Hyperglycemia and Glucose Variability Are Associated with Worse Brain Function and Seizures in Neonatal Encephalopathy: A Prospective Cohort Study

• Published in: The Journal of pediatrics 2019-06, Vol.209, p.23-32
• Main Authors: Pinchefsky, Elana F., Hahn, Cecil D., Kamino, Daphne, Chau, Vann, Brant, Rollin, Moore, Aideen M., Tam, Emily W.Y.
• Format: Article
• Language: English
• Subjects: Academic Medical Centers; amplitude-integrated electroencephalography; Apgar Score; Blood Glucose - analysis; Brain Diseases - diagnostic imaging; Brain Diseases - epidemiology; Cohort Studies; Electroencephalography - methods; Female; Gestational Age; glucose derangements; Humans; Hyperglycemia - complications; Hyperglycemia - diagnosis; hypoglycemia; Hypoglycemia - complications; Hypoglycemia - diagnosis; Hypoxia, Brain - diagnostic imaging; Hypoxia, Brain - physiopathology; Infant, Newborn; Male; Prevalence; Prospective Studies; Seizures - diagnostic imaging; Seizures - epidemiology; Severity of Illness Index
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2019.02.027

To investigate how glucose abnormalities correlate with brain function on amplitude-integrated electroencephalography (aEEG) in infants with neonatal encephalopathy. 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). 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