Sudeepta K Basu1, Katherine Ottolini1, Vedavalli Govindan2, Suleiman Mashat2, Gilbert Vezina3, Yunfei Wang4, Michaelande Ridore1, Taeun Chang5, Jeffrey R Kaiser6, An N Massaro7. 1. Division of Neonatology, Children's National Health System, Washington, DC. 2. Fetal Medicine Institute, Children's National Health System, Washington, DC. 3. Department of Radiology, Children's National Health System, Washington, DC. 4. Department of Bio-Statistics, Children's National Health System, Washington, DC. 5. Department of Neurology, Children's National Health System, Washington, DC. 6. Department of Pediatrics (Neonatal-Perinatal Medicine), Penn State Health Children's Hospital, Hershey, PA; Department of Obstetrics & Gynecology, Penn State Health Children's Hospital, Hershey, PA. 7. Division of Neonatology, Children's National Health System, Washington, DC; Fetal Medicine Institute, Children's National Health System, Washington, DC. Electronic address: anguyenm@childrensnational.org.
Abstract
OBJECTIVE: To investigate whether the early glycemic profile in infants with hypoxic ischemic encephalopathy is associated with distinct patterns of brain injury on magnetic resonance imaging (MRI). STUDY DESIGN: We performed a secondary analysis of 178 prospectively enrolled infants who received therapeutic hypothermia for hypoxic ischemic encephalopathy. Glycemic profiles were identified by glucose concentrations within 24 hours after birth: normoglycemia (all glucose concentrations of >47 to ≤150 mg/dL; n = 62); hypoglycemia (≥1 concentration ≤47 mg/dL; n = 17); hyperglycemia (≥1 concentration >150 mg/dL; n = 76); and labile glucose (both hypoglycemia and hyperglycemia; n = 23). Patterns of brain injury were identified for 151 infants based on Barkovich scores from the postrewarming brain MRIs at a median age of 9 days. RESULTS: A normal brain MRI was reported in 37 of 62 infants (60%) with normal blood glucose values compared with 37 of 116 infants (32%) with an abnormal glucose profile (adjusted for Sarnat stage of encephalopathy and Apgar score at 5 minutes; P = .02). The distribution of MRI patterns of brain injury differed among the glycemic groups (P = .03). The odds of predominant watershed or focal-multifocal injury was higher in infants with hypoglycemia (aOR, 6; 95% CI, 1.5-24.2) and labile glucose (6.6; 95% CI, 1.6-27) compared with infants with normoglycemia. Infants with labile glucose had higher odds (5.6; 95% CI, 1.1-29.3) of predominant basal ganglia or global injury compared with infants with normal blood glucose values. CONCLUSIONS: The early glycemic profile in infants with hypoxic ischemic encephalopathy is associated with specific patterns of brain injury on MRI. Further investigation is needed to explore its prognostic significance and role as a phenotype biomarker.
OBJECTIVE: To investigate whether the early glycemic profile in infants with hypoxic ischemic encephalopathy is associated with distinct patterns of brain injury on magnetic resonance imaging (MRI). STUDY DESIGN: We performed a secondary analysis of 178 prospectively enrolled infants who received therapeutic hypothermia for hypoxic ischemic encephalopathy. Glycemic profiles were identified by glucose concentrations within 24 hours after birth: normoglycemia (all glucose concentrations of >47 to ≤150 mg/dL; n = 62); hypoglycemia (≥1 concentration ≤47 mg/dL; n = 17); hyperglycemia (≥1 concentration >150 mg/dL; n = 76); and labile glucose (both hypoglycemia and hyperglycemia; n = 23). Patterns of brain injury were identified for 151 infants based on Barkovich scores from the postrewarming brain MRIs at a median age of 9 days. RESULTS: A normal brain MRI was reported in 37 of 62 infants (60%) with normal blood glucose values compared with 37 of 116 infants (32%) with an abnormal glucose profile (adjusted for Sarnat stage of encephalopathy and Apgar score at 5 minutes; P = .02). The distribution of MRI patterns of brain injury differed among the glycemic groups (P = .03). The odds of predominant watershed or focal-multifocal injury was higher in infants with hypoglycemia (aOR, 6; 95% CI, 1.5-24.2) and labile glucose (6.6; 95% CI, 1.6-27) compared with infants with normoglycemia. Infants with labile glucose had higher odds (5.6; 95% CI, 1.1-29.3) of predominant basal ganglia or global injury compared with infants with normal blood glucose values. CONCLUSIONS: The early glycemic profile in infants with hypoxic ischemic encephalopathy is associated with specific patterns of brain injury on MRI. Further investigation is needed to explore its prognostic significance and role as a phenotype biomarker.
Authors: Emily W Y Tam; Laurel A Haeusslein; Sonia L Bonifacio; Hannah C Glass; Elizabeth E Rogers; Rita J Jeremy; A James Barkovich; Donna M Ferriero Journal: J Pediatr Date: 2012-02-04 Impact factor: 4.406
Authors: Seetha Shankaran; Athina Pappas; Scott A McDonald; Betty R Vohr; Susan R Hintz; Kimberly Yolton; Kathryn E Gustafson; Theresa M Leach; Charles Green; Rebecca Bara; Carolyn M Petrie Huitema; Richard A Ehrenkranz; Jon E Tyson; Abhik Das; Jane Hammond; Myriam Peralta-Carcelen; Patricia W Evans; Roy J Heyne; Deanne E Wilson-Costello; Yvonne E Vaucher; Charles R Bauer; Anna M Dusick; Ira Adams-Chapman; Ricki F Goldstein; Ronnie Guillet; Lu-Ann Papile; Rosemary D Higgins Journal: N Engl J Med Date: 2012-05-31 Impact factor: 91.245
Authors: Steven P Miller; Vijay Ramaswamy; David Michelson; A James Barkovich; Barbara Holshouser; Nathaniel Wycliffe; David V Glidden; Douglas Deming; J Colin Partridge; Yvonne W Wu; Stephen Ashwal; Donna M Ferriero Journal: J Pediatr Date: 2005-04 Impact factor: 4.406
Authors: Britt J M van Kooij; Mariëlle van Handel; Rutger A J Nievelstein; Floris Groenendaal; Marian J Jongmans; Linda S de Vries Journal: J Pediatr Date: 2010-04-09 Impact factor: 4.406
Authors: A J Barkovich; B L Hajnal; D Vigneron; A Sola; J C Partridge; F Allen; D M Ferriero Journal: AJNR Am J Neuroradiol Date: 1998-01 Impact factor: 3.825
Authors: Susan E Jacobs; Marie Berg; Rod Hunt; William O Tarnow-Mordi; Terrie E Inder; Peter G Davis Journal: Cochrane Database Syst Rev Date: 2013-01-31
Authors: Peter D Gluckman; John S Wyatt; Denis Azzopardi; Roberta Ballard; A David Edwards; Donna M Ferriero; Richard A Polin; Charlene M Robertson; Marianne Thoresen; Andrew Whitelaw; Alistair J Gunn Journal: Lancet Date: 2005 Feb 19-25 Impact factor: 79.321
Authors: Denis Azzopardi; Brenda Strohm; Neil Marlow; Peter Brocklehurst; Aniko Deierl; Oya Eddama; Julia Goodwin; Henry L Halliday; Edmund Juszczak; Olga Kapellou; Malcolm Levene; Louise Linsell; Omar Omar; Marianne Thoresen; Nora Tusor; Andrew Whitelaw; A David Edwards Journal: N Engl J Med Date: 2014-07-10 Impact factor: 91.245
Authors: Kathryn A Martinello; Christopher Meehan; Adnan Avdic-Belltheus; Ingran Lingam; Tatenda Mutshiya; Qin Yang; Mustafa Ali Akin; David Price; Magdalena Sokolska; Alan Bainbridge; Mariya Hristova; Ilias Tachtsidis; Cally J Tann; Donald Peebles; Henrik Hagberg; Tim G A M Wolfs; Nigel Klein; Boris W Kramer; Bobbi Fleiss; Pierre Gressens; Xavier Golay; Nicola J Robertson Journal: Pediatr Res Date: 2021-05-28 Impact factor: 3.953
Authors: John Madar; Charles C Roehr; Sean Ainsworth; Hege Ersda; Colin Morley; Mario Rüdiger; Christiane Skåre; Tomasz Szczapa; Arjan Te Pas; Daniele Trevisanuto; Berndt Urlesberger; Dominic Wilkinson; Jonathan P Wyllie Journal: Notf Rett Med Date: 2021-06-02 Impact factor: 0.892
Authors: Laura Costanza De Angelis; Giorgia Brigati; Giulia Polleri; Mariya Malova; Alessandro Parodi; Diego Minghetti; Andrea Rossi; Paolo Massirio; Cristina Traggiai; Mohamad Maghnie; Luca Antonio Ramenghi Journal: Front Endocrinol (Lausanne) Date: 2021-03-16 Impact factor: 5.555