Early Glycemic Profile Is Associated with Brain Injury Patterns on Magnetic Resonance Imaging in Hypoxic Ischemic Encephalopathy

Sudeepta K. Basu, Katherine Ottolini, Vedavalli Govindan, Suleiman Mashat, Gilbert Vezina, Yunfei Wang, Michaelande Ridore, Taeun Chang, Jeffrey R. Kaiser, An N. Massaro

Research output: Contribution to journalArticle

Abstract

Objective: To investigate whether the early glycemic profile in infants with hypoxic ischemic encephalopathy is associated with distinct patterns of brain injury on magnetic resonance imaging (MRI). Study design: We performed a secondary analysis of 178 prospectively enrolled infants who received therapeutic hypothermia for hypoxic ischemic encephalopathy. Glycemic profiles were identified by glucose concentrations within 24 hours after birth: normoglycemia (all glucose concentrations of >47 to ≤150 mg/dL; n = 62); hypoglycemia (≥1 concentration ≤47 mg/dL; n = 17); hyperglycemia (≥1 concentration >150 mg/dL; n = 76); and labile glucose (both hypoglycemia and hyperglycemia; n = 23). Patterns of brain injury were identified for 151 infants based on Barkovich scores from the postrewarming brain MRIs at a median age of 9 days. Results: A normal brain MRI was reported in 37 of 62 infants (60%) with normal blood glucose values compared with 37 of 116 infants (32%) with an abnormal glucose profile (adjusted for Sarnat stage of encephalopathy and Apgar score at 5 minutes; P =.02). The distribution of MRI patterns of brain injury differed among the glycemic groups (P =.03). The odds of predominant watershed or focal-multifocal injury was higher in infants with hypoglycemia (aOR, 6; 95% CI, 1.5-24.2) and labile glucose (6.6; 95% CI, 1.6-27) compared with infants with normoglycemia. Infants with labile glucose had higher odds (5.6; 95% CI, 1.1-29.3) of predominant basal ganglia or global injury compared with infants with normal blood glucose values. Conclusions: The early glycemic profile in infants with hypoxic ischemic encephalopathy is associated with specific patterns of brain injury on MRI. Further investigation is needed to explore its prognostic significance and role as a phenotype biomarker.

Original languageEnglish (US)
Pages (from-to)137-143
Number of pages7
JournalJournal of Pediatrics
Volume203
DOIs
StatePublished - Dec 2018

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Brain Hypoxia-Ischemia
Brain Injuries
Magnetic Resonance Imaging
Glucose
Hypoglycemia
Hyperglycemia
Blood Glucose
Induced Hypothermia
Apgar Score
Wounds and Injuries
Brain
Brain Diseases
Basal Ganglia
Biomarkers
Parturition
Phenotype

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health

Cite this

Basu, Sudeepta K. ; Ottolini, Katherine ; Govindan, Vedavalli ; Mashat, Suleiman ; Vezina, Gilbert ; Wang, Yunfei ; Ridore, Michaelande ; Chang, Taeun ; Kaiser, Jeffrey R. ; Massaro, An N. / Early Glycemic Profile Is Associated with Brain Injury Patterns on Magnetic Resonance Imaging in Hypoxic Ischemic Encephalopathy. In: Journal of Pediatrics. 2018 ; Vol. 203. pp. 137-143.
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abstract = "Objective: To investigate whether the early glycemic profile in infants with hypoxic ischemic encephalopathy is associated with distinct patterns of brain injury on magnetic resonance imaging (MRI). Study design: We performed a secondary analysis of 178 prospectively enrolled infants who received therapeutic hypothermia for hypoxic ischemic encephalopathy. Glycemic profiles were identified by glucose concentrations within 24 hours after birth: normoglycemia (all glucose concentrations of >47 to ≤150 mg/dL; n = 62); hypoglycemia (≥1 concentration ≤47 mg/dL; n = 17); hyperglycemia (≥1 concentration >150 mg/dL; n = 76); and labile glucose (both hypoglycemia and hyperglycemia; n = 23). Patterns of brain injury were identified for 151 infants based on Barkovich scores from the postrewarming brain MRIs at a median age of 9 days. Results: A normal brain MRI was reported in 37 of 62 infants (60{\%}) with normal blood glucose values compared with 37 of 116 infants (32{\%}) with an abnormal glucose profile (adjusted for Sarnat stage of encephalopathy and Apgar score at 5 minutes; P =.02). The distribution of MRI patterns of brain injury differed among the glycemic groups (P =.03). The odds of predominant watershed or focal-multifocal injury was higher in infants with hypoglycemia (aOR, 6; 95{\%} CI, 1.5-24.2) and labile glucose (6.6; 95{\%} CI, 1.6-27) compared with infants with normoglycemia. Infants with labile glucose had higher odds (5.6; 95{\%} CI, 1.1-29.3) of predominant basal ganglia or global injury compared with infants with normal blood glucose values. Conclusions: The early glycemic profile in infants with hypoxic ischemic encephalopathy is associated with specific patterns of brain injury on MRI. Further investigation is needed to explore its prognostic significance and role as a phenotype biomarker.",
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Basu, SK, Ottolini, K, Govindan, V, Mashat, S, Vezina, G, Wang, Y, Ridore, M, Chang, T, Kaiser, JR & Massaro, AN 2018, 'Early Glycemic Profile Is Associated with Brain Injury Patterns on Magnetic Resonance Imaging in Hypoxic Ischemic Encephalopathy', Journal of Pediatrics, vol. 203, pp. 137-143. https://doi.org/10.1016/j.jpeds.2018.07.041

Early Glycemic Profile Is Associated with Brain Injury Patterns on Magnetic Resonance Imaging in Hypoxic Ischemic Encephalopathy. / Basu, Sudeepta K.; Ottolini, Katherine; Govindan, Vedavalli; Mashat, Suleiman; Vezina, Gilbert; Wang, Yunfei; Ridore, Michaelande; Chang, Taeun; Kaiser, Jeffrey R.; Massaro, An N.

In: Journal of Pediatrics, Vol. 203, 12.2018, p. 137-143.

Research output: Contribution to journalArticle

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T1 - Early Glycemic Profile Is Associated with Brain Injury Patterns on Magnetic Resonance Imaging in Hypoxic Ischemic Encephalopathy

AU - Basu, Sudeepta K.

AU - Ottolini, Katherine

AU - Govindan, Vedavalli

AU - Mashat, Suleiman

AU - Vezina, Gilbert

AU - Wang, Yunfei

AU - Ridore, Michaelande

AU - Chang, Taeun

AU - Kaiser, Jeffrey R.

AU - Massaro, An N.

PY - 2018/12

Y1 - 2018/12

N2 - Objective: To investigate whether the early glycemic profile in infants with hypoxic ischemic encephalopathy is associated with distinct patterns of brain injury on magnetic resonance imaging (MRI). Study design: We performed a secondary analysis of 178 prospectively enrolled infants who received therapeutic hypothermia for hypoxic ischemic encephalopathy. Glycemic profiles were identified by glucose concentrations within 24 hours after birth: normoglycemia (all glucose concentrations of >47 to ≤150 mg/dL; n = 62); hypoglycemia (≥1 concentration ≤47 mg/dL; n = 17); hyperglycemia (≥1 concentration >150 mg/dL; n = 76); and labile glucose (both hypoglycemia and hyperglycemia; n = 23). Patterns of brain injury were identified for 151 infants based on Barkovich scores from the postrewarming brain MRIs at a median age of 9 days. Results: A normal brain MRI was reported in 37 of 62 infants (60%) with normal blood glucose values compared with 37 of 116 infants (32%) with an abnormal glucose profile (adjusted for Sarnat stage of encephalopathy and Apgar score at 5 minutes; P =.02). The distribution of MRI patterns of brain injury differed among the glycemic groups (P =.03). The odds of predominant watershed or focal-multifocal injury was higher in infants with hypoglycemia (aOR, 6; 95% CI, 1.5-24.2) and labile glucose (6.6; 95% CI, 1.6-27) compared with infants with normoglycemia. Infants with labile glucose had higher odds (5.6; 95% CI, 1.1-29.3) of predominant basal ganglia or global injury compared with infants with normal blood glucose values. Conclusions: The early glycemic profile in infants with hypoxic ischemic encephalopathy is associated with specific patterns of brain injury on MRI. Further investigation is needed to explore its prognostic significance and role as a phenotype biomarker.

AB - Objective: To investigate whether the early glycemic profile in infants with hypoxic ischemic encephalopathy is associated with distinct patterns of brain injury on magnetic resonance imaging (MRI). Study design: We performed a secondary analysis of 178 prospectively enrolled infants who received therapeutic hypothermia for hypoxic ischemic encephalopathy. Glycemic profiles were identified by glucose concentrations within 24 hours after birth: normoglycemia (all glucose concentrations of >47 to ≤150 mg/dL; n = 62); hypoglycemia (≥1 concentration ≤47 mg/dL; n = 17); hyperglycemia (≥1 concentration >150 mg/dL; n = 76); and labile glucose (both hypoglycemia and hyperglycemia; n = 23). Patterns of brain injury were identified for 151 infants based on Barkovich scores from the postrewarming brain MRIs at a median age of 9 days. Results: A normal brain MRI was reported in 37 of 62 infants (60%) with normal blood glucose values compared with 37 of 116 infants (32%) with an abnormal glucose profile (adjusted for Sarnat stage of encephalopathy and Apgar score at 5 minutes; P =.02). The distribution of MRI patterns of brain injury differed among the glycemic groups (P =.03). The odds of predominant watershed or focal-multifocal injury was higher in infants with hypoglycemia (aOR, 6; 95% CI, 1.5-24.2) and labile glucose (6.6; 95% CI, 1.6-27) compared with infants with normoglycemia. Infants with labile glucose had higher odds (5.6; 95% CI, 1.1-29.3) of predominant basal ganglia or global injury compared with infants with normal blood glucose values. Conclusions: The early glycemic profile in infants with hypoxic ischemic encephalopathy is associated with specific patterns of brain injury on MRI. Further investigation is needed to explore its prognostic significance and role as a phenotype biomarker.

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