Hyperglycemia and Glucose Variability Are Associated with Worse Brain Function and Seizures in Neonatal Encephalopathy: A Prospective Cohort Study - 23/05/19
Abstract |
Objectives |
To investigate how glucose abnormalities correlate with brain function on amplitude-integrated electroencephalography (aEEG) in infants with neonatal encephalopathy.
Study design |
Neonates born at full term with encephalopathy were enrolled within 6 hours of birth in a prospective cohort study at a pediatric academic referral hospital. Continuous interstitial glucose monitors and aEEG were placed soon after birth and continued for 3 days. Episodes of hypoglycemia (≤50 mg/dL; ≤2.8 mmol/L) and hyperglycemia (>144 mg/dL; >8.0 mmol/L) were identified. aEEG was classified in 6-hour epochs for 3 domains (background, sleep–wake cycling, electrographic seizures). Generalized estimating equations assessed the relationship of hypo- or hyperglycemia with aEEG findings, adjusting for clinical markers of hypoxia-ischemia (Apgar scores, umbilical artery pH, and base deficit).
Results |
Forty-five infants (gestational age 39.5 ± 1.4 weeks) were included (24 males). During aEEG monitoring, 16 episodes of hypoglycemia were detected (9 infants, median duration 77.5, maximum 220 minutes) and 18 episodes of hyperglycemia (13 infants, median duration 237.5, maximum 3125 minutes). Epochs of hypoglycemia were not associated with aEEG changes. Compared with epochs of normoglycemia, epochs of hyperglycemia were associated with worse aEEG background scores (B 1.120, 95% CI 0.501-1.738, P < .001), less sleep–wake cycling (B 0.587, 95% CI 0.417-0.757, P < .001) and more electrographic seizures (B 0.433, 95% CI 0.185-0.681, P = .001), after adjusting for hypoxia–ischemia severity.
Conclusions |
In neonates with encephalopathy, epochs of hyperglycemia were temporally associated with worse global brain function and seizures, even after we adjusted for hypoxia–ischemia severity. Whether hyperglycemia causes neuronal injury or is simply a marker of severe brain injury requires further study.
Le texte complet de cet article est disponible en PDF.Keywords : glucose derangements, hypoglycemia, amplitude-integrated electroencephalography
Abbreviations : aEEG, CGM, HIE, MRI
Plan
Funded by Canadian Institutes of Health Research (MOP-133710 [to E.T.]), Savoy Epilepsy Foundation, Canada (to E.P.), and SickKids Research Training Center Restracomp award, Canada (to E.P.). Equipment provided by Medtronic Canada. The sponsor had no role the design and conduct of the study; collection, analysis, and interpretation of the data; preparation and writing of the manuscript; and decision to submit the manuscript for publication. No honorarium, grant, or other form of payment was given to anyone to produce the manuscript. The authors have no conflicts of interest to disclose. |
Vol 209
P. 23-32 - juin 2019 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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