Department of Pediatrics, Division of Neonatology, University of Washintgon School of Medicine, Seattle Children's Hospital, Seattle, Washington.
Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, Washington.
Pediatrics. 2023 Oct 1;152(4). doi: 10.1542/peds.2022-060965.
In infants with hypoxic-ischemic encephalopathy (HIE), conflicting information on the association between early glucose homeostasis and outcome exists. We characterized glycemic profiles in the first 12 hours after birth and their association with death and neurodevelopmental impairment (NDI) in neonates with moderate or severe HIE undergoing therapeutic hypothermia.
This post hoc analysis of the High-dose Erythropoietin for Asphyxia and Encephalopathy trial included n = 491 neonates who had blood glucose (BG) values recorded within 12 hours of birth. Newborns were categorized based on their most extreme BG value. BG >200 mg/dL was defined as hyperglycemia, BG <50 mg/dL as hypoglycemia, and 50 to 200 mg/dL as euglycemia. Primary outcome was defined as death or any NDI at 22 to 36 months. We calculated odds ratios for death or NDI adjusted for factors influencing glycemic state (aOR).
Euglycemia was more common in neonates with moderate compared with severe HIE (63.6% vs 36.6%; P < .001). Although hypoglycemia occurred at similar rates in severe and moderate HIE (21.4% vs 19.5%; P = .67), hyperglycemia was more common in severe HIE (42.3% vs 16.9%; P < .001). Compared with euglycemic neonates, both, hypo- and hyperglycemic neonates had an increased aOR (95% confidence interval) for death or NDI (2.62; 1.47-4.67 and 1.77; 1.03-3.03) compared to those with euglycemia. Hypoglycemic neonates had an increased aOR for both death (2.85; 1.09-7.43) and NDI (2.50; 1.09-7.43), whereas hyperglycemic neonates had increased aOR of 2.52 (1.10-5.77) for death, but not NDI.
Glycemic profile differs between neonates with moderate and severe HIE, and initial glycemic state is associated death or NDI at 22 to 36 months.
在患有缺氧缺血性脑病（HIE）的婴儿中，关于早期血糖稳态与结局之间的关联存在相互矛盾的信息。我们描述了在接受治疗性低温治疗的中重度 HIE 新生儿出生后 12 小时内的血糖谱，并探讨了其与死亡和神经发育障碍（NDI）的关系。
这项 High-dose Erythropoietin for Asphyxia and Encephalopathy 试验的事后分析纳入了 n = 491 名在出生后 12 小时内记录了血糖（BG）值的新生儿。根据其最极端的 BG 值对新生儿进行分类。BG＞200mg/dL 定义为高血糖，BG＜50mg/dL 为低血糖，50 至 200mg/dL 为血糖正常。主要结局定义为 22 至 36 个月时死亡或任何 NDI。我们计算了校正影响血糖状态的因素后，死亡或 NDI 的调整比值比（aOR）。
与重度 HIE 相比，中重度 HIE 中血糖正常更为常见（63.6% vs 36.6%；P＜0.001）。虽然严重和中度 HIE 低血糖的发生率相似（21.4% vs 19.5%；P=0.67），但重度 HIE 中高血糖更为常见（42.3% vs 16.9%；P＜0.001）。与血糖正常的新生儿相比，低血糖和高血糖的新生儿发生死亡或 NDI 的 aOR（95%置信区间）均增加（2.62；1.47-4.67 和 1.77；1.03-3.03）。低血糖的新生儿死亡（2.85；1.09-7.43）和 NDI（2.50；1.09-7.43）的 aOR 均增加，而高血糖的新生儿死亡的 aOR 为 2.52（1.10-5.77），但 NDI 无此相关性。
中重度 HIE 新生儿的血糖谱不同，初始血糖状态与 22 至 36 个月时的死亡或 NDI 有关。
