Glycemia and Neonatal Encephalopathy: Outcomes in the LyTONEPAL (Long-Term Outcome of Neonatal Hypoxic EncePhALopathy in the Era of Neuroprotective Treatment With Hypothermia) Cohort

Isabelle Guellec; Pierre-Yves Ancel; Jonathan Beck; Gauthier Loron; Marie Chevallier; Véronique Pierrat; Gilles Kayem; Antoine Vilotitch; Olivier Baud; Anne Ego; Thierry Debillon

doi:10.1016/j.jpeds.2023.02.003

Glycemia and Neonatal Encephalopathy: Outcomes in the LyTONEPAL (Long-Term Outcome of Neonatal Hypoxic EncePhALopathy in the Era of Neuroprotective Treatment With Hypothermia) Cohort

J Pediatr. 2023 Jun:257:113350. doi: 10.1016/j.jpeds.2023.02.003. Epub 2023 Feb 23.

Authors

Affiliations

¹ Neonatal Intensive Care Medicine Department, University Hospital Nice Cote d'Azur, Nice, France; Universite de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPE, INSERM, INRAE, Paris, France. Electronic address: [email protected].
² Universite de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPE, INSERM, INRAE, Paris, France.
³ Universite de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPE, INSERM, INRAE, Paris, France; Department of Neonatology, Alix de Champagne-Reims University Hospital, France.
⁴ Department of Neonatology, Alix de Champagne-Reims University Hospital, France.
⁵ Neonatal Intensive Care Medicine Department, CNRS, Neonatal Intensive Care Unit, CHU Grenoble Alpes, Grenoble INP∗, TIMC-IMAG, Univ. Grenoble Alpes, Grenoble, France ∗ Institute of Engineering Univ. Grenoble Alpes, Grenoble, France.
⁶ Universite de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPE, INSERM, INRAE, Paris, France; Department of Neonatal Medicine, CHU Lille, Jeanne de Flandre Hospital, Lille, France.
⁷ Universite de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPE, INSERM, INRAE, Paris, France; Department of Obstetrics and Gynecology, Trousseau Hospital, AP-HP, Paris, France.
⁸ Data Engineering Unit, Public Health Department, CHU Grenoble Alpes, Grenoble, France.
⁹ Division of Neonatology and Pediatric Intensive Care, Children's University Hospital of Geneva, Geneva, Switzerland; Faculté de Médecine, Inserm UMR 1141 NeuroDiderot, Université de Paris, France.
¹⁰ Universite de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPE, INSERM, INRAE, Paris, France; Neonatal Intensive Care Medicine Department, CNRS, Neonatal Intensive Care Unit, CHU Grenoble Alpes, Grenoble INP∗, TIMC-IMAG, Univ. Grenoble Alpes, Grenoble, France ∗ Institute of Engineering Univ. Grenoble Alpes, Grenoble, France; Inserm CIC U1406, Grenoble, France.

PMID: 36828343
DOI: 10.1016/j.jpeds.2023.02.003

Abstract

Objectives: To assess in newborns with neonatal encephalopathy (NE), presumptively related to a peripartum hypoxic-ischemic event, the frequency of dysglycemia and its association with neonatal adverse outcomes.

Study design: We conducted a secondary analysis of LyTONEPAL (Long-Term Outcome of Neonatal hypoxic EncePhALopathy in the era of neuroprotective treatment with hypothermia), a population-based cohort study including 545 patients with moderate-to-severe NE. Newborns were categorized by the glycemia values assessed by routine clinical care during the first 3 days of life: normoglycemic (all glycemia measurements ranged from 2.2 to 8.3 mmol/L), hyperglycemic (at least 1 measurement >8.3 mmol/L), hypoglycemic (at least 1 measurement <2.2 mmol/L), or with glycemic lability (measurements included at least 1 episode of hypoglycemia and 1 episode of hyperglycemia). The primary adverse outcome was a composite outcome defined by death and/or brain lesions on magnetic resonance imaging, regardless of severity or location.

Results: In total, 199 newborns were categorized as normoglycemic (36.5%), 74 hypoglycemic (13.6%), 213 hyperglycemic (39.1%), and 59 (10.8%) with glycemic lability, based on the 2593 glycemia measurements collected. The primary adverse outcome was observed in 77 (45.8%) normoglycemic newborns, 37 (59.7%) with hypoglycemia, 137 (67.5%) with hyperglycemia, and 40 (70.2%) with glycemic lability (P < .01). With the normoglycemic group as the reference, the aORs and 95% 95% CIs for the adverse outcome were significantly greater for the group with hyperglycemia (aOR 1.81; 95% CI 1.06-3.11).

Conclusions: Dysglycemia affects nearly two-thirds of newborns with NE and is independently associated with a greater risk of mortality and/or brain lesions on magnetic resonance imaging.

Trial registration: NCT02676063.

Keywords: brain lesions; dysglycemia; hypoxic-ischemic perinatal event; magnetic resonance imaging; neonatal encephalopathy; neonatal mortality; secondary cerebral insult.

Publication types

Clinical Trial
Research Support, Non-U.S. Gov't

MeSH terms

Cohort Studies
Humans
Hyperglycemia*
Hypoglycemia* / therapy
Hypoglycemic Agents
Hypothermia*
Hypothermia, Induced* / methods
Hypoxia-Ischemia, Brain* / therapy
Infant, Newborn
Infant, Newborn, Diseases* / therapy

Substances

Hypoglycemic Agents

Associated data

ClinicalTrials.gov/NCT02676063