Dysglycemia during neonatal encephalopathy and early school-age neurodevelopmental outcomes.

Aim

To assess the relationship between neonatal dysglycemia and early school-age neurodevelopmental outcomes after neonatal encephalopathy.

Method

A prospective cohort born at 36 weeks or more of gestation with neonatal encephalopathy underwent continuous glucose monitoring, neonatal magnetic resonance imaging, and neurodevelopmental assessments at 5 years 6 months (5 months). Linear regression analyses assessed the relationship between glucose (minimum, maximum thresholds of 8-13 mmol/l, and SD) and neurodevelopmental outcomes (Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition and Child Behavior Checklist composite scores), adjusting for sex, neonatal brain injury severity, and parental education.

Results

Of 61 newborn infants (40 males), three had mild, 55 had moderate, and three had severe encephalopathy. Maximum glucose greater than 13 mmol/L was associated with a 17.4-point lower full-scale IQ (p = 0.043), 17.4 lower Fluid Reasoning Index (p = 0.037), and 13.5 lower Processing Speed Index (p = 0.032). Higher SD of glucose was associated with a 5.0-point lower Fluid Reasoning Index (p = 0.038). Significance was lost after adjusting for neonatal brain injury and/or paternal education. No associations were found between minimum glucose and 5- to 6-year outcomes (p > 0.456).

Interpretation

In the era of therapeutic hypothermia, hyperglycemia and increased glucose variability during the first few days of life are associated with worse neurodevelopmental outcomes at early school-age in survivors of neonatal encephalopathy. These associations could be explained by neonatal brain injury and/or paternal education.