Long Duration of Hyperglycemia in the First 96 Hours of Life Is Associated with Severe Intraventricular Hemorrhage in Preterm Infants

• Published in: The Journal of pediatrics Vol. 163; no. 2; pp. 388 - 393
• Main Authors: Auerbach, Adi, MD, Eventov-Friedman, Smadar, MD, PhD, Arad, Ilan, MD, Peleg, Ofra, MD, Bdolah-Abram, Tali, MSc, Bar-Oz, Benjamin, MD, Zangen, David Haim, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2013
• Subjects: Cerebral Hemorrhage - etiology; Humans; Hyperglycemia - blood; Hyperglycemia - complications; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases - etiology; Pediatrics; Retrospective Studies; Severity of Illness Index; Time Factors; RDS; Patent ductus arteriosus; Respiratory distress syndrome; Neonatal intensive care unit; NICU; IVH; Intraventricular hemorrhage; PDA; Ultrasound; US
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2013.01.051

Objective To assess the association between severe intraventricular hemorrhage (IVH) and blood glucose variables during the first 96 hours of life in preterm infants. Study design 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). Conclusion 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.