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Neonatal hyperglycaemia is associated with worse neurodevelopmental outcomes in extremely preterm infants

Zamir, Itay ; Stoltz Sjöström, Elisabeth LU ; Ahlsson, Fredrik LU ; Hansen-Pupp, Ingrid LU orcid ; Serenius, Fredrik LU and Domellöf, Magnus (2021) In Archives of Disease in Childhood: Fetal and Neonatal Edition 106(5). p.460-466
Abstract

Objective: To assess the associations between neonatal hyperglycaemia and insulin treatment, versus long-Term neurodevelopmental outcomes in children born extremely preterm. Design and setting: Observational national cohort study (Extremely Preterm Infants in Sweden Study) using prospectively and retrospectively collected data. Neurodevelopmental assessment was performed at 6.5 years of age. Patients: 533 infants born <27 gestational weeks during 2004-2007; 436 survivors were assessed at 6.5 years. Outcome measures: Neurodevelopmental disability (NDD), survival without moderate to severe NDD, Wechsler Intelligence Scale for Children IV Full scale intelligence quotient (WISC-IV FSIQ) and Movement Assessment Battery for Children 2... (More)

Objective: To assess the associations between neonatal hyperglycaemia and insulin treatment, versus long-Term neurodevelopmental outcomes in children born extremely preterm. Design and setting: Observational national cohort study (Extremely Preterm Infants in Sweden Study) using prospectively and retrospectively collected data. Neurodevelopmental assessment was performed at 6.5 years of age. Patients: 533 infants born <27 gestational weeks during 2004-2007; 436 survivors were assessed at 6.5 years. Outcome measures: Neurodevelopmental disability (NDD), survival without moderate to severe NDD, Wechsler Intelligence Scale for Children IV Full scale intelligence quotient (WISC-IV FSIQ) and Movement Assessment Battery for Children 2 (MABC-2) total score. Results: Duration of neonatal hyperglycaemia >8 mmol/L was associated with WISC-IV scores-for each day with hyperglycaemia there was a decrease of 0.33 points (95% CI 0.03 to 0.62) in FSIQ. Neonatal hyperglycaemia >8 mmol/L occurring on 3 consecutive days was associated with lower MABC-2 scores (adjusted mean difference:-4.90; 95% CI-8.90 to-0.89). For each day with hyperglycaemia >8 mmol/L, there was a decrease of 0.55 points (95% CI 0.17 to 0.93) in MABC-2 total score. Insulin treatment was not associated with any of the outcome measures. Conclusion: Neonatal hyperglycaemia >8 mmol/L was associated with lower intelligence scores and worse motor outcomes at 6.5 years of age. Insulin treatment was not associated with either worsened or improved neurodevelopmental outcomes. Randomised controlled trials are needed to clarify the role of insulin in treating hyperglycaemia in extremely preterm infants.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
endocrinology, neonatology, neurology
in
Archives of Disease in Childhood: Fetal and Neonatal Edition
volume
106
issue
5
pages
460 - 466
publisher
BMJ Publishing Group
external identifiers
  • scopus:85104640408
  • pmid:33863775
ISSN
1359-2998
DOI
10.1136/archdischild-2020-319926
language
English
LU publication?
yes
id
2e027cf2-2c8c-4a32-8ebf-6dba4536b6f0
date added to LUP
2021-05-04 11:23:00
date last changed
2024-06-15 10:48:36
@article{2e027cf2-2c8c-4a32-8ebf-6dba4536b6f0,
  abstract     = {{<p>Objective: To assess the associations between neonatal hyperglycaemia and insulin treatment, versus long-Term neurodevelopmental outcomes in children born extremely preterm. Design and setting: Observational national cohort study (Extremely Preterm Infants in Sweden Study) using prospectively and retrospectively collected data. Neurodevelopmental assessment was performed at 6.5 years of age. Patients: 533 infants born &lt;27 gestational weeks during 2004-2007; 436 survivors were assessed at 6.5 years. Outcome measures: Neurodevelopmental disability (NDD), survival without moderate to severe NDD, Wechsler Intelligence Scale for Children IV Full scale intelligence quotient (WISC-IV FSIQ) and Movement Assessment Battery for Children 2 (MABC-2) total score. Results: Duration of neonatal hyperglycaemia &gt;8 mmol/L was associated with WISC-IV scores-for each day with hyperglycaemia there was a decrease of 0.33 points (95% CI 0.03 to 0.62) in FSIQ. Neonatal hyperglycaemia &gt;8 mmol/L occurring on 3 consecutive days was associated with lower MABC-2 scores (adjusted mean difference:-4.90; 95% CI-8.90 to-0.89). For each day with hyperglycaemia &gt;8 mmol/L, there was a decrease of 0.55 points (95% CI 0.17 to 0.93) in MABC-2 total score. Insulin treatment was not associated with any of the outcome measures. Conclusion: Neonatal hyperglycaemia &gt;8 mmol/L was associated with lower intelligence scores and worse motor outcomes at 6.5 years of age. Insulin treatment was not associated with either worsened or improved neurodevelopmental outcomes. Randomised controlled trials are needed to clarify the role of insulin in treating hyperglycaemia in extremely preterm infants.</p>}},
  author       = {{Zamir, Itay and Stoltz Sjöström, Elisabeth and Ahlsson, Fredrik and Hansen-Pupp, Ingrid and Serenius, Fredrik and Domellöf, Magnus}},
  issn         = {{1359-2998}},
  keywords     = {{endocrinology; neonatology; neurology}},
  language     = {{eng}},
  number       = {{5}},
  pages        = {{460--466}},
  publisher    = {{BMJ Publishing Group}},
  series       = {{Archives of Disease in Childhood: Fetal and Neonatal Edition}},
  title        = {{Neonatal hyperglycaemia is associated with worse neurodevelopmental outcomes in extremely preterm infants}},
  url          = {{http://dx.doi.org/10.1136/archdischild-2020-319926}},
  doi          = {{10.1136/archdischild-2020-319926}},
  volume       = {{106}},
  year         = {{2021}},
}