Elsevier

The Journal of Pediatrics

Volume 188, September 2017, Pages 115-121
The Journal of Pediatrics

Original Articles
Relationship between Measures of Neonatal Glycemia, Neonatal Illness, and 2-Year Outcomes in Very Preterm Infants

https://doi.org/10.1016/j.jpeds.2017.05.052Get rights and content

Objectives

To investigate relationships between early neonatal glycemia, neonatal characteristics, neonatal illness, and developmental outcomes in very preterm infants.

Study design

A retrospective, observational cohort study of 443 infants born weighing <1500 g or <30 weeks of gestation, and admitted within 24 hours to National Women's Hospital, Auckland, New Zealand. Glucose variability was defined as the standard deviation around the mean after log transformation of all blood glucose concentrations. Absolute glycemic excursions in the first week were used to divide the infants into 4 groups: normoglycemic; hypoglycemic; hyperglycemic, and unstable.

Results

Compared with normoglycemic infants, hypoglycemic and unstable infants had lower birth weight z-scores, and hyperglycemic and unstable infants were of lower birth weight. Hypoglycemic infants had similar outcomes to normoglycemic infants. Hyperglycemic and unstable infants were less likely to survive without neonatal morbidity and less likely to survive without neurodevelopmental impairment at 2 years of age. Higher mean blood glucose concentration was seen in the hyperglycemic and unstable groups, and was associated with worse neonatal and 2-year outcomes. Greater glucose variability was seen in the hypoglycemic and unstable groups, and was associated with worse neonatal illness but not outcome at 2 years. No associations between measures of neonatal glycemia and neonatal or 2-year outcomes remained after correction for gestation, birth weight z-score, and socioeconomic status.

Conclusions

In very preterm infants, measures of neonatal glycemia are markers of gestational age and intrauterine growth, and are not independent predictors of neonatal illness or outcomes at 2 years of age.

Section snippets

Methods

Eligible infants were born weighing <1500 g or at <30 weeks of gestation and admitted to the National Women's Health, Auckland City Hospital neonatal intensive care unit (NICU) from July 2005 to October 2008. Infants were excluded if they were admitted to the NICU after 24 hours of age, died or were discharged before day 7, or had a significant congenital abnormality.

The usual clinical practice during the study period was to start intravenous 10% dextrose at 60-90 mL/kg/day as soon as possible

Results

During the study period, 536 eligible infants were admitted to the NICU, of whom 443 (83%) had glucose profiles available for analysis and 346 (65%) had a 2-year developmental assessment available (Figure).

Of participants whose glucose profiles were available for analysis, 287 of the 443 (65%) were categorized as normoglycemic (Table I). Infants in the hypoglycemic category (42/443, 9%) were of similar gestational age and birth weight to those in the normoglycemic category. Infants in the

Discussion

In this cohort of very preterm and very low birth weight infants, absolute glycemic excursions were strongly associated with birth weight, gestational age, intrauterine growth, and illness severity as indicated by CRIB II scores. In general, infants with normal growth were more likely to have normoglycemic glucose profiles, whereas hypoglycemia was seen in more growth-restricted infants, and hyperglycemia was more likely in smaller and sicker infants. Unstable glucose profiles were more likely

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    Supported by Gravida, National Centre for Growth and Development (12-01 [to A.T.]) and The Health Research Council of New Zealand (12-095 [to F.B.]). The authors declare no conflicts of interest.

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