Neonatal Glycemia and Neurodevelopmental Outcomes at 2 Years.
Neonatal Glycemia and Neurodevelopmental Outcomes at 2 Years.
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DOI：
10.1056/nejmoa1504909
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发表时间：
2015-10-15
期刊：
影响因子：
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通讯作者：
CHYLD Study Group
中科院分区：
文献类型：
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作者：
McKinlay CJ;Alsweiler JM;Ansell JM;Anstice NS;Chase JG;Gamble GD;Harris DL;Jacobs RJ;Jiang Y;Paudel N;Signal M;Thompson B;Wouldes TA;Yu TY;Harding JE;CHYLD Study Group
新生儿低血糖是常见的，可导致神经功能损害，但证据支持干预的阈值是有限的。我们进行了一项前瞻性队列研究，涉及528名胎龄至少为35周的新生儿，他们被认为有低血糖的风险;所有人都接受了治疗，以维持血糖浓度至少为47 mg/dl（2.6 mmol/L）。我们间歇性地测量血糖长达7天。我们持续监测间质葡萄糖浓度，临床工作人员对此不知情。2岁时的评估包括贝利婴儿发育量表III以及执行和视觉功能测试。在614名儿童中，528名合格，404名（77%的合格儿童）接受了评估; 216名儿童（53%）患有新生儿低血糖（血糖浓度<47 mg/dl）。低血糖，当治疗以维持血糖浓度至少为47毫克/分升时，与感觉神经损害的主要结局风险增加无关（风险比，0.95; 95%置信区间[CI]，0.75至1.20; P = 0.67）和处理困难，定义为执行功能评分或运动连贯性阈值与平均值相差1.5 SD以上（风险比，0.92; 95% CI，0.56 - 1.51; P = 0.74）。未被识别的低血糖（仅低间质葡萄糖浓度）儿童的风险没有增加。最低血糖浓度、低血糖发作和事件的数量以及负间质增量（高于间质葡萄糖浓度曲线且低于47 mg/dl的面积）也不能预测结果。在该队列中，当提供治疗以维持血糖浓度至少为47 mg/dl时，新生儿低血糖与不良神经系统结局无关。（由Eunice Kennedy Shriver国家儿童健康和人类发展研究所和其他机构资助。
Neonatal hypoglycemia is common and can cause neurologic impairment, but evidence supporting thresholds for intervention is limited. We performed a prospective cohort study involving 528 neonates with a gestational age of at least 35 weeks who were considered to be at risk for hypoglycemia; all were treated to maintain a blood glucose concentration of at least 47 mg per deciliter (2.6 mmol per liter). We intermittently measured blood glucose for up to 7 days. We continuously monitored interstitial glucose concentrations, which were masked to clinical staff. Assessment at 2 years included Bayley Scales of Infant Development III and tests of executive and visual function. Of 614 children, 528 were eligible, and 404 (77% of eligible children) were assessed; 216 children (53%) had neonatal hypoglycemia (blood glucose concentration, <47 mg per deciliter). Hypoglycemia, when treated to maintain a blood glucose concentration of at least 47 mg per deciliter, was not associated with an increased risk of the primary outcomes of neurosensory impairment (risk ratio, 0.95; 95% confidence interval [CI], 0.75 to 1.20; P = 0.67) and processing difficulty, defined as an executive-function score or motion coherence threshold that was more than 1.5 SD from the mean (risk ratio, 0.92; 95% CI, 0.56 to 1.51; P = 0.74). Risks were not increased among children with unrecognized hypoglycemia (a low interstitial glucose concentration only). The lowest blood glucose concentration, number of hypoglycemic episodes and events, and negative interstitial increment (area above the interstitial glucose concentration curve and below 47 mg per deciliter) also did not predict the outcome. In this cohort, neonatal hypoglycemia was not associated with an adverse neurologic outcome when treatment was provided to maintain a blood glucose concentration of at least 47 mg per deciliter. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and others.)