533 - Early Hypoglycemia Is Not An Independent Risk Factor For 2-Year Neurodevelopmental Impairment In Appropriate-For-Gestational Age Preterm Infants Of Less Than 32 Weeks.

Publication Number: 533.4872

Martina Palazzo, Department of Odontostomatologic and Specialized Clinical Sciences, Polytechnic University of Marche, Ancona, Italy, Ancona, Marche, Italy; Margherita Bonanni, ASUFC, Udine, Friuli-Venezia Giulia, Italy; Alessio Correani, Università Politecnica delle Marche, Ancona, Marche, Italy; Enrica Ferretti, Azienda Ospedaliero Universitaria delle Marche, Senigallia (AN), Marche, Italy; Rita D'Ascenzo, AOU delle Marche, Ancona, Marche, Italy; Chiara Biagetti, Salesi Children's Hospital, Ancona, Marche, Italy; Ilaria Burattini, Division of Neonatology, Mother and Child Department, G. Salesi Children’s Hospital, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy, Ancona, Marche, Italy; Virgilio Carnielli, Polytechnic Univeristy of Ancona, Ancona, Marche, Italy

Background: There is an unmet need to clarify the association between early hypoglycemia and neurodevelopment in preterm infants, in the absence of main conditions known to be associated with an increased risk of hypoglycemia and poor neurodevelopmental outcomes (i.e. small for gestational age, SGA; large for gestational age, LGA; infants of diabetic mothers, IDM).

Objective: To evaluate the association between hypoglycemia within the first 6 hours of life (HOL) and 2-year neurodevelopmental impairment in appropriate-for-gestational age (AGA) preterm infants with a gestational age (GA) < 32 +0/7 weeks/days.

Design/Methods: We retrospectively reviewed data of 598 AGA preterm infants (GA: 24 +0/7 -31 +6/7 weeks/days). Infants with at least one episode of hypoglycemia within the first 6 HOL (blood glucose concentration below 40mg/dL; Glyc < 40 [Birth-6HOL] ) were compared with infants without hypoglycemia (Glyc≥40 [Birth-6HOL] ). Propensity score matching analysis was conducted for comparisons. Logistic regression analyses were used to evaluate the association of Glyc < 40 [Birth-6HOL] with 2-year cognitive (COG) and motor (MOT) impairments defined as a Bayley-III score < 85.

Results: Of the 598 AGA preterm infants, 129 (21.6%) were classified as Glyc < 40 [Birth-6HOL] , and 469 (78.4%) as Glyc≥40 [Birth-6HOL] . Time from birth to the start of intravenous glucose infusion did not significantly differ between Glyc < 40 [Birth-6HOL] and Glyc≥40 [Birth-6HOL] (Table 1). After multiple adjustments, Glyc < 40 [Birth-6HOL] infants did not have a significantly higher risk of both 2-year COG (ExpB: 1.150, p=0.656) and MOT (ExpB: 0.982, p=0.834) impairment compared to Glyc≥40 [Birth-6HOL] . No differences in 2-year neurodevelopmental scores were found between the 79 matched infant pairs (Figure 1).

Conclusion(s): In AGA preterm infants with a GA 24 +0/7 -31 +6/7 weeks/days, hypoglycemia within the first 6HOL was not an independent risk factor for 2-year COG and MOT impairment.

Table 1. Characteristics at birth, selected interventions and diseases from birth to 36 weeks in Glyc <40[Birth-6HOL] and Glyc≥40[Birth-6HOL] infants.
Data are presented as mean ± SD, median |25P 75P|, or %. Independent t-test, Chi-square test, Fisher test and Mann-Whitney test were used for the statistical analysis (*p < 0.05). GA: gestational age; BW: birth weight; TL: total length; HC: head circumference; SGA: small for gestational age; WT: weight; EN: enteral nutrition; PN: parenteral nutrition; CPAP: continuous positive airway pressure; RDS: respiratory distress syndrome; HMD: hyaline membrane disease; BPD: bronchopulmonary dysplasia; EOS: early onset sepsis; PDA: patent ductus arteriosus; PVL: periventricular leukomalacia; RBC: red blood cells; ROP: retinopathy of prematurity; LOS: late onset sepsis; NEC: necrotizing enterocolitis; IVH: intraventricular hemorrhage; SDS: standard deviation score; NPE: non protein energy.

Figure 1. COG (A) and MOT (B) scores at 2 years of corrected age (Bayley-III test) in 79 Glyc <40[Birth-6HOL] (empty triangles) and Glyc≥40[Birth-6HOL] (empty circles) matched infant pairs.
Data are reported as mean ± SD. Paired t-test was used for the statistical analysis. COG: cognitive; MOT: motor; Glyc <40[Birth-6HOL]: at least one blood glucose concentration of less than 40 mg/dL within the first 6 hours of life; Glyc≥40[Birth-6HOL]: all blood glucose concentrations greater than 40 mg/dL within the first 6 hours of life.