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Hyperglycaemia in infants with hypoxic–ischaemic encephalopathy is associated with improved outcomes after therapeutic hypothermia: a post hoc analysis of the CoolCap Study

Research output: Contribution to journalArticle

  • Sudeepta K Basu
  • Jason L Salemi
  • Alistair J Gunn
  • Jeffrey R Kaiser
  • CoolCap Study Group
Original languageEnglish
Pages (from-to)F299-F306
Number of pages8
JournalArchives of Disease in Childhood: Fetal and Neonatal Edition
Volume102
Issue number4
Early online date31 Oct 2016
DOIs
DateAccepted/In press - 7 Oct 2016
DateE-pub ahead of print - 31 Oct 2016
DatePublished (current) - Jul 2017

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 ≥36 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 72 hours starting within 6 hours of birth or standard care. Plasma glucose levels were measured at predetermined time intervals after randomisation.

MAIN OUTCOME MEASURE: Unfavourable primary outcome was defined as death and/or severe neurodevelopmental disability at 18 months. Glycaemic profile (hypoglycaemia (≤40 mg/dL, ≤2.2 mmol/L), hyperglycaemia (>150 mg/dL, >8.3 mmol/L) and normoglycaemia) during 12 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.

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    Rights statement: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via BMJ Publishing Group at doi:10.1136/archdischild-2016-311385. Please refer to any applicable terms of use of the publisher.

    Accepted author manuscript, 412 KB, PDF-document

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