Glycaemic control in infants undergoing therapeutic hypothermia (TH) for hypoxic ischaemic encephalopathy (HIE) may have a significant impact on long-term outcomes. Limited information is available on the optimal blood glucose levels in such infants. This study aims to explore (1) the glycaemic control in the first 72 h; and (2) the association between glycaemic control and neurodevelopmental outcomes at 2 years of these infants.Method
Medical charts of all infants with HIE treated with therapeutic hypothermia between 2008 and 2010 were reviewed. Clinical details including blood glucose levels (BGL), glucose delivery rate and fluid volume in the first 72 h of life and neurodevelopmental scores (BSID-II: Bayley scale of infant development 2nd edition) were recorded.Results
65 infants had a total of 918 glucose measurements within 72 h of life. Variation in BGLs was greatest in the 1st24 h and improved over time. Hypoglycaemia (BGL < 2.6 mmol/L) was present in 17/65 (26%) with most occurring during the 1st24 h. With increasing episodes of hypoglycaemia there was a trend to lower mean BSID-II scores (P > 0.05). Infants that had strict glycaemic control (BGLs between 4–8 mmol/L) showed a trend towards higher mean BSID-II scores than infants with BGLs outside that range (P > 0.05).Conclusions
Hypoglycaemia was common in our cohort. Hypoglycaemia and hyperglycaemia may have a negative influence on long-term neurodevelopment. Early and aggressive management of both hypo- and hyperglycaemia should be considered.