Basu Sudeepta K, Salemi Jason L, Gunn Alistair J, Kaiser Jeffrey R
Department of Pediatrics, Children's National Medical Center, Washington DC, USA.
Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
Arch Dis Child Fetal Neonatal Ed. 2017 Jul;102(4):F299-F306. doi: 10.1136/archdischild-2016-311385. Epub 2016 Oct 31.
To investigate whether glycaemic profile is associated with multiorgan dysfunction and with response to hypothermia after perinatal hypoxic-ischaemic encephalopathy (HIE).
Post hoc analysis of the CoolCap Study.
25 perinatal centres in UK, USA and New Zealand during 1999-2002.
194/234 (83%) infants of ≥36 weeks' gestation with moderate-to-severe HIE enrolled in the CoolCap Study with documented plasma glucose levels and follow-up outcome.
Infants were randomised to head cooling for 72 hours starting within 6 hours of birth or standard care. Plasma glucose levels were measured at predetermined time intervals after randomisation.
Unfavourable primary outcome was defined as death and/or severe neurodevelopmental disability at 18 months. Glycaemic profile (hypoglycaemia (≤40 mg/dL, ≤2.2 mmol/L), hyperglycaemia (>150 mg/dL, >8.3 mmol/L) and normoglycaemia) during 12 hours after randomisation was investigated for association with multiorgan dysfunction or risk reduction of primary outcome after hypothermia treatment.
Hypoglycaemia but not hyperglycaemia was associated with more deranged multiorgan function parameters (mean pH 7.23 (SD 0.16) vs 7.36 (0.13), p<0.001; aspartate transaminase 2101 (2450) vs 318 (516) IU/L, p=0.002; creatinine 1.95 (0.59) vs 1.26 (0.5) mg/dL, p<0.001) compared with normoglycaemia. After adjusting for Sarnat stage and 5 min Apgar score, only hyperglycaemic infants randomised to hypothermia had reduced risk of unfavourable outcome (adjusted risk ratio: 0.80, 95% CI 0.66 to 0.99), whereas hypoglycaemic and normoglycaemic infants did not.
Early glycaemic profile in infants with moderate-to-severe HIE may help to identify risk of multiorgan dysfunction and response to therapeutic hypothermia.
NCT00383305.
研究围产期缺氧缺血性脑病（HIE）后血糖水平是否与多器官功能障碍以及低温治疗反应相关。
CoolCap研究的事后分析。
1999 - 2002年期间英国、美国和新西兰的25个围产期中心。
CoolCap研究中纳入的194/234例（83%）孕龄≥36周的中重度HIE婴儿，有记录的血糖水平和随访结果。
婴儿在出生后6小时内随机分为接受72小时头部降温或标准护理。随机分组后按预定时间间隔测量血糖水平。
不良主要结局定义为18个月时死亡和/或严重神经发育残疾。研究随机分组后12小时内的血糖情况（低血糖（≤40mg/dL，≤2.2mmol/L）、高血糖（>150mg/dL，>8.3mmol/L）和正常血糖）与多器官功能障碍或低温治疗后主要结局风险降低之间的关联。
与正常血糖相比，低血糖而非高血糖与更紊乱的多器官功能参数相关（平均pH值7.23（标准差0.16）对7.36（0.13），p<0.001；天冬氨酸转氨酶2101（2450）对318（516）IU/L，p = 0.002；肌酐1.95（0.59）对1.26（0.5）mg/dL，p<0.001）。在调整Sarnat分期和5分钟阿氏评分后，只有随机接受低温治疗的高血糖婴儿不良结局风险降低（调整风险比：0.80，95%可信区间0.66至0.99），而低血糖和正常血糖婴儿则不然。
中重度HIE婴儿的早期血糖情况可能有助于识别多器官功能障碍风险和对治疗性低温的反应。
NCT00383305。
