Glycemia and Neonatal Encephalopathy: Outcomes in the LyTONEPAL (Long-Term Outcome of Neonatal Hypoxic EncePhALopathy in the Era of Neuroprotective Treatment With Hypothermia) Cohort - 17/06/23
, Pierre-Yves Ancel, MD, PhD 2, Jonathan Beck, MD 2, 3, Gauthier Loron, MD, PhD 3, Marie Chevallier, MD, PhD 4, Véronique Pierrat, MD, PhD 2, 5, Gilles Kayem, MD, PhD 2, 6, Antoine Vilotitch 7, Olivier Baud, MD, PhD 8, 9, Anne Ego, MD, PhD 2, 4, 10, Thierry Debillon, MD, PhD 4Abstract |
Objectives |
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.
Study design |
We conducted a secondary analysis of LyTONEPAL (Long-Term Outcome of Neonatal hypoxic EncePhALopathy in the era of neuroprotective treatment with hypothermia), 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 1 measurement >8.3 mmol/L), hypoglycemic (at least 1 measurement <2.2 mmol/L), or with glycemic lability (measurements included at least 1 episode of hypoglycemia and 1 episode of hyperglycemia). The primary adverse outcome was a composite outcome defined by death and/or brain lesions on magnetic resonance imaging, regardless of severity or location.
Results |
In total, 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 2593 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 aORs and 95% 95% CIs for the adverse outcome were significantly greater for the group with hyperglycemia (aOR 1.81; 95% CI 1.06-3.11).
Conclusions |
Dysglycemia affects nearly two-thirds of newborns with NE and is independently associated with a greater risk of mortality and/or brain lesions on magnetic resonance imaging.
Trial registration |
NCT02676063
Le texte complet de cet article est disponible en PDF.Keywords : neonatal mortality, brain lesions, magnetic resonance imaging, secondary cerebral insult, dysglycemia, neonatal encephalopathy, hypoxic-ischemic perinatal event
Abbreviations : LyTONEPAL, MRI, NE
Plan
| Supported by 2013 French Program for Hospital Clinical Research (PHRC-N-13-0327). Newborn Safety Net foundation; Roualet Price. The funder had no role in the design and conduct of the study. The authors declare no conflicts of interest. |
Vol 257
Article 113350- juin 2023 Retour au numéro
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