Long-Term Outcomes of Hyperglycemic Preterm Infants Randomized to Tight Glycemic Control

J Pediatr. 2018 Feb;193:68-75.e1. doi: 10.1016/j.jpeds.2017.09.081. Epub 2017 Dec 1.

Abstract

Objective: To determine whether tight glycemic control of neonatal hyperglycemia changes neurodevelopment, growth, and metabolism at school age.

Study design: Children born very low birth weight and randomized as hyperglycemic neonates to a trial of tight vs standard glycemic control were assessed at 7 years corrected age, including Wechsler Intelligence Scale for Children Fourth Edition, Movement Assessment Battery for Children 2, visual and neurologic examinations, growth measures, dual X-ray absorptiometry, and frequently sampled intravenous glucose tolerance test. The primary outcome was survival without neurodevelopmental impairment at age 7 years. Outcomes were compared using linear regression, adjusted for sex, small for gestational age, birth plurality, and the clustering of twins. Data are reported as number (%) or mean (SD).

Results: Of the 88 infants randomized, 11 (13%) had died and 57 (74% of eligible children) were assessed at corrected age 7 years. Survival without neurodevelopmental impairment occurred in 25 of 68 children (37%), with no significant difference between tight (14 of 35; 40%) and standard (11 of 33; 33%) glycemic control groups (P = .60). Children in the tight group were shorter than those in the standard group (121.3 [6.3] cm vs 125.1 [5.4] cm; P < .05), but had similar weight and head circumference. Children in the tight group had greater height-adjusted lean mass (18.7 [0.3] vs 17.6 [0.2] kg; P < .01) and lower fasting glucose concentrations (84.6 [6.30] vs 90.0 [5.6] mg⋅dL-1; P < .05), but no other differences in measures of body composition or insulin-glucose metabolism.

Conclusion: Tight glycemic control for neonatal hyperglycemia does not change survival without neurodevelopmental impairment, but reduces height, increases height-adjusted lean mass, and reduces fasting blood glucose concentrations at school age.

Trial registration: ACTRN: 12606000270516.

Keywords: blood glucose; hyperglycemia; insulin; neonate; neurodevelopment.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Absorptiometry, Photon
  • Blood Glucose / analysis*
  • Blood Glucose / drug effects
  • Child
  • Child Development / physiology*
  • Female
  • Glucose Tolerance Test
  • Humans
  • Hyperglycemia / blood
  • Hyperglycemia / complications*
  • Hyperglycemia / mortality
  • Infant
  • Infant, Newborn
  • Infant, Newborn, Diseases / blood
  • Infant, Newborn, Diseases / epidemiology*
  • Infant, Newborn, Diseases / etiology
  • Infant, Premature
  • Infant, Very Low Birth Weight
  • Male
  • Neurodevelopmental Disorders / blood
  • Neurodevelopmental Disorders / epidemiology*
  • Neurodevelopmental Disorders / etiology
  • Survival Rate

Substances

  • Blood Glucose