Jagła Mateusz, Szymońska Izabela, Starzec Katarzyna, Kwinta Przemko
Chair of Pediatrics, Jagiellonian University Medical College, Krakow, Poland.
Dev Period Med. 2019;23(1):7-14. doi: 10.34763/devperiodmed.20192301.0714.
Background: Glycemic variability (GV) has been a matter of interest in recent years. However, glycemic variability in preterm infants has not been adequately investigated. Objectives: To evaluate the impact of glycemic variability obtained from continuous glucose monitoring on mortality and neurologic outcomes: grade 3 or 4 intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), and retinopathy of prematurity (ROP) requiring treatment among very low birth weight infants.
Material and methods:A prospective, single-center, open cohort study enrolled 74 very low birth weight infants with a mean birthweight of 1066 g (+/-267). A continuous glucose monitoring system (CGM) was used to measure glucose during the first week of life. The impact of glycemic variability (standard deviation SD; coefficient of variation CV; and mean amplitude of glucose excursion MAGE) on mortality and neurologic outcomes of infants was evaluated.
Results: Univariate analysis revealed that glycemic variability occurring during the first week of life was not be associated with mortality before term-equivalent age and PVL. Higher GV was associated with grade 3 or 4 IVH (CV p=0.025; MAGE p=0.032) and ROP requiring treatment (SD p=0.019; CV p=0.026; MAGE=0.029). However, logistic regression models did not show a significant association between GV occurring during the first week of life and grade 3 or 4 IVH (MAGE OR 2.64; 95% CI 0.71-9.92) or ROP requiring treatment (MAGE OR 1.74; 95% CI 0.57-5.32).
Conclusions: Further prospective studies are needed to fully investigate the impact of GV on mortality and morbidity in premature infants. The potential benefits of reducing glucose blood fluctuations in VLBW infants need to be addressed.
背景：近年来，血糖变异性（GV）一直是人们关注的问题。然而，早产儿的血糖变异性尚未得到充分研究。目标：评估连续血糖监测获得的血糖变异性对极低出生体重儿死亡率和神经学结局的影响：3级或4级脑室内出血（IVH）、脑室周围白质软化（PVL）以及需要治疗的早产儿视网膜病变（ROP）。
材料与方法：一项前瞻性、单中心、开放队列研究纳入了74例极低出生体重儿，平均出生体重为1066 g（±267）。在出生后第一周使用连续血糖监测系统（CGM）测量血糖。评估血糖变异性（标准差SD；变异系数CV；以及血糖波动平均幅度MAGE）对婴儿死亡率和神经学结局的影响。
结果：单因素分析显示，出生后第一周出现的血糖变异性与足月等效年龄前的死亡率和PVL无关。较高的血糖变异性与3级或4级IVH（CV p=0.025；MAGE p=0.032）以及需要治疗的ROP（SD p=0.019；CV p=0.026；MAGE=0.029）相关。然而，逻辑回归模型未显示出生后第一周出现的血糖变异性与3级或4级IVH（MAGE比值比2.64；95%置信区间0.71-9.92）或需要治疗的ROP（MAGE比值比1.74；95%置信区间0.57-5.32）之间存在显著关联。
结论：需要进一步的前瞻性研究来全面调查血糖变异性对早产儿死亡率和发病率的影响。需要探讨降低极低出生体重儿血糖波动的潜在益处。
