title: Hyperglycaemia in infants with hypoxic-ischaemic encephalopathy is associated with improved outcomes after therapeutic hypothermia: a post hoc analysis of the CoolCap Study.
abstract: OBJECTIVE
  To investigate whether glycaemic profile is associated with multiorgan dysfunction and with response to hypothermia after perinatal hypoxic-ischaemic encephalopathy (HIE).
  
  
  METHODS
  Post hoc analysis of the CoolCap Study.
  
  
  METHODS
  25 perinatal centres in UK, USA and New Zealand during 1999-2002.
  
  
  METHODS
  194/234 (83%) infants of ≥36 weeks' gestation with moderate-to-severe HIE enrolled in the CoolCap Study with documented plasma glucose levels and follow-up outcome.
  
  
  METHODS
  Infants were randomised to head cooling for 72 hours starting within 6 hours of birth or standard care. Plasma glucose levels were measured at predetermined time intervals after randomisation.
  
  
  METHODS
  Unfavourable primary outcome was defined as death and/or severe neurodevelopmental disability at 18 months. Glycaemic profile (hypoglycaemia (≤40 mg/dL, ≤2.2 mmol/L), hyperglycaemia (>150 mg/dL, >8.3 mmol/L) and normoglycaemia) during 12 hours after randomisation was investigated for association with multiorgan dysfunction or risk reduction of primary outcome after hypothermia treatment.
  
  
  RESULTS
  Hypoglycaemia but not hyperglycaemia was associated with more deranged multiorgan function parameters (mean pH 7.23 (SD 0.16) vs 7.36 (0.13), p<0.001; aspartate transaminase 2101 (2450) vs 318 (516) IU/L, p=0.002; creatinine 1.95 (0.59) vs 1.26 (0.5) mg/dL, p<0.001) compared with normoglycaemia. After adjusting for Sarnat stage and 5 min Apgar score, only hyperglycaemic infants randomised to hypothermia had reduced risk of unfavourable outcome (adjusted risk ratio: 0.80, 95% CI 0.66 to 0.99), whereas hypoglycaemic and normoglycaemic infants did not.
  
  
  CONCLUSIONS
  Early glycaemic profile in infants with moderate-to-severe HIE may help to identify risk of multiorgan dysfunction and response to therapeutic hypothermia.
  
  
  BACKGROUND
  NCT00383305.
authors: Department of Pediatrics, Children's National Medical Center, Washington DC, USA.|Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
authors: Sudeepta K
authors: SK
authors: Basu
authors: Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA.
authors: Jason L
authors: JL
authors: Salemi
authors: Department of Physiology, University of Auckland, Auckland, New Zealand.
authors: Alistair J
authors: AJ
authors: Gunn
authors: Departments of Pediatrics and Obstetrics & Gynecology, Baylor College of Medicine, Houston, Texas, USA.
authors: Jeffrey R
authors: JR
authors: Kaiser
mesh_terms: D001034:Apgar Score; D001724:Birth Weight; D001786:Blood Glucose / Q000032:analysis; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology / Q000517:prevention & control*; D007036:Hypothermia, Induced / Q000379:methods*; D020925:Hypoxia-Ischemia, Brain / Q000150:complications / Q000628:therapy*; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D065886:Neurodevelopmental Disorders / Q000517:prevention & control*; D009520:New Zealand; D011379:Prognosis; D006113:United Kingdom; D014481:United States
chemical_list: D001786:Blood Glucose
keywords: CoolCap Study; hyperglycaemia; hypoglycaemia; neonatal hypoxic ischaemic encephalopathy; response to hypothermia treatment