1. Long –Term Developmental Outcomes in Preterm Neonates Exposed to Hyperglycemia Camila Goldner Pérez, Judy Saslow MD, Vilmaris Quiñones Cardona MD, Elizabeth Saslow, PhD, Alla Kushnir, MD
Department of Pediatrics, Division of Neonatology, Cooper University Hospital, Camden, NJ;
Ponce Health Sciences University, Ponce, PR; St. Christopher’s Children’s Hospital, Philadelphia, PA
Background
Demographics and Clinical Characteristics
Hyperglycemia and Effect on Bayley III
Results
Hyperglycemia is a common complication in preterm, very low birth weight infants. This may be due to rapid glucose infusion, relative insulin resistance, insulin deficiency, or a defect in processing of pro-insulin to insulin in the pancreas.
There is evidence indicating that hyperglycemia has an effect on short-term outcomes, namely an increased risk for retinopathy of prematurity, respiratory distress syndrome, and intraventricular hemorrhage. However, long-term neurodevelopmental outcomes of hyperglycemia have not been studied.
To evaluate whether exposure to hyperglycemia in the first week and month of life increases the risk of developing long-term neurodevelopmental sequela at months.
IRB approved retrospective study of preterm infants born between 01/08 and 12/31/12.
Neonates with birth weight ≤1500 grams, ≤ 32 weeks gestation who were admitted to the Neonatal Intensive Care Unit (NICU) , and underwent Bayley evaluation, were selected.
Hyperglycemia was categorized as mild ( mg/dL), moderate ( mg/dL), or severe (>210 mg/dL).
Degree and duration of hyperglycemia recorded for the first week and month of life.
Insulin exposure, duration, and maximum dose were documented.
Neurodevelopmental assessment performed at months corrected gestational age, using the Bayley III Scales of Infant Development.
Total of 232 neonates were evaluated for hyperglycemia; 68 (29%) received developmental evaluation at months.
Moderate hyperglycemia in the first week (p=0.002) and month (p=0.026) of life was associated with motor deficits
Moderate hyperglycemia in the first week was also associated with language delays.
Language component of Bayley Scale correlated with gestational age (p=0.01).
Composite Bayley score was significantly lower (1SD) in infants with hyperglycemia greater than 180 mg/dL in the first week of life (p=0.02), but not in the first month.
No significant changes in development with mild or severe hyperglycemia in the first week or month of life.
Hemachandra A, Cowett R. Neonatal Hyperglycemia. Pediatrics in Review July;20(7):16-24.
Van der Lugt N, Smits-Wintjens V, van Zwieten PH, Walther F. Short and long term outcome of neonatal hyperglycemia in very preterm infants. BMC Pediatrics July;10:52.
Hays SP, Smith EO, Sunehag AL; Hyperglycemia is a risk factor for early death and morbidity in extremely low birth-weight infants. Pdediatrics. 2006;118(5):
Sabzehei MK, et al. Hyperglycemia in VLBW infants; incidence, risk factors and outcome. Arch Iran Med June; 17(6): .
Characteristics
Euglycemic group (n=24)
Hyperglycemic group
(n=44) p
Gender: male (%)
11 (46)
26 (59)
0.29
Birth weight, (grams)
1188 ± 226
877 ± 215
<0.001*
Gestational age, (weeks)
29.7 ± 1.7
26.8 ± 2.2
Rate of ROP
17 (18)
80 (58)
0.007*
Insulin Used, week 1
9 (21)
0.016*
Insulin Used, month 1
BPD
3 (12.5)
14 (31.8)
0.079
NEC
7 (15.9)
0.039*
IVH
6 (25)
13 (30)
0.69
PDA
1 (4)
18 (41)
0.001*
Death
0 (0)
N/A
Data are presented as n(%), except for gestational age and birth weight which are presented as mean ± standard deviation.
* p<0.05
Hyperglycemia and Composite Bayley Scores *
Objective *
Conclusions
Methods
Levels of Hyperglycemia and Effect on Bayley III Components
There is minimal effect of hyperglycemia on neurodevelopment of preterm infants. Moderate hyperglycemia in the first week of life is associated with motor and language deficits, even after adjusting for gestational age and birth weight of the infant.
Level of hyperglycemia
Composite Bayley Score
Motor Score
Language Score
Cognitive Score
Week 1
Mild -
p=0.761
Moderate
p=0.002*
Severe
p=0.318
Moderate/ Severe
p=0.019*
p=0.329
p=0.092
p=0.504
Month 1
p=0.02*
p=0.644
p=0.454
p=0.755
p=0.957
p=0.176
Results are corrected for gestational age
* p <0.05
References *
* p <0.05