Wang Jing, Liu Ning, Zheng Shiyi, Wang Xintong, Zhang Peng, Lu Chunmei, Wang Laishuan, Zhou Wenhao, Cheng Guoqiang, Hu Liyuan
Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China.
Department of Neonatology, General Hospital of Northern Theater Command, Shenyang, China.
Early Hum Dev. 2023 Dec;187:105878. doi: 10.1016/j.earlhumdev.2023.105878. Epub 2023 Oct 16.
The detection and management of blood glucose abnormalities in high-risk neonates are crucial for clinical care. The objective of the study was to investigate the continuous glucose profile of hypoxic-ischemic encephalopathy (HIE) patients in the whole-process of therapeutic hypothermia (TH) and its association with clinical and neurological outcomes.
In this single-center retrospective study, HIE patients who received both TH and continuous glucose monitoring (CGM) were recruited from March 2016 to September 2021.
Of 47 neonates recruited, 24 had unfavorable outcome. Dysglycemia was most prevalent in the first 24 h of TH, among which hyperglycemia occurred more frequently. CGM showed that the duration, episodes and area under curve (AUC) of hypoglycemia were statistically different in neonates with different outcomes. The occurrence, longer duration, greater AUC of hypoglycemia and an early high coefficient of variation (CV%, CV = SD/mean) were associated with unfavorable outcomes (aOR 26.55 [2.02-348.5], aOR 2.11 [1.08-4.14], aOR 1.80 [1.11-2.91] and aOR respectively), while hyperglycemia was not.
During the whole process of TH, hypoglycemia and early unstable glycemic variability were strongly associated with unfavorable outcomes. CGM can instantly detect dysglycemia and facilitate precise glucose management in HIE neonates.
高危新生儿血糖异常的检测与管理对临床护理至关重要。本研究的目的是调查低温治疗（TH）全过程中缺氧缺血性脑病（HIE）患者的连续血糖情况及其与临床和神经学结局的关联。
在这项单中心回顾性研究中，选取了2016年3月至2021年9月期间接受TH及连续血糖监测（CGM）的HIE患者。
在纳入的47例新生儿中，24例预后不良。血糖异常在TH的最初24小时最为常见，其中高血糖更为频繁。CGM显示，不同结局的新生儿低血糖的持续时间、发作次数和曲线下面积（AUC）在统计学上存在差异。低血糖的发生、较长的持续时间、较大的AUC以及早期较高的变异系数（CV%，CV = 标准差/均值）与不良结局相关（调整后比值比分别为26.55 [2.02 - 348.5]、2.11 [1.08 - 4.14]、1.80 [1.11 - 2.91]），而高血糖则不然。
在TH全过程中，低血糖和早期血糖变异性不稳定与不良结局密切相关。CGM可即时检测血糖异常，有助于对HIE新生儿进行精准血糖管理。
