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Observational Study
. 2018 Dec:203:137-143.
doi: 10.1016/j.jpeds.2018.07.041. Epub 2018 Sep 6.

Early Glycemic Profile Is Associated with Brain Injury Patterns on Magnetic Resonance Imaging in Hypoxic Ischemic Encephalopathy

Sudeepta K Basu  1 , Katherine Ottolini  1 , Vedavalli Govindan  2 , Suleiman Mashat  2 , Gilbert Vezina  3 , Yunfei Wang  4 , Michaelande Ridore  1 , Taeun Chang  5 , Jeffrey R Kaiser  6 , An N Massaro  7
Affiliations
Observational Study

Early Glycemic Profile Is Associated with Brain Injury Patterns on Magnetic Resonance Imaging in Hypoxic Ischemic Encephalopathy

Sudeepta K Basu et al. J Pediatr. 2018 Dec.

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.

Keywords: MRI; basal ganglia injury; brain injury pattern; focal-multifocal infarct; hyperglycemia; hypoglycemia; hypoxic ischemic encephalopathy; neonatal; phenotype; watershed.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1.
Figure 1.
Distribution of patterns of brain injury on MRI stratified by glycemic groups a) Among infants with post-rewarming MRI: P value .004 (adjusted 0.03)* b) Including infants who died prior to MRI: P value .009 (adjusted .09)*
Figure 1.
Figure 1.
Distribution of patterns of brain injury on MRI stratified by glycemic groups a) Among infants with post-rewarming MRI: P value .004 (adjusted 0.03)* b) Including infants who died prior to MRI: P value .009 (adjusted .09)*
See this image and copyright information in PMC

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