Saidu Medical College, Swat, Pakistan.
Aga Khan University, Karachi, Pakistan.
Medicine (Baltimore). 2024 Sep 6;103(36):e39488. doi: 10.1097/MD.0000000000039488.
Neonatal encephalopathy (NE) is a serious condition with various neurological dysfunctions in newborns. Disruptions in glucose metabolism, including both hypoglycemia and hyperglycemia, are common in NE and can significantly impact outcomes. Hypoglycemia, defined as blood glucose below 45 mg/dL, is associated with increased mortality, neurodevelopmental disabilities, and brain lesions on MRI. Conversely, hyperglycemia, above 120 to 150 mg/dL, has also been linked to heightened mortality, hearing impairment, and multiorgan dysfunction. Both aberrant glucose states appear to worsen prognosis compared to normoglycemic infants. Therapeutic hypothermia is the standard of care for NE that provides neuroprotection by reducing metabolic demands and inflammation. Adjunct therapies like glucagon and continuous glucose monitoring show promise in managing dysglycemia and improving outcomes. Glucagon can enhance cerebral blood flow and glucose supply, while continuous glucose monitoring enables real-time monitoring and personalized interventions. Maintaining balanced blood sugar levels is critical in managing NE. Early detection and intervention of dysglycemia are crucial to improve outcomes in neonates with encephalopathy. Further research is needed to optimize glycemic management strategies and explore the potential benefits of interventions like glucagon therapy.
新生儿脑病（NE）是一种严重的疾病，可导致新生儿出现各种神经功能障碍。葡萄糖代谢紊乱，包括低血糖和高血糖，在 NE 中很常见，并且会显著影响结局。低血糖定义为血糖低于 45mg/dL，与死亡率增加、神经发育障碍和 MRI 上的脑损伤有关。相反，血糖高于 120 至 150mg/dL 也与更高的死亡率、听力障碍和多器官功能障碍有关。与血糖正常的婴儿相比，这两种异常葡萄糖状态似乎都使预后恶化。亚低温治疗是 NE 的标准治疗方法，通过降低代谢需求和炎症来提供神经保护。胰高血糖素和连续血糖监测等辅助治疗在治疗糖代谢异常和改善结局方面显示出前景。胰高血糖素可以增强脑血流和葡萄糖供应，而连续血糖监测可以实现实时监测和个性化干预。维持平衡的血糖水平对于 NE 的管理至关重要。早期发现和干预糖代谢异常对于改善脑病新生儿的结局至关重要。需要进一步研究以优化血糖管理策略，并探索胰高血糖素治疗等干预措施的潜在益处。
