title: High glucose variability is associated with poor neurodevelopmental outcomes in neonatal hypoxic ischemic encephalopathy.
abstract: BACKGROUND
  In neonatal hypoxic ischemic encephalopathy (HIE), hypo- and hyperglycemia have been associated with poor outcomes. However, glucose variability has not been reported in this population.
  
  
  OBJECTIVE
  To examine the association between serum glucose variability within the first 24 hours and two-year neurodevelopmental outcomes in neonates cooled for HIE.
  
  
  METHODS
  In this retrospective cohort study, glucose, clinical and demographic data were documented from 23 term newborns treated with whole body therapeutic hypothermia. Severe neurodevelopmental outcomes from planned two-year assessments were defined as the presence of any one of the following: Gross Motor Function Classification System levels 3 to 5, Bayley III Motor Standard Score <70, Bayley III Language Score <70 and Bayley III Cognitive Standard Score <70.
  
  
  RESULTS
  The neurodevelopmental outcomes from 8 of 23 patients were considered severe, and this group demonstrated a significant increase of mean absolute glucose (MAG) change (-0.28 to -0.03, 95% CI, p = 0.032). There were no significant differences between outcome groups with regards to number of patients with hyperglycemic means, one or multiple hypo- or hyperglycemic measurement(s). There were also no differences between both groups with mean glucose, although mean glucose standard deviation was approaching significance.
  
  
  CONCLUSIONS
  Poor neurodevelopmental outcomes in whole body cooled HIE neonates are significantly associated with MAG changes. This information may be relevant for prognostication and potential management strategies.
authors.affiliation: Section of Neonatology, Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital, Winnipeg, Manitoba, Canada.
authors.forename: N
authors.initials: N
authors.lastname: Al Shafouri
authors.affiliation: Section of Neonatology, Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital, Winnipeg, Manitoba, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Narvey
authors.affiliation: Section of Neonatology, Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital, Winnipeg, Manitoba, Canada.
authors.forename: G
authors.initials: G
authors.lastname: Srinivasan
authors.affiliation: Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Vallance
authors.affiliation: Section of Pediatric Intensive Care, Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital, Winnipeg, Manitoba, Canada.
authors.forename: G
authors.initials: G
authors.lastname: Hansen
mesh_terms: D015415:Biomarkers / Q000097:blood; D002170:Canada / Q000453:epidemiology; D003422:Critical Care; D006442:Glycated Hemoglobin / Q000378:metabolism; D038321:Glycemic Index; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D007003:Hypoglycemia / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D007036:Hypothermia, Induced / Q000379:methods*; D020925:Hypoxia-Ischemia, Brain / Q000097:blood / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D007231:Infant, Newborn; D008991:Monitoring, Physiologic; D065886:Neurodevelopmental Disorders / Q000097:blood / Q000209:etiology / Q000503:physiopathology* / Q000517:prevention & control; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Neonatal; glucose; hypothermia; hypoxic ischemic encephalopathy; treatment outcomes