Glucose abnormalities in infants with birth asphyxia are associated with later neurological diagnoses

Abstract

Objective To investigate the association between early glycemic profile and neurological outcome in neonates with birth asphyxia.

Study design Retrospective study on infants born ≥ 36 weeks gestational age with an ICD-10 diagnosis of birth asphyxia and/or hypoxic-ischemic encephalopathy. Early glucose values (<72 hours) and clinical follow-up data were extracted from medical records. Primary outcome: death or any ICD-10 diagnoses indicating neurodevelopmental disorders (psychiatric, epileptical, paralytical, visual or hearing disorders); secondary outcomes: individual diagnostic classes. Estimates were adjusted for infant sex, delivery mode and therapeutic hypothermia.

Results Among 273 neonates 24 (8.8%) had minimum glucose < 1.6 mmol/l, 56 (20.5%) < 2.2 mmol/l and 91 (33.3%) < 2.6 mmol/l during the first 72 hours of life. 60 (22.0%) infants had maximum glucose > 8.3 mmol/l and 34 (12.5%) > 10.0 mmol/l. In multivariable analyses the association was significant between hypoglycemia (glucose < 1.6 mmol/l) and NDD (aOR = 3.3, 95%Cl 1.3 – 8.6), epilepsy (aOR = 8.1, 95%CI 1.4 – 47.1) and hearing disorders (aOR = 9.8, 95%CI 2.1 – 45.7). Hyperglycemia (glucose >8.3mmol/l) was significantly associated with epilepsy (aOR = 6.2, 95%Cl 1.4 – 28.2), cerebral palsy (OR = 4.4, 95%Cl 1.2 – 15.8) and hearing disorders (OR = 8.2, 95%Cl 1.8 – 38.1).

Conclusions This study shows that the glycemic profile in neonates with birth asphyxia during the first 72h is associated with neurodevelopmental disorders. We found a dose-dependent association between hypo- and hyperglycemia and hearing disorders. Further research is needed to investigate if neurological outcome could be improved by rigorous glycemic control.