Neonatal Intensive Care Medicine Department, University Hospital Nice Cote d'Azur, Nice, France; Universite de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPE, INSERM, INRAE, Paris, France.
Universite de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPE, INSERM, INRAE, Paris, France.
J Pediatr. 2023 Jun;257:113350. doi: 10.1016/j.jpeds.2023.02.003. Epub 2023 Feb 23.
To assess in newborns with neonatal encephalopathy (NE), presumptively related to a peripartum hypoxic-ischemic event, the frequency of dysglycemia and its association with neonatal adverse outcomes.
We conducted a secondary analysis of LyTONEPAL (Long-Term Outcome of Neonatal hypoxic EncePhALopathy in the era of neuroprotective treatment with hypothermia), a population-based cohort study including 545 patients with moderate-to-severe NE. Newborns were categorized by the glycemia values assessed by routine clinical care during the first 3 days of life: normoglycemic (all glycemia measurements ranged from 2.2 to 8.3 mmol/L), hyperglycemic (at least 1 measurement >8.3 mmol/L), hypoglycemic (at least 1 measurement <2.2 mmol/L), or with glycemic lability (measurements included at least 1 episode of hypoglycemia and 1 episode of hyperglycemia). The primary adverse outcome was a composite outcome defined by death and/or brain lesions on magnetic resonance imaging, regardless of severity or location.
In total, 199 newborns were categorized as normoglycemic (36.5%), 74 hypoglycemic (13.6%), 213 hyperglycemic (39.1%), and 59 (10.8%) with glycemic lability, based on the 2593 glycemia measurements collected. The primary adverse outcome was observed in 77 (45.8%) normoglycemic newborns, 37 (59.7%) with hypoglycemia, 137 (67.5%) with hyperglycemia, and 40 (70.2%) with glycemic lability (P < .01). With the normoglycemic group as the reference, the aORs and 95% 95% CIs for the adverse outcome were significantly greater for the group with hyperglycemia (aOR 1.81; 95% CI 1.06-3.11).
Dysglycemia affects nearly two-thirds of newborns with NE and is independently associated with a greater risk of mortality and/or brain lesions on magnetic resonance imaging.
NCT02676063.
评估疑似围产期缺氧缺血事件引起的新生儿脑病（NE）新生儿的血糖异常发生率及其与新生儿不良结局的关系。
我们对 LyTONEPAL（新生儿缺氧性脑病在神经保护治疗低温时代的长期结局）进行了二次分析，这是一项基于人群的队列研究，纳入了 545 名中重度 NE 新生儿。根据新生儿在生命最初 3 天内常规临床护理评估的血糖值进行分类：血糖正常（所有血糖测量值均在 2.2 至 8.3mmol/L 之间）、高血糖（至少有 1 次测量值>8.3mmol/L）、低血糖（至少有 1 次测量值<2.2mmol/L）或血糖波动（测量值包括至少 1 次低血糖和 1 次高血糖发作）。主要不良结局为定义为死亡和/或磁共振成像上脑损伤的复合结局，无论严重程度或部位如何。
根据采集的 2593 次血糖测量值，共有 199 名新生儿被归类为血糖正常（36.5%）、74 名低血糖（13.6%）、213 名高血糖（39.1%）和 59 名血糖波动（10.8%）。主要不良结局发生在 77 名（45.8%）血糖正常新生儿、37 名（59.7%）低血糖新生儿、137 名（67.5%）高血糖新生儿和 40 名（70.2%）血糖波动新生儿中（P<.01）。与血糖正常组作为参考，高血糖组不良结局的比值比（aOR）和 95%置信区间（95% CI）显著更大（aOR 1.81；95% CI 1.06-3.11）。
血糖异常影响近三分之二的 NE 新生儿，与死亡率增加和/或磁共振成像上的脑损伤独立相关。
NCT02676063。
