Initial Hypoglycemia and Neonatal Brain Injury in Term Infants With Severe Fetal Acidemia

• Published in: Pediatrics (Evanston) 2004-08, Vol.114 (2), p.361-366
• Main Authors: Salhab, Walid A, Wyckoff, Myra H, Laptook, Abbot R, Perlman, Jeffrey M
• Format: Article
• Language: English
• Subjects: Acidosis - complications; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Babies; Biological and medical sciences; Birth Weight; Brain; Brain damage; Brain injuries; Emergency and intensive care: neonates and children. Prematurity. Sudden death; General aspects; Gestational Age; Glucose; Health aspects; Humans; Hydrogen-Ion Concentration; Hypoglycemia; Hypoglycemia - complications; Hypoxia-Ischemia, Brain - etiology; Infant, Newborn; Infants; Injuries; Injuries of the abdomen. Foreign bodies of the digestive system; Intensive care medicine; Logistic Models; Medical sciences; Multivariate Analysis; Neurology; Pediatrics; Retrospective Studies; Risk factors; Seizures - etiology; Traumas. Diseases due to physical agents
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.114.2.361

To determine the potential contribution of initial hypoglycemia to the development of neonatal brain injury in term infants with severe fetal acidemia. A retrospective chart review was conducted of 185 term infants who were admitted to the neonatal intensive care unit between January 1993 and December 2002 with an umbilical arterial pH 40 mg/dL had an abnormal neurologic outcome (odds ratio [OR]: 6.3; 95% confidence interval [CI]: 2.6-15.3). Infants with abnormal outcomes and a blood sugar < or =40 mg/dL versus >40 mg/dL had a higher pH (6.86 +/- 0.07 vs 6.75 +/- 0.09), a lesser base deficit (-19 +/- 4 vs -23.8 +/- 4 mEq/L), and lower mean arterial blood pressure (34 +/- 10 vs 45 +/- 14 mm Hg), respectively. There was no difference between groups in the proportion of infants who required cardiopulmonary resuscitation (7 [46%] vs 15 [57%]) and those with a 5-minute Apgar score 40 mg/dL (OR: 18.5; 95% CI: 3.1-111.9), cord arterial pH < or =6.90 versus >6.90 (OR: 9.8; 95% CI: 2.1-44.7), a 5-minute Apgar score < or =5 versus >5 (OR: 6.4; 95% CI: 1.7-24.5), and the requirement for intubation with or without cardiopulmonary resuscitation versus neither (OR: 4.7; 95% CI: 1.2-17.9). Initial hypoglycemia is an important risk factor for perinatal brain injury, particularly in depressed term infants who require resuscitation and have severe fetal acidemia. It remains unclear, however, whether earlier detection of hypoglycemia, such as in the delivery room, in this population could modify subsequent neurologic outcome.