Glycemia and Neonatal Encephalopathy: Outcomes in the LyTONEPAL (Long-Term Outcome of Neonatal Hypoxic EncePhALopathy in the Era of Neuroprotective Treatment With Hypothermia) Cohort

Abstract

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, 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 one measurement > 8.3 mmol/L), hypoglycemic (at least one measurement < 2.2 mmol/L), or with glycemic lability (measurements included at least one episode of hypoglycemia and one of hyperglycemia). The primary adverse outcome was a composite outcome defined by death and/or brain lesions on MRI, regardless of severity or location. 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 2,593 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 adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) for the adverse outcome were significantly higher 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 higher risk of mortality and/or brain lesions on MRI.