Palazzo Martina, Correani Alessio, Bonanni Margherita, Ferretti Enrica, D'Ascenzo Rita, Biagetti Chiara, Burattini Ilaria, Cogo Paola, Carnielli Virgilio
Department of Odontostomatologic and Specialized Clinical Sciences, Polytechnic University of Marche, Ancona, Italy.
Department of Medicine, University Hospital S Maria Della Misericordia, University of Udine, Udine, Italy.
Eur J Pediatr. 2024 Dec 21;184(1):97. doi: 10.1007/s00431-024-05936-2.
The objective of this study is to evaluate whether early hypoglycemia is an independent risk factor for 2-year cognitive (COG) impairment in small for gestational age (SGA) preterm infants with gestational age (GA) < 32 weeks. We retrospectively reviewed data of 1364 preterm infants with a GA 24-31 weeks. Infants were classified based on blood glucose concentrations within the first 6 h of life (HOL) as < or ≥ 40 mg/dL (Glyc < 40 and Glyc ≥ 40, respectively) and subsequently by birth weight z-score as SGA or appropriate for gestational age (AGA). Propensity score matching analyses were conducted for each comparison. Multiple logistic regression was used to evaluate the association of Glyc < 40 with 2-year COG impairment, defined as a Bayley-III score < 85, in SGA infants. Out of the 747 preterm infants who met the inclusion criteria, 173 (23.2%) were classified as Glyc < 40, and 574 (76.8%) as Glyc ≥ 40. The proportion of SGA infants was significantly higher in Glyc < 40 than in Glyc ≥ 40 (25.4 vs 18.3%, p = 0.039). The incidence of 2-year COG impairment was significantly higher in SGA infants compared to matched AGA counterparts both in Glyc < 40 (+ 20%, p = 0.040) and Glyc ≥ 40 (+ 17%, p = 0.029). Neither in the entire cohort nor in the SGA infants, Glyc < 40 was significantly associated with 2-year COG impairment (aOR: 1.077, p = 0.768; 0.993, p = 0.935; respectively) after the adjustment for GA, sex, Apgar score at 5 min < 7, SGA status, complications of prematurity, duration of mechanical ventilator support > 7 days, cumulative energy intakes from birth to 36 weeks, and maternal university level.
Among SGA preterm infants with GA between 24 and 31 weeks/days, hypoglycemia within the first 6 HOL was not an independent risk factor for 2-year COG impairment.
• Hypoglycemia is associated with poor neurodevelopmental outcomes in preterm infants. • Small for gestational age (SGA) preterm infants are more prone to cognitive (COG) impairment compared to AGA counterparts.
• In a large cohort of preterm infants < 32 weeks, the incidence of hypoglycemia within the first 6 hours of life (HOL) was higher in SGA compared to AGA. • Hypoglycemia within the first 6 HOL was not an independent risk factor for 2-year COG impairment in SGA preterm infants.
本研究的目的是评估早期低血糖是否为胎龄（GA）<32周的小于胎龄（SGA）早产儿2年认知（COG）障碍的独立危险因素。我们回顾性分析了1364例GA为24 - 31周的早产儿的数据。根据出生后6小时内（HOL）的血糖浓度将婴儿分为<或≥40mg/dL（分别为血糖<40和血糖≥40），随后根据出生体重z评分分为SGA或适于胎龄（AGA）。对每组比较进行倾向得分匹配分析。采用多因素logistic回归评估SGA婴儿中血糖<40与2年COG障碍（定义为贝利婴幼儿发展量表第三版（Bayley-III）评分<85）之间的关联。在符合纳入标准的747例早产儿中，173例（23.2%）被分类为血糖<40，574例（76.8%）为血糖≥40。血糖<40组中SGA婴儿的比例显著高于血糖≥40组（25.4%对18.3%，p = 0.039）。在血糖<40组（+20%，p = 0.040）和血糖≥40组（+17%，p = 0.029）中，SGA婴儿2年COG障碍的发生率均显著高于匹配的AGA婴儿。在对GA、性别、5分钟阿氏评分<7、SGA状态、早产并发症、机械通气支持时间>7天、出生至36周的累计能量摄入以及母亲大学学历进行校正后，无论是在整个队列中还是在SGA婴儿中，血糖<40与2年COG障碍均无显著关联（校正优势比分别为：1.077，p = 0.768；0.993，p = 0.935）。
在GA为24至31周/天的SGA早产儿中，出生后6小时内的低血糖不是2年COG障碍的独立危险因素。
• 低血糖与早产儿不良神经发育结局相关。• 与AGA早产儿相比，SGA早产儿更易发生认知（COG）障碍。
• 在一大群<32周的早产儿中，SGA婴儿出生后6小时内（HOL）低血糖的发生率高于AGA婴儿。• 出生后6小时内的低血糖不是SGA早产儿2年COG障碍的独立危险因素。
