title: Long duration of hyperglycemia in the first 96 hours of life is associated with severe intraventricular hemorrhage in preterm infants.
abstract: OBJECTIVE
  To assess the association between severe intraventricular hemorrhage (IVH) and blood glucose variables during the first 96 hours of life in preterm infants.
  
  
  METHODS
  Preterm infants with IVH grade 3-4 (n = 70) were compared with matched infants of similar gestational age and birth weight, but with no IVH (n = 108). Studied variables included the frequency and duration of hyper/hypoglycemic (>6.9/<3.3 mmol/L, respectively) events, the extreme slope of an event evolution, the maximal glucose value observed, and the "hyper/hypoglycemic index" representing a weighted average of the hyper/hypoglycemic amplitude.
  
  
  RESULTS
  The IVH group had significantly more hyperglycemic events (2.9 ± 1.7 vs 2.4 ± 1.8 events, P < .05) with longer duration (22.2 ± 14.2 vs 14.1 ± 12.5 hours, P < .001) and a higher hyperglycemic index (1.0 ± 0.9 vs 1.4 ± 1.0, P = .003) compared with the non-IVH controls. Respiratory distress syndrome, hypotension, and thrombocytopenia increased the adjusted OR for IVH. Hypoglycemia was not independently associated with IVH. Conversely, the increase in hyperglycemic duration was most prominently increasing the aOR for severe IVH (OR = 10.33, 95% CI = 10.0-10.6, P = .033).
  
  
  CONCLUSIONS
  Longer duration of hyperglycemia in the first 96 hours of life was most strongly associated with severe IVH in preterm infants. Consequently, interventional studies to determine the selective effect of continuous control of long-lasting hyperglycemia by appropriate and timed insulin treatment on the incidence of severe IVH are warranted.
authors.affiliation: Division of Pediatric Endocrinology, Department of Pediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Adi
authors.initials: A
authors.lastname: Auerbach
authors.forename: Smadar
authors.initials: S
authors.lastname: Eventov-Friedman
authors.forename: Ilan
authors.initials: I
authors.lastname: Arad
authors.forename: Ofra
authors.initials: O
authors.lastname: Peleg
authors.forename: Tali
authors.initials: T
authors.lastname: Bdolah-Abram
authors.forename: Benjamin
authors.initials: B
authors.lastname: Bar-Oz
authors.forename: David Haim
authors.initials: DH
authors.lastname: Zangen
mesh_terms: D002543:Cerebral Hemorrhage / Q000209:etiology*; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000150:complications*; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000209:etiology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors
keywords: IVH; Intraventricular hemorrhage; NICU; Neonatal intensive care unit; PDA; Patent ductus arteriosus; RDS; Respiratory distress syndrome; US; Ultrasound