Hypoglycaemia and hyperglycaemia are associated with unfavourable outcome in infants with hypoxic ischaemic encephalopathy: A post hoc analysis of the CoolCap Study

Sudeepta K. Basu, Jeffrey R. Kaiser, Danielle Guffey, Charles G. Minard, Ronnie Guillet, Alistair J. Gunn

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Objective To investigate the association of neonatal hypoglycaemia and hyperglycaemia with outcomes in infants with hypoxic ischaemic encephalopathy (HIE). Design Post hoc analysis of the CoolCap Study. Setting 25 perinatal centres in the UK, the USA and New Zealand during 1999-2002. Patients 234 infants at =36 weeks' gestation with moderate-to-severe HIE enrolled in the CoolCap Study. 214 (91%) infants had documented plasma glucose and follow-up outcome data. Intervention Infants were randomised to head cooling for 72 h starting within 6 h of birth, or standard care. Plasma glucose levels were measured at predetermined time intervals after randomisation. Main outcome measure The unfavourable primary outcome of the study was death and/or severe neurodevelopmental disability at 18 months. Hypoglycaemia (≤40 mg/dL, ≤2.2 mmol/L) and hyperglycaemia (>150 mg/dL, >8.3 mmol/L) during the first 12 h after randomisation were investigated for univariable and multivariable associations with unfavourable primary outcome. Results 121 (57%) infants had abnormal plasma glucose values within 12 h of randomisation. Unfavourable outcome was observed in 126 (60%) infants and was more common among subjects with hypoglycaemia (81%, p=0.004), hyperglycaemia (67%, p=0.01) and any glucose derangement within the first 12 h (67%, p=0.002) compared with normoglycaemic infants (48%) in univariable analysis. These associations remained significant after adjusting for birth weight, Apgar score, pH, Sarnat stage and hypothermia therapy. Conclusions Both hypoglycaemia and hyperglycaemia in infants with moderate-to-severe HIE were independently associated with unfavourable outcome. Future studies are needed to investigate the prognostic significance of these associations and their role as biomarkers of brain injury.

Original languageEnglish (US)
Pages (from-to)F149-F155
JournalArchives of Disease in Childhood: Fetal and Neonatal Edition
Volume101
Issue number2
DOIs
StatePublished - Mar 2016

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Brain Hypoxia-Ischemia
Hypoglycemia
Hyperglycemia
Random Allocation
Glucose
Outcome Assessment (Health Care)
Apgar Score
Hypothermia
New Zealand
Birth Weight
Brain Injuries
Biomarkers
Head
Parturition
Pregnancy

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

@article{123641689662436c8bc9f28962fcb78d,
title = "Hypoglycaemia and hyperglycaemia are associated with unfavourable outcome in infants with hypoxic ischaemic encephalopathy: A post hoc analysis of the CoolCap Study",
abstract = "Objective To investigate the association of neonatal hypoglycaemia and hyperglycaemia with outcomes in infants with hypoxic ischaemic encephalopathy (HIE). Design Post hoc analysis of the CoolCap Study. Setting 25 perinatal centres in the UK, the USA and New Zealand during 1999-2002. Patients 234 infants at =36 weeks' gestation with moderate-to-severe HIE enrolled in the CoolCap Study. 214 (91{\%}) infants had documented plasma glucose and follow-up outcome data. Intervention Infants were randomised to head cooling for 72 h starting within 6 h of birth, or standard care. Plasma glucose levels were measured at predetermined time intervals after randomisation. Main outcome measure The unfavourable primary outcome of the study was death and/or severe neurodevelopmental disability at 18 months. Hypoglycaemia (≤40 mg/dL, ≤2.2 mmol/L) and hyperglycaemia (>150 mg/dL, >8.3 mmol/L) during the first 12 h after randomisation were investigated for univariable and multivariable associations with unfavourable primary outcome. Results 121 (57{\%}) infants had abnormal plasma glucose values within 12 h of randomisation. Unfavourable outcome was observed in 126 (60{\%}) infants and was more common among subjects with hypoglycaemia (81{\%}, p=0.004), hyperglycaemia (67{\%}, p=0.01) and any glucose derangement within the first 12 h (67{\%}, p=0.002) compared with normoglycaemic infants (48{\%}) in univariable analysis. These associations remained significant after adjusting for birth weight, Apgar score, pH, Sarnat stage and hypothermia therapy. Conclusions Both hypoglycaemia and hyperglycaemia in infants with moderate-to-severe HIE were independently associated with unfavourable outcome. Future studies are needed to investigate the prognostic significance of these associations and their role as biomarkers of brain injury.",
author = "Basu, {Sudeepta K.} and Kaiser, {Jeffrey R.} and Danielle Guffey and Minard, {Charles G.} and Ronnie Guillet and Gunn, {Alistair J.}",
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Hypoglycaemia and hyperglycaemia are associated with unfavourable outcome in infants with hypoxic ischaemic encephalopathy : A post hoc analysis of the CoolCap Study. / Basu, Sudeepta K.; Kaiser, Jeffrey R.; Guffey, Danielle; Minard, Charles G.; Guillet, Ronnie; Gunn, Alistair J.

In: Archives of Disease in Childhood: Fetal and Neonatal Edition, Vol. 101, No. 2, 03.2016, p. F149-F155.

Research output: Contribution to journalArticle

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T1 - Hypoglycaemia and hyperglycaemia are associated with unfavourable outcome in infants with hypoxic ischaemic encephalopathy

T2 - A post hoc analysis of the CoolCap Study

AU - Basu, Sudeepta K.

AU - Kaiser, Jeffrey R.

AU - Guffey, Danielle

AU - Minard, Charles G.

AU - Guillet, Ronnie

AU - Gunn, Alistair J.

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N2 - Objective To investigate the association of neonatal hypoglycaemia and hyperglycaemia with outcomes in infants with hypoxic ischaemic encephalopathy (HIE). Design Post hoc analysis of the CoolCap Study. Setting 25 perinatal centres in the UK, the USA and New Zealand during 1999-2002. Patients 234 infants at =36 weeks' gestation with moderate-to-severe HIE enrolled in the CoolCap Study. 214 (91%) infants had documented plasma glucose and follow-up outcome data. Intervention Infants were randomised to head cooling for 72 h starting within 6 h of birth, or standard care. Plasma glucose levels were measured at predetermined time intervals after randomisation. Main outcome measure The unfavourable primary outcome of the study was death and/or severe neurodevelopmental disability at 18 months. Hypoglycaemia (≤40 mg/dL, ≤2.2 mmol/L) and hyperglycaemia (>150 mg/dL, >8.3 mmol/L) during the first 12 h after randomisation were investigated for univariable and multivariable associations with unfavourable primary outcome. Results 121 (57%) infants had abnormal plasma glucose values within 12 h of randomisation. Unfavourable outcome was observed in 126 (60%) infants and was more common among subjects with hypoglycaemia (81%, p=0.004), hyperglycaemia (67%, p=0.01) and any glucose derangement within the first 12 h (67%, p=0.002) compared with normoglycaemic infants (48%) in univariable analysis. These associations remained significant after adjusting for birth weight, Apgar score, pH, Sarnat stage and hypothermia therapy. Conclusions Both hypoglycaemia and hyperglycaemia in infants with moderate-to-severe HIE were independently associated with unfavourable outcome. Future studies are needed to investigate the prognostic significance of these associations and their role as biomarkers of brain injury.

AB - Objective To investigate the association of neonatal hypoglycaemia and hyperglycaemia with outcomes in infants with hypoxic ischaemic encephalopathy (HIE). Design Post hoc analysis of the CoolCap Study. Setting 25 perinatal centres in the UK, the USA and New Zealand during 1999-2002. Patients 234 infants at =36 weeks' gestation with moderate-to-severe HIE enrolled in the CoolCap Study. 214 (91%) infants had documented plasma glucose and follow-up outcome data. Intervention Infants were randomised to head cooling for 72 h starting within 6 h of birth, or standard care. Plasma glucose levels were measured at predetermined time intervals after randomisation. Main outcome measure The unfavourable primary outcome of the study was death and/or severe neurodevelopmental disability at 18 months. Hypoglycaemia (≤40 mg/dL, ≤2.2 mmol/L) and hyperglycaemia (>150 mg/dL, >8.3 mmol/L) during the first 12 h after randomisation were investigated for univariable and multivariable associations with unfavourable primary outcome. Results 121 (57%) infants had abnormal plasma glucose values within 12 h of randomisation. Unfavourable outcome was observed in 126 (60%) infants and was more common among subjects with hypoglycaemia (81%, p=0.004), hyperglycaemia (67%, p=0.01) and any glucose derangement within the first 12 h (67%, p=0.002) compared with normoglycaemic infants (48%) in univariable analysis. These associations remained significant after adjusting for birth weight, Apgar score, pH, Sarnat stage and hypothermia therapy. Conclusions Both hypoglycaemia and hyperglycaemia in infants with moderate-to-severe HIE were independently associated with unfavourable outcome. Future studies are needed to investigate the prognostic significance of these associations and their role as biomarkers of brain injury.

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U2 - 10.1136/archdischild-2015-308733

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