Abstract
To determine the incidence of hypoglycemia among infants with hypoxic-ischemic encephalopathy (HIE) who received therapeutic hypothermia, and to assess whether infants with hypoglycemia had more brain injury on magnetic resonance imaging (MRI) or differences in neurodevelopmental outcome. Single-center, retrospective cohort study including infants cooled for HIE. Hypoglycemia (blood glucose <36.0mg/dL <2hours and <46.8mg/dL ≥2hours after birth) was analyzed in the period before brain MRI. Brain injury was graded using a validated score. Motor and neurocognitive outcomes were assessed at 2years for all survivors, and 5.5years for a subset who had reached this age. Of 223 infants analyzed, 79 (35.4%) had hypoglycemia. MRI was performed in 187 infants. Infants with hypoglycemia (n=65) had higher brain injury scores (P=.018). After adjustment for HIE severity, hypoglycemia remained associated with higher injury scores (3.6 points higher; 95% CI, 0.8-6.4). Hyperglycemia did not affect MRI scores. In survivors at 2years (n=154) and 5.5years (n=102), a univariable analysis showed lower 2-year motor scores and lower motor and cognitive scores at preschool age in infants with hypoglycemia. After adjustment for HIE severity, infants with hypoglycemia had 9 points lower IQs (P=.023) and higher odds of adverse outcomes at preschool age (3.6; 95% CI, 1.4-9.0). More than one-third of infants cooled for HIE had hypoglycemia. These infants had a higher degree of brain injury on MRI and lower cognitive function at preschool age. Strategies to avoid hypoglycemia should be optimized in this setting.
Highlights
Hypoglycemia in infants with hypoxic-ischemic encephalopathy is associated with additional brain injury and worse neurodevelopmental outcome
After adjustment for hypoxic-ischemic encephalopathy (HIE) severity, hypoglycemia remained associated with higher injury scores (3.6 points higher, 95% CI 0.8 to 6.4)
This study demonstrated that 35.4% of infants with HIE who received therapeutic hypothermia (TH) at our neonatal intensive care unit (NICU) had hypoglycemia, which was severe in 22.4%
Summary
To determine the incidence of hypoglycemia among infants with hypoxic-ischemic encephalopathy (HIE) who received therapeutic hypothermia (TH), and to assess whether infants with hypoglycemia had more brain injury on magnetic resonance imaging (MRI) or differences in neurodevelopmental outcome. Our data showing higher rates of abnormalities of the MBs among infants with hypoglycemia, and worse VIQ scores in hypoglycemic infants with abnormal MBs, Journal Pre-proof suggest that these infants are at increased risk for neurocognitive impairments later in life, as a recent study has reported a strong association between MB atrophy with episodic memory and neurocognitive outcome at 10 years of age.[17]. These findings all strongly support continued 0po9neurodevelopmental follow-up beyond 24 months of age. Additional studies to investigate the association of hyperglycemia with and without hypoglycemia on brain injury and long-term outcome, and the optimal glucose levels in these newborns are warranted
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