Hyperglycemia associated with acute brain injury in neonatal encephalopathy

https://doi.org/10.1016/j.nicl.2021.102835Get rights and content
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Highlights

  • Cohort study of neonatal encephalopathy using continuous glucose monitoring.

  • Higher glucose on day 1 associated with widespread changes in brain microstructure.

  • Lower glucose not associated with brain microstructural changes.

  • No changes in MR spectroscopy found related to higher or lower glucose.

Abstract

Objective

To identify how alterations in glucose levels are associated with regional brain injury in neonatal encephalopathy.

Methods

This was a prospective cohort study of 102 newborns with neonatal encephalopathy, with continuous glucose monitoring for 72 h. 97 (95%) completed 72 h of therapeutic hypothermia. Brain imaging around day 5 of life included diffusion tensor imaging and MR spectroscopy. Regions of interest were placed for both DTI and MR spectroscopy, and tractography of the optic radiation and corticospinal tract were evaluated. Linear regression models related each MR metric with minimum and maximum glucose values during each day of life, adjusting for 5-minute Apgar scores and umbilical artery pH.

Results

Higher maximum glucose levels on the first day of life were associated with widespread changes in mean diffusivity in the anterior and posterior white matter, splenium of the corpus callosum, lentiform nucleus, pulvinar nucleus of the thalamus, posterior limb of the internal capsule, and optic radiations, thus including regions traditionally associated with hypoxia–ischemia or hypoglycemia. No associations were found between lower minimum glucose levels and DTI changes in any regions tested, or between glucose levels and MR spectroscopy.

Conclusions

In this cohort of neonatal encephalopathy with therapeutic hypothermia, higher maximal glucose on the first day of life was associated with widespread microstructural changes, but lower minimum glucose levels were not associated with changes in any of the regions tested. Long-term follow-up will determine if imaging findings translate to long-term outcomes.

Keywords

Hypoglycemia
Hyperglycemia
Neonatal encephalopathy
Diffusion tensor imaging

Abbreviations

CGM
continuous glucose monitoring
DTI
diffusion tensor imaging
FA
fractional anisotropy
MD
mean diffusivity
ROI
region of interest
NAA
N-acetylaspartate
Cho
total choline
FDR
false discovery rate

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