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Insert Program or Hospital Logo Texas Pediatric Society Electronic Poster Contest Hypoglycemia and Hyperglycemia are Associated with Poor Outcome in Neonatal Hypoxic-Ischemic Encephalopathy Sudeepta K Basu 1, Danielle Guffey, Charles G Minard, Jeffrey R Kaiser and Alistair J Gunn 1 2 nd yr Fellow, Neonatal Perinatal Medicine, Baylor College of Medicine Hypoglycemia and Hyperglycemia are Associated with Poor Outcome in Neonatal Hypoxic-Ischemic Encephalopathy Sudeepta K Basu 1, Danielle Guffey, Charles G Minard, Jeffrey R Kaiser and Alistair J Gunn 1 2 nd yr Fellow, Neonatal Perinatal Medicine, Baylor College of Medicine Introduction Hypoxic-ischemic encephalopathy (HIE) is an important cause of mortality and poor neurodevelopmental outcomes in neonates 1,2 Neonatal hypoglycemia is associated with poor outcomes 2,3,4 Derangement of glucose homeostasis is common in infants with HIE, but the mechanisms are not clearly understood 3 Whether early glucose derangement in infants with HIE affects outcomes is not conclusive 2,3,4 The CoolCap Study was a multi-center randomized controlled trial conducted in 2002-06 involving 234 infants with HIE Selective head cooling in infants with HIE improved outcomes at 18 months 1 Secondary analysis of CoolCap Study data Of the 234 infants randomized in the CoolCap Study, 16 (7%) infants were lost to follow-up and glucose data was unavailable in 4 (2%) of infants Plasma glucose levels noted at 0, 4, 8, 12, 24, 48 and 72 hrs after study randomization in 214 (91%) infants Hypoglycemia (≤40 mg/dL) and hyperglycemia (>150mg/dL) identified as single or recurrent occurrences in first 72 hrs Primary poor outcome - death and/or severe neurodevelopmental disability at 18 months of age Chi-square analysis to test for association of deranged glucose in infants with good vs poor outcome Multivariable logistic regression model used to adjust for birth weight, severity of HIE, randomization to cooling or standard therapy 1) Gluckman et al.: Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial. Lancet 2005; 365: 663–70 2) Salhab et al.: Initial hypoglycemia and neonatal brain injury in term infants with severe fetal acidemia. Pediatrics 2004, 114:361-6. 3) Nadeem et al.: Early blood glucose profile and neurodevelopmental outcome at two years in neonatal hypoxic ischaemic encephalopathy. BMC Pediatrics 2011 11:10. 4) Basu et al.: Contribution of the blood glucose level in perinatal asphyxia. Eur J Pediatr 2009, 168(7):833-8. Deranged glucose homeostasis is common in infants with HIE Hypoglycemia as well as hyperglycemia within 12 hrs after randomization to the CoolCap Study were associated with poor outcome (death and /or neurodevelopmental deficit) Early deranged glucose homeostasis is a poor prognostic factor independent of severity of HIE, birth weight and head cooling therapy Abstract Results Description of Study Total infants (N=214) Good Outcome N=85 (39.5%) Poor Outcome N=130 (60.5%) p- value Birth weight, Mean (SD) 3445 (646)3294 (625)3543 (642)<0.01 Head cooling107 (50%)49 (58%)58 (45%)0.06 HIE Severity (Sarnat 3 vs 2) 74 (35%)15 (18%)59 (46%)<0.01 Gender (Male) 114 (53%)44 (52%)70 (54%)0.76 Delivery (Vag vs C-sec) 66 (31%)21 (25%)45 (35%)0.12 Delivery complications 174 (81%)66 (78%)108 (83%)0.32 Mother’s race (Caucasian) 136 (63%)54 (64%)82 (63%)0.95 Demographics: Conclusions References Glucose homeostasis derangement is frequently noted in infants with HIE but its association with poor outcomes is unclear. We hypothesized that hypoglycemia as well as hyperglycemia in infants with HIE is associated with poor outcomes. We performed secondary analysis of data from 214(91%) infants enrolled in the CoolCap Study. 126 (60 %) infants had a poor outcome and 121 (57%) had deranged glucose homeostasis. Hypoglycemia as well as hyperglycemia within first 12 hrs of randomization was associated with poor outcomes (hypoglycemia [81%, p=.02], recurrent hyperglycemia [77%, p=.02], hypoglycemia and/or hyperglycemia [69%, p=<.01] and recurrent glucose derangement [79%, p<.01]). The association remained significant after adjusting for birth weight, HIE severity and cooling therapy by multivariable logistic regression analysis. We conclude that hypoglycemia as well as hyperglycemia in infants with HIE is associated with poor outcome and may be an important early prognostic factor. Further studies are needed to evaluate if intervention to maintain normoglycemia would improve outcomes in HIE infants. Early Deranged Glucose is Common in HIE infants Hypoglycemia was Associated with Poor Outcome Hyperglycemia was Associated with Poor Outcome Deranged Plasma Glucose is Associated with Poor Outcome (Adjusted for HIE severity, birth weight and cooling therapy) Glucose parameter Poor outcome among infants with deranged glucose Poor outcome among infants with normal glucose Multiple logistic regression OR, (95% CI) Hypoglycemia 81%57%5.8, (1.4-23.9) Hyperglycemia 67%54%2.1, (1.2-3.6) Either hypoglycemia or hyperglycemia 69%48%2.5, (1.4-4.5) Recurrent Hyperglycemia 77%56%3.1, (1.4-7.2) Recurrent hyperglycemia or hypoglycemia 79%51%4, (1.8-8.7) Hypotheses Birth asphyxia affects many organs including the brain and liver. Neonatal brain metabolism is dependent on glucose supply. Our hypotheses are: Deranged glucose homeostasis is frequent in infants with HIE Hypoglycemia as well as hyperglycemia in infants with HIE are associated with poor outcomes independent of the severity of HIE