Neonatal hyperglycaemia is associated with worse neurodevelopmental outcomes in extremely preterm infants

Abstract

ObjectiveTo assess the associations between neonatal hyperglycaemia and insulin treatment, versus long-term neurodevelopmental outcomes in children born extremely preterm.Design and settingObservational national cohort study (Extremely Preterm Infants in Sweden Study) using prospectively and retrospectively collected data. Neurodevelopmental assessment was performed at 6.5 years of age.Patients533 infants born <27 gestational weeks during 2004–2007; 436 survivors were assessed at 6.5 years.Outcome measuresNeurodevelopmental disability (NDD), survival without moderate to severe NDD, Wechsler Intelligence Scale for Children IV Full scale intelligence quotient (WISC-IV FSIQ) and Movement Assessment Battery for Children 2 (MABC-2) total score.ResultsDuration of neonatal hyperglycaemia >8 mmol/L was associated with WISC-IV scores—for each day with hyperglycaemia there was a decrease of 0.33 points (95% CI 0.03 to 0.62) in FSIQ. Neonatal hyperglycaemia >8 mmol/L occurring on 3 consecutive days was associated with lower MABC-2 scores (adjusted mean difference: −4.90; 95% CI −8.90 to −0.89). For each day with hyperglycaemia >8 mmol/L, there was a decrease of 0.55 points (95% CI 0.17 to 0.93) in MABC-2 total score. Insulin treatment was not associated with any of the outcome measures.ConclusionNeonatal hyperglycaemia >8 mmol/L was associated with lower intelligence scores and worse motor outcomes at 6.5 years of age. Insulin treatment was not associated with either worsened or improved neurodevelopmental outcomes. Randomised controlled trials are needed to clarify the role of insulin in treating hyperglycaemia in extremely preterm infants.

Neonatal Hyperglycemia and Neurodevelopmental Outcomes in Preterm Infants: A Review

“…One further study was excluded following full-text review due to the lack of a full text [ 24 ] and two others were excluded due to the lack of control groups [ 20 , 25 ]. Thus, a total of 6 studies were included, comprising 2226 infants at enrolment, with neurodevelopment assessment available in 1059 (48%) infants [ 19 , 26 , 27 , 28 , 29 , 30 ]. Meta-analysis was not performed due to the heterogeneity of the studies, especially the tools used to assess long-term neurodevelopment outcome.…”

Neurodevelopmental consequences of early plasma sodium changes in very preterm infants

“…We found that early fluctuations in glucose levels were also independently associated with both a lower GA and suboptimal neurological outcomes, in line with a previous study that reported an association of neonatal hyperglycemia with impaired neurodevelopmental outcomes in extremely preterm infants. 24 This highlights the necessity to correct plasma sodium levels for glucose levels when attempting to determine whether acute changes in plasma sodium may lead to adverse neonatal outcomes.…”

Early versus later initiation of parenteral nutrition for very preterm infants: a propensity score-matched observational study

“…23 Hyperglycaemia and hypertriglyceridaemia are associated with increased mortality and morbidity in very preterm infants. [24][25][26] In both arms of the same trial, 50% developed blood urea levels >7 mmol/L, with 50% developing blood urea >10 mmol/L in the high intake arm, suggesting intakes exceeding anabolic capacity with the current recommended intakes. Indeed, studies of higher intakes of macronutrients in very preterm babies in the early postnatal period are associated with other metabolic derangements, including the refeeding syndrome.…”