Short and long term outcome of neonatal hyperglycemia in very preterm infants: a retrospective follow-up study.
BACKGROUND
Hyperglycemia in premature infants is associated with increased morbidity and mortality, but data on long-term outcome are limited. We investigated the effects of neonatal hyperglycemia (blood glucose > or = 10 mmol/l, treated with insulin for > or = 12 hours) on growth and neurobehavioral outcome at 2 years of age.


METHODS
Retrospective follow-up study at 2 years of age among 859 infants < or =32 weeks of gestation admitted to a tertiary neonatal center between January 2002 and December 2006. Thirty-three survivors treated with insulin for hyperglycemia and 63 matched controls without hyperglycemia were evaluated at a corrected age of 2 years. Outcome measures consisted of growth (weight, length, and head circumference) and neurological and behavioural development.


RESULTS
66/859 (8%) infants < or = 32 weeks of gestation developed hyperglycemia. Mortality during admission was 27/66 (41%) in the hyperglycemia group versus 62/793 (8%) in those without hyperglycemia (p < 0.001). Mortality was higher in infants with hyperglycemia with a birth weight < or =1,000 gram (p = 0.005) and/or gestational age of 24-28 weeks (p = 0.009) than in control infants without hyperglycemia. Sepsis was more prominent in infants with hyperglycemia and a birth weight of >1,000 gram (p = 0.002) and/or gestational age of 29-32 weeks (p = 0.009) than in control infants without hyperglycemia. Growth at 2 years of age was similar, but neurological and behavioural development was more frequently abnormal among those with neonatal hyperglycemia (p = 0.036 and 0.021 respectively).


CONCLUSIONS
Mortality was higher in very preterm infants with hyperglycemia treated with insulin during the neonatal period. At 2 years of age survivors showed normal growth, but a higher incidence of neurological and behavioural problems. Better strategies to manage hyperglycemia may improve outcome of very preterm infants.
van der Lugt
N Margreth
NM
Department of Pediatrics, Leiden University Medical Center, The Netherlands.
Smits-Wintjens
Vivianne E H J
VE
van Zwieten
Paul H T
PH
Walther
Frans J
FJ
D001724:Birth Weight; D002657:Child Development; D002675:Child, Preschool; D005260:Female; D005865:Gestational Age; D006128:Growth; D006801:Humans; D006943:Hyperglycemia / Q000150:complications*; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases; D008297:Male