Early Hyperglycemia in Very Preterm Infants Is Associated with Reduced White Matter Volume and Worse Cognitive and Motor Outcomes at 2.5 Years

Abstract

<b><i>Introduction:</i></b> Hyperglycemia in very preterm infants is associated with increased morbidity and mortality. We aimed to investigate potential associations between early hyperglycemia, neonatal cerebral magnetic resonance imaging (MRI), and neurodevelopment at 2.5 years. <b><i>Methods:</i></b> The study population included 69 infants with gestational age (GA) 22.3–31.9 weeks (<i>n</i> = 29 with GA <28 weeks), born 2011–2014. Plasma glucose concentrations during the first week were checked according to clinical routines. Hyperglycemia was defined as glucose concentrations above 8.3 mmol/L (150 mg/dL) and above 10 mmol/L (180 mg/dL), respectively, categorized as the highest glucose days 0–2, number of days above 8.3 and 10 mmol/L, and prolonged (yes/no) 2 days or more above 8.3 and 10 mmol/L. The MRI analysis included morphological assessment, regional brain volumes, and assessment of apparent diffusion coefficient (ADC). Neurodevelopmental impairment (NDI) developed in 13 of 67 infants with available outcomes, of which 57 were assessed with the Bayley-III. Univariate and multiple linear and logistic regressions were performed with adjustments for GA, birth weight z-scores, and illness severity expressed as days on mechanical ventilation. <b><i>Results:</i></b> Hyperglycemia above 8.3 mmol/L and 10 mmol/L was present in 47.8% and 31.9% of the infants. Hyperglycemia correlated independently with lower white matter volume, but not with other regional brain volumes, and was also associated with lower ADC values in white matter. Hyperglycemia also correlated with lower Bayley-III cognitive and motor scores in infants with GA <28 weeks, but there was no significant effect on NDI. <b><i>Conclusion:</i></b> Early hyperglycemia is associated with white matter injury and poorer neurodevelopment in very preterm infants.

Early, low-dose hydrocortisone and near-term brain connectivity in extremely preterm infants

“…Neonatal hyperglycemia after preterm birth has been associated with decreased apparent diffusion coefficient in white matter. 38 While there were no differences in several major neonatal medical conditions in the two groups, this study was not powered to exhaustively account for the many factors that contribute to white matter development. Of 86 eligible infants who received non-protocol or protocol steroids during the 13 study period, 31 (36%) had imaging that was unsuitable for tractography.…”