Liggins Institute, University of Auckland, Auckland, New Zealand.
Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.
J Pediatr. 2018 Feb;193:68-75.e1. doi: 10.1016/j.jpeds.2017.09.081. Epub 2017 Dec 1.
To determine whether tight glycemic control of neonatal hyperglycemia changes neurodevelopment, growth, and metabolism at school age.
Children born very low birth weight and randomized as hyperglycemic neonates to a trial of tight vs standard glycemic control were assessed at 7 years corrected age, including Wechsler Intelligence Scale for Children Fourth Edition, Movement Assessment Battery for Children 2, visual and neurologic examinations, growth measures, dual X-ray absorptiometry, and frequently sampled intravenous glucose tolerance test. The primary outcome was survival without neurodevelopmental impairment at age 7 years. Outcomes were compared using linear regression, adjusted for sex, small for gestational age, birth plurality, and the clustering of twins. Data are reported as number (%) or mean (SD).
Of the 88 infants randomized, 11 (13%) had died and 57 (74% of eligible children) were assessed at corrected age 7 years. Survival without neurodevelopmental impairment occurred in 25 of 68 children (37%), with no significant difference between tight (14 of 35; 40%) and standard (11 of 33; 33%) glycemic control groups (P = .60). Children in the tight group were shorter than those in the standard group (121.3 [6.3] cm vs 125.1 [5.4] cm; P < .05), but had similar weight and head circumference. Children in the tight group had greater height-adjusted lean mass (18.7 [0.3] vs 17.6 [0.2] kg; P < .01) and lower fasting glucose concentrations (84.6 [6.30] vs 90.0 [5.6] mg⋅dL; P < .05), but no other differences in measures of body composition or insulin-glucose metabolism.
Tight glycemic control for neonatal hyperglycemia does not change survival without neurodevelopmental impairment, but reduces height, increases height-adjusted lean mass, and reduces fasting blood glucose concentrations at school age.
ACTRN: 12606000270516.
确定新生儿高血糖的严格血糖控制是否会改变学龄期的神经发育、生长和代谢。
极低出生体重儿随机分为高血糖组接受严格血糖控制与标准血糖控制的试验，在校正年龄 7 岁时进行评估，包括韦氏儿童第四版智力量表、儿童运动评估电池 2、视觉和神经检查、生长测量、双能 X 线吸收法和频繁采样静脉葡萄糖耐量试验。主要结局是 7 岁时无神经发育障碍的生存。使用线性回归比较结局，调整性别、小于胎龄儿、多胎分娩和双胞胎聚类。数据以数字（%）或平均值（SD）报告。
在 88 名随机分组的婴儿中，11 名（13%）死亡，57 名（合格儿童的 74%）在校正年龄 7 岁时进行了评估。在 68 名儿童中，25 名（37%）无神经发育障碍，严格血糖控制组（14 名/35 名；40%）与标准血糖控制组（11 名/33 名；33%）无显著差异（P = .60）。严格组的儿童比标准组的儿童矮（121.3[6.3]cm 比 125.1[5.4]cm；P < .05），但体重和头围相似。严格组的儿童身高调整后的瘦体重更高（18.7[0.3]比 17.6[0.2]kg；P < .01），空腹血糖浓度更低（84.6[6.30]比 90.0[5.6]mg/dL；P < .05），但在身体成分或胰岛素-葡萄糖代谢的其他测量指标上没有差异。
新生儿高血糖的严格血糖控制不会改变无神经发育障碍的生存，但会降低身高，增加身高调整后的瘦体重，并降低学龄期的空腹血糖浓度。
ACTRN: 12606000270516。
