Tan Jason Khay Ghim, Minutillo Corrado, McMichael Judy, Rao Shripada
Neonatal Intensive Care Unit, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.
Centre for Neonatal Research and Education, The University of Western Australia, Perth, Western Australia, Australia.
BMJ Paediatr Open. 2017 Sep 18;1(1):e000175. doi: 10.1136/bmjpo-2017-000175. eCollection 2017.
Low blood glucose levels (BGLs) in infants are known to adversely affect neurodevelopmental outcomes. However, this risk is not well explored in infants with hypoxic ischaemic encephalopathy (HIE) that receive therapeutic hypothermia (TH). Additionally, little information is available on the optimal BGLs to target in infants with HIE.
To explore the association between hypoglycaemia and neurodevelopmental outcomes at different BGL thresholds (2.6 and 3.0 mmol/L) in neonates with HIE treated with TH.
Retrospective cohort study. Clinical information and 2-year neurodevelopmental data using Bayley Scales of Infant Development, third edition (BSID-III) and disabilities were recorded for infants born in Western Australia with HIE and treated with TH between February 2008 and February 2012. Multivariable logistic regression models explored the association between hypoglycaemia and neurodevelopmental outcomes.
122 infants underwent a total of 1616 BGL estimations before and during 72 hours of TH. Hypoglycaemia (BGL<2.6 mmol/L) occurred in 38/122 (31%) infants and 11/122 (9%) had recurrent hypoglycaemia (three or more episodes). Infants with recurrent hypoglycaemia (<2.6 mmol/L) had significantly lower mean BSID-III cognitive, language and socioemotional subscale scores. On multivariable analysis, recurrent hypoglycaemia (<2.6 mmol/L) was associated with increased odds of death or disability (adjusted OR 8.15; 95% CI 1.31 to 50.58; p=0.024). Recurrent hypoglycaemia (<3.0 mmol/L) during the first 12 hours of life was also associated with severe disability among survivors (adjusted OR 11.13; 95% CI 2.06 to 59.89; p=0.005).
Early recurrent hypoglycaemia was associated with increased risk of death or severe disability in neonates undergoing TH for HIE. Prospective studies are needed to identify the ideal target BGL in this population.
已知婴儿低血糖水平（BGLs）会对神经发育结局产生不利影响。然而，对于接受治疗性低温（TH）的缺氧缺血性脑病（HIE）婴儿，这种风险尚未得到充分研究。此外，关于HIE婴儿的最佳目标BGLs的信息也很少。
探讨接受TH治疗的HIE新生儿在不同BGL阈值（2.6和3.0 mmol/L）下低血糖与神经发育结局之间的关联。
回顾性队列研究。记录了2008年2月至2012年2月在西澳大利亚出生并接受TH治疗的HIE婴儿的临床信息以及使用贝利婴儿发育量表第三版（BSID-III）得出的2岁神经发育数据和残疾情况。多变量逻辑回归模型探讨了低血糖与神经发育结局之间的关联。
122名婴儿在TH治疗的72小时内及之前共进行了1616次BGL测量。38/122（31%）名婴儿出现低血糖（BGL<2.6 mmol/L），11/122（9%）名婴儿出现反复低血糖（三次或更多次发作）。反复低血糖（<2.6 mmol/L）的婴儿的平均BSID-III认知、语言和社会情感子量表得分显著较低。多变量分析显示，反复低血糖（<2.6 mmol/L）与死亡或残疾几率增加相关（调整后的OR为8.15；95%CI为1.31至50.58；p=0.024）。出生后前12小时内反复低血糖（<3.0 mmol/L）也与幸存者中的严重残疾相关（调整后的OR为11.13；95%CI为2.06至59.89；p=0.005）。
早期反复低血糖与接受TH治疗的HIE新生儿死亡或严重残疾风险增加相关。需要进行前瞻性研究以确定该人群的理想目标BGL。
