Tottman Anna Catherine, Alsweiler Jane Marie, Bloomfield Frank Harry, Pan Maggie, Harding Jane Elizabeth
Liggins Institute, University of Auckland, Auckland, New Zealand.
Department of Pediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand; National Women's Health, Auckland City Hospital, Auckland, New Zealand.
J Pediatr. 2017 Sep;188:115-121. doi: 10.1016/j.jpeds.2017.05.052. Epub 2017 Jun 21.
To investigate relationships between early neonatal glycemia, neonatal characteristics, neonatal illness, and developmental outcomes in very preterm infants.
A retrospective, observational cohort study of 443 infants born weighing <1500 g or <30 weeks of gestation, and admitted within 24 hours to National Women's Hospital, Auckland, New Zealand. Glucose variability was defined as the standard deviation around the mean after log transformation of all blood glucose concentrations. Absolute glycemic excursions in the first week were used to divide the infants into 4 groups: normoglycemic; hypoglycemic; hyperglycemic, and unstable.
Compared with normoglycemic infants, hypoglycemic and unstable infants had lower birth weight z-scores, and hyperglycemic and unstable infants were of lower birth weight. Hypoglycemic infants had similar outcomes to normoglycemic infants. Hyperglycemic and unstable infants were less likely to survive without neonatal morbidity and less likely to survive without neurodevelopmental impairment at 2 years of age. Higher mean blood glucose concentration was seen in the hyperglycemic and unstable groups, and was associated with worse neonatal and 2-year outcomes. Greater glucose variability was seen in the hypoglycemic and unstable groups, and was associated with worse neonatal illness but not outcome at 2 years. No associations between measures of neonatal glycemia and neonatal or 2-year outcomes remained after correction for gestation, birth weight z-score, and socioeconomic status.
In very preterm infants, measures of neonatal glycemia are markers of gestational age and intrauterine growth, and are not independent predictors of neonatal illness or outcomes at 2 years of age.
探讨极早产儿早期新生儿血糖水平、新生儿特征、新生儿疾病与发育结局之间的关系。
一项回顾性观察队列研究，纳入了443例出生体重<1500g或孕周<30周，并在出生后24小时内入住新西兰奥克兰国家妇女医院的婴儿。血糖变异性定义为所有血糖浓度经对数转换后围绕均值的标准差。根据第一周内的绝对血糖波动情况将婴儿分为4组：血糖正常组；低血糖组；高血糖组和血糖不稳定组。
与血糖正常的婴儿相比，低血糖和血糖不稳定的婴儿出生体重Z评分较低，高血糖和血糖不稳定的婴儿出生体重较低。低血糖婴儿的结局与血糖正常的婴儿相似。高血糖和血糖不稳定的婴儿在无新生儿发病的情况下存活的可能性较小，在2岁时无神经发育障碍存活的可能性也较小。高血糖和血糖不稳定组的平均血糖浓度较高，且与较差的新生儿期和2岁时的结局相关。低血糖和血糖不稳定组的血糖变异性较大，且与较差的新生儿疾病相关，但与2岁时的结局无关。在校正孕周、出生体重Z评分和社会经济地位后，新生儿血糖指标与新生儿期或2岁时的结局之间无关联。
在极早产儿中，新生儿血糖指标是胎龄和宫内生长的标志物，并非新生儿疾病或2岁时结局的独立预测因素。
