Elsevier

Pediatric Neurology

Volume 50, Issue 6, June 2014, Pages 586-590
Pediatric Neurology

Original Article
Early Hyperglycemia Is Associated With Poor Gross Motor Outcome in Asphyxiated Term Newborns

https://doi.org/10.1016/j.pediatrneurol.2014.01.043Get rights and content

Abstract

Background

Hyperglycemia after ischemic stroke in adults and after near-drowning in children is associated with a poor neurological outcome. Anaerobic metabolism of glucose leads to buildup of lactic acid, free radical production, mitochondrial failure, and ultimately an increase in neurological injury. In asphyxiated infants, high lactate peaks are seen in the basal ganglia with magnetic resonance spectroscopy. Because motor disability in asphyxiated full-term newborns often relates to injury in the basal ganglia, we hypothesized that hyperglycemia and associated buildup of lactic acid may lead to worse gross motor outcome.

Methods

Glucose, blood gas values, and demographic data were abstracted from the medical records of 41 term infants with asphyxia and without confounding diagnoses. Their Gross Motor Function Classification System scores were determined from the medical record or by structured telephone interviews.

Results

The outcomes of 14 infants were considered poor on the basis of death within the first 6 months or moderate-to-severe cerebral palsy (Gross Motor Function Classification System score 1-5). The other 27 infants had no gross motor disability (Gross Motor Function Classification System score 0). The highest recorded blood glucose correlated with poor outcome (P = 0.046 by logistic regression). Infants with hyperglycemia (blood glucose > 150 mg/dL) were more likely to have poor outcome (P = 0.017; odds ratio: 5.9; 95% confidence interval: 1.4-24.7).

Conclusions

High blood glucose in the first 12 hours is associated with poor gross motor outcome in this cohort of asphyxiated term infants. Clinicians should avoid hyperglycemia in managing term infants with asphyxia.

Section snippets

Background

High blood glucose is associated with worse outcome after hypoxia and/or ischemia in several clinical situations. Adults with diabetes are more prone than those without to irreversible brain damage and worse prognosis and disability after ischemic stroke.1, 2 Even in nondiabetic adults, those with greater admission glucose levels had larger strokes and a worse neurological outcome.3, 4 Blood glucose ≥155 mg/dL in the first 48 hours after ischemic stroke is associated with poor outcome

Methods

The Akron Children's Hospital neonatal intensive care unit (NICU) database was used to identify all term infants (≥37 weeks gestation) with discharge diagnosis of hypoxic ischemic encephalopathy, neonatal asphyxia, neonatal depression, and/or delayed adaptation in the delivery room admitted from their hospital of birth between January 2003 and December 2008. Our goal was to capture all infants who had clear evidence for neonatal asphyxia, with a range of likely outcomes, and exclude those with

Results

Twenty-seven infants had no gross motor deficits (GMFCS score 0). The poor-outcome group comprised one infant with a GMFCS score of 3, one with a GMFCS score of 4, five with a GMFCS score of 5, five infants who died in the NICU, and two infants who died within 6 months of discharge with severe motor deficits and requiring tube feedings. All but one of the infants in the poor-outcome group were followed in our system and classified on the basis of adequate information in their records or actual

Discussion

We found that higher blood glucose was associated with worse gross motor outcome or death in this cohort of asphyxiated term infants. This finding is consistent with previous studies that found greater blood glucose levels are associated with worse impairment and brain damage in stroke and asphyxia from drowning.1, 2, 3, 4, 5, 6, 7

One previous study of 52 term human neonates with asphyxia investigated adverse outcome in relation to hyperglycemia (defined as blood glucose >150 mg/dL) in the

Conclusions

We found that hyperglycemia in the first 12 hours of life is associated with poor gross motor outcome or death in asphyxiated term infants. In addition, we found that gross motor outcomes in the surviving infants are either normal or moderately to severely impaired, suggesting that there may be a narrow window between successful compensation and moderate-to-severe injury of the basal ganglia.

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