Long-Term Outcomes of Hyperglycemic Preterm Infants Randomized to Tight Glycemic Control - 01/12/17

Doi : 10.1016/j.jpeds.2017.09.081

Anna Catherine Tottman, MBBS ¹, Jane Marie Alsweiler, PhD ^1,², Frank Harry Bloomfield, PhD ¹, Greg Gamble, MSc ¹, Yannan Jiang, PhD ¹, Myra Leung, BOptom ³, Tanya Poppe, MSc ³, Benjamin Thompson, PhD ³, Trecia Ann Wouldes, PhD ⁴, Jane Elizabeth Harding, DPhil ^1,^*
on behalf of the
PIANO Study Group^*
List of additional members of the PIANO study group is available at www.jpeds.com (Appendix).
Jane M. Alsweiler, PhD ⁵, Janene B. Biggs, PGDip ⁶, Coila Bevan, BA ⁵, Joanna M. Black, PhD ⁷, Frank H. Bloomfield, PhD ⁶, Kelly Fredell ⁶, Greg D. Gamble, MSc ⁶, Jane E. Harding, DPhil ⁶, Sabine Huth, BA ⁶, Yannan Jiang, PhD ⁶, Christine Kevan ⁶, Myra Leung, BOptom ⁷, Geraint Phillips, OD ⁷, Tanya Poppe, MSc ⁷, Jennifer A. Rogers, MHSc ⁶, Heather Stewart, NZRN ⁶, Benjamin S. Thompson, PhD ⁷, Anna C. Tottman, MBBS ⁶, Kathryn A. Williamson, MSc ⁵, Trecia A. Wouldes, PhD ⁸
⁵ Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
⁶ Liggins Institute, University of Auckland, Auckland, New Zealand
⁷ School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
⁸ Department of Psychological Medicine, University of Auckland, Auckland, New Zealand

¹ Liggins Institute, University of Auckland, Auckland, New Zealand
² Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
³ School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
⁴ Department of Psychological Medicine, University of Auckland, Auckland, New Zealand

^*Reprint requests: Jane Elizabeth Harding, DPhil, Liggins Institute, University of Auckland, Private Bag 92019, Auckland 1023, New Zealand.Liggins InstituteUniversity of AucklandPrivate Bag 92019Auckland1023New Zealand

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Friday 01 December 2017
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Abstract

Objective

To determine whether tight glycemic control of neonatal hyperglycemia changes neurodevelopment, growth, and metabolism at school age.

Study design

Children born very low birth weight and randomized as hyperglycemic neonates to a trial of tight vs standard glycemic control were assessed at 7 years corrected age, including Wechsler Intelligence Scale for Children Fourth Edition, Movement Assessment Battery for Children 2, visual and neurologic examinations, growth measures, dual X-ray absorptiometry, and frequently sampled intravenous glucose tolerance test. The primary outcome was survival without neurodevelopmental impairment at age 7 years. Outcomes were compared using linear regression, adjusted for sex, small for gestational age, birth plurality, and the clustering of twins. Data are reported as number (%) or mean (SD).

Results

Of the 88 infants randomized, 11 (13%) had died and 57 (74% of eligible children) were assessed at corrected age 7 years. Survival without neurodevelopmental impairment occurred in 25 of 68 children (37%), with no significant difference between tight (14 of 35; 40%) and standard (11 of 33; 33%) glycemic control groups (P = .60). Children in the tight group were shorter than those in the standard group (121.3 [6.3] cm vs 125.1 [5.4] cm; P < .05), but had similar weight and head circumference. Children in the tight group had greater height-adjusted lean mass (18.7 [0.3] vs 17.6 [0.2] kg; P < .01) and lower fasting glucose concentrations (84.6 [6.30] vs 90.0 [5.6] mg⋅dL⁻¹; P < .05), but no other differences in measures of body composition or insulin-glucose metabolism.

Conclusion

Tight glycemic control for neonatal hyperglycemia does not change survival without neurodevelopmental impairment, but reduces height, increases height-adjusted lean mass, and reduces fasting blood glucose concentrations at school age.

Trial registration

ACTRN: 12606000270516.

Le texte complet de cet article est disponible en PDF.

Keywords : hyperglycemia, insulin, blood glucose, neonate, neurodevelopment

Abbreviations : BRIEF, HINT, MABC-2, PMA

Plan

Supported by the Health Research Council of New Zealand programme grant (12-095) and the A+ trust project grant (5486). A.T. received research support from the University of Auckland Senior Health Researcher Scholarship and a Gravida: National Centre for Growth and Development doctoral scholarship. The authors declare no conflicts of interest.