006 年 12 月期间，在一家三级新生儿中心住院的＜或=32 周早产儿中进行回顾性随访研究。在纠正年龄 2 岁时，对 33 名接受胰岛素治疗高血糖的幸存者和 63 名无高血糖的匹配对照进行评估。结局测量包括生长（体重、身长和头围）以及神经和行为发育。
＜或=32 周的 859 名婴儿中，有 66 名（8%）发生高血糖。高血糖组住院期间死亡率为 27/66（41%），无高血糖组为 62/793（8%）（p＜0.001）。出生体重＜或=1000 克（p=0.005）和/或胎龄 24-28 周（p=0.009）的高血糖婴儿死亡率高于对照组无高血糖婴儿。高血糖且出生体重＞1000 克（p=0.002）和/或胎龄 29-32 周（p=0.009）的婴儿，其感染更为明显。2 岁时的生长情况相似，但神经和行为发育异常的情况在新生儿高血糖患儿中更为常见（分别为 p=0.036 和 0.021）。
在新生儿期用胰岛素治疗高血糖的极早产儿死亡率较高。2 岁时，幸存者生长正常，但神经和行为问题的发生率较高。更好的高血糖管理策略可能会改善极早产儿的预后。
