Effect of glucose metabolism disorders on the short-term prognosis in neonates with asphyxia: a multicenter study in Hubei Province, China
LIU Chun-Hua, WANG Hui, PENG Si-Cong, WANG Wen-Xiang, JIAO Rong, PAN Sha, ZHU Tian-Jiao, LUAN Xiao-Ying, ZHU Xiao-Fang, WU Su-Ying, WEI De-Guo, FU Bing-Feng, YAN Rui-Hong, YANG Shu-Jie, LUO Ya-Hui, LI Gui-Ping, YANG Min, JIA De-Zhao, GAO Chuang, XIAO Xiong-Fei, XIONG Li, SUN Jie, XIAO Jia-Peng, LI Bo-Wen, LI Yan-Ni, ZHANG Lian-Hong, LI Tian-Guo, CHENG Min, XIA Jian-Xin, XIA Shi-Wen
School of Medicine, Wuhan University of Science and Technology, Wuhan 430065, China
Abstract Objective To study the effect of glucose metabolism disorders on the short-term prognosis in neonates with asphyxia. Methods A retrospective analysis was performed on the medical data of the neonates with asphyxia who were admitted to 52 hospitals in Hubei Province of China from January to December, 2018 and had blood glucose data within 12 hours after birth. Their blood glucose data at 1, 2, 6, and 12 hours after birth (with an allowable time error of 0.5 hour) were recorded. According to the presence or absence of brain injury and/or death during hospitalization, the neonates were divided into a poor prognosis group with 693 neonates and a good prognosis group with 779 neonates. The two groups were compared in the incidence of glucose metabolism disorders within 12 hours after birth and short-term prognosis. Results Compared with the good prognosis group, the poor prognosis group had a significantly higher proportion of neonates from secondary hospitals (48.5% vs 42.6%, P<0.05) or with severe asphyxia (19.8% vs 8.1%, P<0.05) or hypothermia therapy (4.8% vs 1.5%, P<0.05), as well as a significantly higher incidence rate of disorder of glucose metabolism (18.8% vs 12.5%, P<0.05). Compared with the good prognosis group, the poor prognosis group had a significantly higher incidence rate of disorder of glucose metabolism at 1, 2, and 6 hours after birth (P<0.05). The multivariate logistic regression analysis showed that recurrent hyperglycemia (adjusted odds ratio=2.380, 95% confidence interval: 1.275-4.442, P<0.05) was an independent risk factor for poor prognosis in neonates with asphyxia. Conclusions Recurrent hyperglycemia in neonates with asphyxia may suggest poor short-term prognosis, and it is necessary to strengthen the early monitoring and management of the nervous system in such neonates.
LIU Chun-Hua,WANG Hui,PENG Si-Cong et al. Effect of glucose metabolism disorders on the short-term prognosis in neonates with asphyxia: a multicenter study in Hubei Province, China[J]. CJCP, 2021, 23(12): 1208-1213.
LIU Chun-Hua,WANG Hui,PENG Si-Cong et al. Effect of glucose metabolism disorders on the short-term prognosis in neonates with asphyxia: a multicenter study in Hubei Province, China[J]. CJCP, 2021, 23(12): 1208-1213.
Odd D, Heep A, Luyt K, et al. Hypoxic-ischemic brain injury: planned delivery before intrapartum events[J]. J Neonatal Perinatal Med, 2017, 10(4): 347-353. PMID: 29286930. DOI: 10.3233/NPM-16152.
3 Cloherty JP, Eichenwald EC, Hansen AR, et al. Manual of neonatal care[M]. 7th ed. Philadelphia: Lippincott Williams & Wilkins, 2011: 711-728.
Qiao J, Wang YY, Li XH, et al. A lancet commission on 70 years of women's reproductive, maternal, newborn, child, and adolescent health in China[J]. Lancet, 2021, 397(10293): 2497-2536. PMID: 34043953. DOI: 10.1016/S0140-6736(20)32708-2.
Wen YL, Hu J, Wang JQ, et al. Effect of glycolysis and heat shock proteins on hypoxia adaptation of Tibetan sheep at different altitude[J]. Gene, 2021, 803: 145893. PMID: 34384864. DOI: 10.1016/j.gene.2021.145893.
Basu SK, Kaiser JR, Guffey D, et al. Hypoglycaemia and hyperglycaemia are associated with unfavourable outcome in infants with hypoxic ischaemic encephalopathy: a post hoc analysis of the CoolCap Study[J]. Arch Dis Child Fetal Neonatal Ed, 2016, 101(2): F149-F155. PMID: 26283669. DOI: 10.1136/archdischild-2015-308733.
Kamino D, Almazrooei A, Pang EW, et al. Abnormalities in evoked potentials associated with abnormal glycemia and brain injury in neonatal hypoxic-ischemic encephalopathy[J]. Clin Neurophysiol, 2021, 132(1): 307-313. PMID: 33158762. PMCID: PMC7855101. DOI: 10.1016/j.clinph.2020.09.024.
Doandes FM, Manea AM, Lungu N, et al. Clinical, biological and electroencephalographic monitoring of newborns with neurological risk in the neonatal intensive care unit[J]. Exp Ther Med, 2021, 22(1): 760. PMID: 34035857. PMCID: PMC8135117. DOI: 10.3892/etm.2021.10192.
Mattersberger C, Schm?lzer GM, Urlesberger B, et al. Blood glucose and lactate levels and cerebral oxygenation in preterm and term neonates—a systematic qualitative review of the literature[J]. Front Pediatr, 2020, 8: 361. PMID: 32903733. PMCID: PMC7438789. DOI: 10.3389/fped.2020.00361.
Jensen EC, Bennet L, Hunter CJ, et al. Post-hypoxic hypoperfusion is associated with suppression of cerebral metabolism and increased tissue oxygenation in near-term fetal sheep[J]. J Physiol, 2006, 572(Pt 1): 131-139. PMID: 16484307. PMCID: PMC1779646. DOI: 10.1113/jphysiol.2005.100768.
Levmore-Tamir M, Weiser G, Berliner E, et al. Stress hyperglycemia in a pediatric emergency department setting and its relationship to the underlying disease and outcome[J]. Isr Med Assoc J, 2020, 22(7): 431-434. PMID: 33236568.
Pinchefsky EF, Hahn CD, Kamino D, et al. Hyperglycemia and glucose variability are associated with worse brain function and seizures in neonatal encephalopathy: a prospective cohort study[J]. J Pediatr, 2019, 209: 23-32. PMID: 30982528. DOI: 10.1016/j.jpeds.2019.02.027.
Lear CA, Davidson JO, Mackay GR, et al. Antenatal dexamethasone before asphyxia promotes cystic neural injury in preterm fetal sheep by inducing hyperglycemia[J]. J Cereb Blood Flow Metab, 2018, 38(4): 706-718. PMID: 28387144. PMCID: PMC5888852. DOI: 10.1177/0271678X17703124.