Early hyperglycemia is associated with poor gross motor outcome in asphyxiated term newborns
| Autor: | Suzanne L. Lababidi, Margaret C. McBride, Erin E. Spies |
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| Rok vydání: | 2013 |
| Předmět: |
Blood Glucose
Male Pediatrics medicine.medical_specialty Gross motor skill Severity of Illness Index Cerebral palsy Cohort Studies Interviews as Topic Developmental Neuroscience medicine Humans Motor skill Asphyxia Asphyxia Neonatorum Movement Disorders business.industry Cerebral Palsy Infant Newborn Gross Motor Function Classification System Odds ratio medicine.disease Prognosis Confidence interval Surgery Logistic Models Neurology Hyperglycemia Pediatrics Perinatology and Child Health Cohort Female Neurology (clinical) medicine.symptom Blood Gas Analysis business |
| Zdroj: | Pediatric neurology. 50(6) |
| ISSN: | 1873-5150 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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