Hyperglycaemia in infants with hypoxic-ischaemic encephalopathy is associated with improved outcomes after therapeutic hypothermia: a post hoc analysis of the CoolCap Study.
Arch Dis Child Fetal Neonatal Ed
; 102(4): F299-F306, 2017 Jul.
Article
em En
| MEDLINE
| ID: mdl-27799322
ABSTRACT
OBJECTIVE:
To investigate whether glycaemic profile is associated with multiorgan dysfunction and with response to hypothermia after perinatal hypoxic-ischaemic encephalopathy (HIE).DESIGN:
Post hoc analysis of the CoolCap Study.SETTING:
25 perinatal centres in UK, USA and New Zealand during 1999-2002. PATIENTS 194/234 (83%) infants of ≥36â weeks' gestation with moderate-to-severe HIE enrolled in the CoolCap Study with documented plasma glucose levels and follow-up outcome. INTERVENTION Infants were randomised to head cooling for 72â hours starting within 6â hours of birth or standard care. Plasma glucose levels were measured at predetermined time intervals after randomisation. MAIN OUTCOMEMEASURE:
Unfavourable primary outcome was defined as death and/or severe neurodevelopmental disability at 18â months. Glycaemic profile (hypoglycaemia (≤40â mg/dL, ≤2.2â mmol/L), hyperglycaemia (>150â mg/dL, >8.3â mmol/L) and normoglycaemia) during 12â hours after randomisation was investigated for association with multiorgan dysfunction or risk reduction of primary outcome after hypothermia treatment.RESULTS:
Hypoglycaemia but not hyperglycaemia was associated with more deranged multiorgan function parameters (mean pH 7.23 (SD 0.16) vs 7.36 (0.13), p<0.001; aspartate transaminase 2101 (2450) vs 318 (516) IU/L, p=0.002; creatinine 1.95 (0.59) vs 1.26 (0.5) mg/dL, p<0.001) compared with normoglycaemia. After adjusting for Sarnat stage and 5 min Apgar score, only hyperglycaemic infants randomised to hypothermia had reduced risk of unfavourable outcome (adjusted risk ratio 0.80, 95% CI 0.66 to 0.99), whereas hypoglycaemic and normoglycaemic infants did not.CONCLUSIONS:
Early glycaemic profile in infants with moderate-to-severe HIE may help to identify risk of multiorgan dysfunction and response to therapeutic hypothermia. TRIAL REGISTRATION NUMBER NCT00383305.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Contexto em Saúde:
2_ODS3
/
6_ODS3_enfermedades_notrasmisibles
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7_ODS3_muertes_prevenibles_nacidos_ninos
Problema de saúde:
2_muertes_prevenibles
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6_cardiovascular_diseases
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6_cerebrovascular_disease
/
6_endocrine_disorders
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6_mental_health_behavioral_disorders
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7_neonatal_care_health
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7_non_communicable_diseases
Assunto principal:
Recém-Nascido Prematuro
/
Hipóxia-Isquemia Encefálica
/
Transtornos do Neurodesenvolvimento
/
Hiperglicemia
/
Hipotermia Induzida
Tipo de estudo:
Clinical_trials
/
Etiology_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Female
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Humans
/
Male
/
Newborn
País/Região como assunto:
America do norte
/
Europa
/
Oceania
Idioma:
En
Revista:
Arch Dis Child Fetal Neonatal Ed
Assunto da revista:
PEDIATRIA
/
PERINATOLOGIA
Ano de publicação:
2017
Tipo de documento:
Article
País de afiliação:
Estados Unidos