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DOI: 10.1055/s-0038-1626706
Relationship between Blood Glucose Fluctuation and Brain Damage in the Hypoglycemia Neonates
Publikationsverlauf
29. November 2017
20. Dezember 2017
Publikationsdatum:
14. Februar 2018 (online)
![](https://www.thieme-connect.de/media/ajp/201810/lookinside/thumbnails/10-1055-s-0038-1626706_170634-1.jpg)
Abstract
Objective To investigate the relationship between blood glucose fluctuation and brain damage in the hypoglycemia neonates.
Study Design A retrospective study including all neonates hospitalized due to hypoglycemia from September 2013 to August 2016 was performed. All the 58 hypoglycemia infants were divided into two groups—the brain-damaged group and the nonbrain-damaged group, according to head magnetic resonance imaging and/or amplitude-integrated electroencephalogram. Relationship between glucose variability and brain damage and whether these variation indexes could act as early indicators for hypoglycemic brain damage were investigated.
Results Of the 13 brain-damaged cases, the lowest blood glucose (LBG) level was lower, while duration of hypoglycemia was longer compared with the 45 nonbrain-damaged cases (p < 0.001). The largest amplitude of glycemic excursions, standard deviation of blood glucose, and mean amplitude of glycemic excursions (MAGE) of the brain-damaged group were higher (p < 0.001). Under receiver-operating characteristic curve, values of area under the curve of MAGE were 0.892, duration of hypoglycemia was 0.921, and LBG was 0.109 (p < 0.0001).
Conclusion Brain damage of the hypoglycemia neonates relates not only with LBG and duration of hypoglycemia but also with the blood glucose variation indexes; MAGE and duration of hypoglycemia could act as predictors for brain damage.
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References
- 1 Han N, Kim YJ, Park SM. , et al. Repeated glucose deprivation/reperfusion induced PC-12 cell death through the involvement of FOXO transcription factor. Diabetes Metab J 2016; 40 (05) 396-405
- 2 Rake AJ, Srinivasan V, Nadkarni V, Kaptan R, Newth CJ. Glucose variability and survival in critically ill children: allostasis or harm?. Pediatr Crit Care Med 2010; 11 (06) 707-712
- 3 Vanhorebeek I, Gielen M, Boussemaere M. , et al. Glucose dysregulation and neurological injury biomarkers in critically ill children. J Clin Endocrinol Metab 2010; 95 (10) 4669-4679
- 4 Thompson-Branch A, Havranek T. Neonatal hypoglycemia. Pediatr Rev 2017; 38 (04) 147-157
- 5 Mao J, Chen LY, Fu JH, Li J, Xue XD. [Clinical evaluation by MRI on the newborn infants with hypoglycemic brain damage]. Zhonghua Er Ke Za Zhi 2007; 45 (07) 518-522
- 6 Kinnala A, Rikalainen H, Lapinleimu H, Parkkola R, Kormano M, Kero P. Cerebral magnetic resonance imaging and ultrasonography findings after neonatal hypoglycemia. Pediatrics 1999; 103 (4 Pt 1): 724-729
- 7 Zhi-Mei G, Fang L, Chun-Feng, et al. Characteristics of amplitude integrated EEG in neonates with hypoglycemic brain damage. J Clin Pediatr 2013; 11: 1019-1023
- 8 Cai Y, Ma G, Jin ZC, Zhang WB, Jiang PC. [Values of glycemic lability index in the prognostic evaluation of critically ill patients in intensive care unit]. Zhonghua Yi Xue Za Zhi 2011; 91 (40) 2853-2857
- 9 Su J, Wang L. [Research progress in neonatal hypoglycemic brain injury]. Zhongguo Dang Dai Er Ke Za Zhi 2011; 13 (05) 446-451
- 10 Sheen YJ, Sheu WH. Association between hypoglycemia and dementia in patients with type 2 diabetes. Diabetes Res Clin Pract 2016; 116: 279-287
- 11 Tam EW, Widjaja E, Blaser SI, Macgregor DL, Satodia P, Moore AM. Occipital lobe injury and cortical visual outcomes after neonatal hypoglycemia. Pediatrics 2008; 122 (03) 507-512
- 12 Burns CM, Rutherford MA, Boardman JP, Cowan FM. Patterns of cerebral injury and neurodevelopmental outcomes after symptomatic neonatal hypoglycemia. Pediatrics 2008; 122 (01) 65-74
- 13 Penn JS, Henry MM, Tolman BL. Exposure to alternating hypoxia and hyperoxia causes severe proliferative retinopathy in the newborn rat. Pediatr Res 1994; 36 (06) 724-731
- 14 Dave KR, Pileggi A, Raval AP. Recurrent hypoglycemia increases oxygen glucose deprivation-induced damage in hippocampal organotypic slices. Neurosci Lett 2011; 496 (01) 25-29
- 15 Cirelli J, McGregor C, Graydon B, James A. Analysis of continuous oxygen saturation data for accurate representation of retinal exposure to oxygen in the preterm infant. Stud Health Technol Inform 2013; 183: 126-131
- 16 Cui X, Abduljalil A, Manor BD, Peng CK, Novak V. Multi-scale glycemic variability: a link to gray matter atrophy and cognitive decline in type 2 diabetes. PLoS One 2014; 9 (01) e86284
- 17 Naranje KM, Poddar B, Bhriguvanshi A. , et al. Blood glucose variability and outcomes in critically ill children. Indian J Crit Care Med 2017; 21 (03) 122-126
- 18 Hawdon JM. Hypoglycaemia and the neonatal brain. Eur J Pediatr 1999; 158 (Suppl. 01) S9-S12
- 19 Montassir H, Maegaki Y, Ogura K. , et al. Associated factors in neonatal hypoglycemic brain injury. Brain Dev 2009; 31 (09) 649-656
- 20 Monnier L, Colette C. Glycemic variability: should we and can we prevent it?. Diabetes Care 2008; 31 (Suppl. 02) S150-S154