Long-Term Outcomes of Hyperglycemic Preterm Infants Randomized to Tight Glycemic Control - 31/01/18
on behalf of the
PIANO Study Group*
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. |
Vol 193
P. 68 - février 2018 Retour au numéro
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