Continuous glucose monitoring profile during therapeutic hypothermia in encephalopathic infants with unfavorable outcome

Montaldo, Paolo; Caredda, Elisabetta; Pugliese, Umberto; Zanfardino, Angela; Delehaye, Chiara; Inserra, Emanuela; Capozzi, L.; Chello, Giovanni; Capristo, Carlo; Giudice, Emanuele Miraglia del; Iafusco, Dario

doi:10.1038/s41390-020-0827-4

Cited by 32 publications

(48 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A detrimental effect of hyperglycemia on perinatal hypoxicischemic (HI) brain injury is consistent with findings in term neonatal dogs and piglets and near-term fetal sheep (48,61,72). Recently, postnatal hyperglycemia has been associated with worse outcomes in term and near-term human infants with HIE (4,5,55).…”

Section: Introduction 44supporting

confidence: 62%

Effects of antenatal dexamethasone and hyperglycemia on cardiovascular adaptation to asphyxia in preterm fetal sheep

Lear

Davidson

Dhillon

et al. 2020

American Journal of Physiology-Regulatory, Integrative and Comp

View full text Add to dashboard Cite

Antenatal glucocorticoids improve outcomes among premature infants but are associated with hyperglycemia, which can exacerbate hypoxic-ischemic injury. It is still unclear how antenatal glucocorticoids or hyperglycemia modulate fetal cardiovascular adaptations to severe asphyxia. In this study, preterm fetal sheep received either saline or 12 mg i.m. maternal dexamethasone, followed 4 h later by complete umbilical cord occlusion (UCO) for 25 min. An additional cohort of fetuses received titrated glucose infusions followed 4 h later by UCO, to control for the possibility that hyperglycemia contributed to the cardiovascular effects of dexamethasone. Fetuses were studied for 7 d after UCO. Maternal dexamethasone was associated with fetal hyperglycemia (p<0.001), increased arterial pressure (p<0.001) and reduced femoral (p<0.005) and carotid (p<0.05) vascular conductance before UCO. UCO was associated with bradycardia, femoral vasoconstriction and transient hypertension. For the first 5 min of UCO, fetal blood pressure in the dexamethasone-asphyxia group was greater than saline-asphyxia (p<0.001). However, the relative increase in arterial pressure was not different from saline-asphyxia. Fetal heart rate and femoral vascular conductance fell to similar nadirs in both saline and dexamethasone-asphyxia groups. Dexamethasone did not affect the progressive decline in femoral vascular tone or arterial pressure during continuing UCO. By contrast, there were no effects of glucose infusions on the response to UCO. In summary, maternal dexamethasone but not fetal hyperglycemia increased fetal arterial pressure before and for the first 5 min of prolonged UCO but did not augment the cardiovascular adaptations to acute asphyxia.

show abstract

Section: Introduction 44supporting

confidence: 62%

Effects of antenatal dexamethasone and hyperglycemia on cardiovascular adaptation to asphyxia in preterm fetal sheep

Lear

Davidson

Dhillon

et al. 2020

American Journal of Physiology-Regulatory, Integrative and Comp

View full text Add to dashboard Cite

show abstract

“…Again, limited data are available on optimal maintenance fluid volumes in NE in LMICs, however extreme fluid restriction and fluid overload are both likely to be harmful. Hypoglycemia and hyperglycemia are common in NE and has been associated with adverse outcomes in HICs, although a direct causal effect is unclear [ 49 ]. Given the high incidence of growth restriction and subacute brain injury the implications of hypoglycemia in LMICs may be very different to HICs, and optimal thresholds and management strategies may be different.…”

Section: Introductionmentioning

confidence: 99%

Need for more evidence in the prevention and management of perinatal asphyxia and neonatal encephalopathy in low and middle-income countries: A call for action

Krishnan

Kumar

Variane³

et al. 2021

Seminars in Fetal and Neonatal Medicine

View full text Add to dashboard Cite

Although low- and middle-income countries (LMICs) shoulder 90 % of the neonatal encephalopathy (NE) burden, there is very little evidence base for prevention or management of this condition in these settings. A variety of antenatal factors including socio-economic deprivation, undernutrition and sub optimal antenatal and intrapartum care increase the risk of NE, although little is known about the underlying mechanisms. Implementing interventions based on the evidence from high-income countries to LMICs, may cause more harm than benefit as shown by the increased mortality and lack of neuroprotection with cooling therapy in the hypothermia for moderate or severe NE in low and middle-income countries (HELIX) trial. Pooled data from pilot trials suggest that erythropoietin monotherapy reduces death and disability in LMICs, but this needs further evaluation in clinical trials. Careful attention to supportive care, including avoiding hyperoxia, hypocarbia, hypoglycemia, and hyperthermia, are likely to improve outcomes until specific neuroprotective or neurorestorative therapies available.

show abstract

“…[3] Prior studies have reported hypoglycemia rates up to 38.9% among asphyxiated infants with HIE receiving TH. [4][5][6][7][8][9] Both animal and neonatal studies have demonstrated a deleterious effect of hypoglycemia on the extent of brain injury in asphyxiated infants with HIE. [10,11] Lower glucose levels are associated with a higher degree of encephalopathy [12] and worse neurodevelopmental outcome at 18-24 months of age.…”

mentioning

confidence: 99%

Hypoglycemia in Infants with Hypoxic-Ischemic Encephalopathy Is Associated with Additional Brain Injury and Worse Neurodevelopmental Outcome

Parmentier

Vries

et al. 2022

The Journal of Pediatrics

View full text Add to dashboard Cite

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

show abstract

Continuous glucose monitoring profile during therapeutic hypothermia in encephalopathic infants with unfavorable outcome

Cited by 32 publications

References 29 publications

Effects of antenatal dexamethasone and hyperglycemia on cardiovascular adaptation to asphyxia in preterm fetal sheep

Effects of antenatal dexamethasone and hyperglycemia on cardiovascular adaptation to asphyxia in preterm fetal sheep

Need for more evidence in the prevention and management of perinatal asphyxia and neonatal encephalopathy in low and middle-income countries: A call for action

Hypoglycemia in Infants with Hypoxic-Ischemic Encephalopathy Is Associated with Additional Brain Injury and Worse Neurodevelopmental Outcome

Contact Info

Product

Resources

About