title: Early hyperglycemia is associated with poor gross motor outcome in asphyxiated term newborns.
abstract: BACKGROUND
  Hyperglycemia after ischemic stroke in adults and after near-drowning in children is associated with a poor neurological outcome. Anaerobic metabolism of glucose leads to buildup of lactic acid, free radical production, mitochondrial failure, and ultimately an increase in neurological injury. In asphyxiated infants, high lactate peaks are seen in the basal ganglia with magnetic resonance spectroscopy. Because motor disability in asphyxiated full-term newborns often relates to injury in the basal ganglia, we hypothesized that hyperglycemia and associated buildup of lactic acid may lead to worse gross motor outcome.
  
  
  METHODS
  Glucose, blood gas values, and demographic data were abstracted from the medical records of 41 term infants with asphyxia and without confounding diagnoses. Their Gross Motor Function Classification System scores were determined from the medical record or by structured telephone interviews.
  
  
  RESULTS
  The outcomes of 14 infants were considered poor on the basis of death within the first 6 months or moderate-to-severe cerebral palsy (Gross Motor Function Classification System score 1-5). The other 27 infants had no gross motor disability (Gross Motor Function Classification System score 0). The highest recorded blood glucose correlated with poor outcome (P = 0.046 by logistic regression). Infants with hyperglycemia (blood glucose > 150 mg/dL) were more likely to have poor outcome (P = 0.017; odds ratio: 5.9; 95% confidence interval: 1.4-24.7).
  
  
  CONCLUSIONS
  High blood glucose in the first 12 hours is associated with poor gross motor outcome in this cohort of asphyxiated term infants. Clinicians should avoid hyperglycemia in managing term infants with asphyxia.
authors.affiliation: Department of Pediatrics, Akron Children's Hospital, Akron, Ohio. Electronic address: espies@chmca.org.
authors.forename: Erin E
authors.initials: EE
authors.lastname: Spies
authors.affiliation: Northeast Ohio Medical University, Rootstown, Ohio.
authors.forename: Suzanne L
authors.initials: SL
authors.lastname: Lababidi
authors.affiliation: Department of Pediatrics, Akron Children's Hospital, Akron, Ohio; Northeast Ohio Medical University, Rootstown, Ohio; Division of Child Neurology, NeuroDevelopmental Science Center, Akron Children's Hospital, Akron, Ohio.
authors.forename: Margaret C
authors.initials: MC
authors.lastname: McBride
mesh_terms: D001238:Asphyxia Neonatorum / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology*; D001784:Blood Gas Analysis; D001786:Blood Glucose / Q000032:analysis; D002547:Cerebral Palsy / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology*; D007231:Infant, Newborn; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D009069:Movement Disorders / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology*; D011379:Prognosis; D012720:Severity of Illness Index
chemical_list: D001786:Blood Glucose
keywords: asphyxia; hyperglycemia; motor development; newborn full term; outcome