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