The relationship between neonatal hyperglycemia, neonatal illness, and 3-year outcomes in extremely preterm infants

Abstract

Aim: To investigate the association between neonatal hyperglycemia during the first month of life and perinatal characteristics, neonatal morbidities, and developmental outcomes at 3 years of age in extremely preterm (EPT) infants.

Methods: This retrospective cohort study included infants born at before 28 weeks of gestation between 2013 and 2020. Infants were categorized into normoglycemia, mild hyperglycemia, and severe hyperglycemia groups based on the frequency of morning blood glucose measurements ≥150 mg/dL and ≥180 mg/dL during the first 28 postnatal days. Perinatal data, clinical outcomes, and neurodevelopmental assessments at 3 years of age using the Kyoto Scale of Psychological Development 2001 (KSPD) were analyzed.

Results: Among 195 infants with available glucose data, 151 underwent neurodevelopmental assessment at 3 years of age. Greater degrees of hyperglycemia were associated with lower gestational age (GA) and birth weight. Severe hyperglycemia was significantly associated with increased rates of postnatal steroid use and late-onset circulatory collapse (LCC). Infants with severe hyperglycemia demonstrated significantly lower overall Development Quotient (DQ) and Postural-Motor (P-M) DQ scores in univariate analyses. Similarly, higher mean blood glucose levels were associated with lower scores in these domains. However, after adjustment for birth weight and LCC, these associations were no longer statistically significant.

Conclusion: In EPT infants, neonatal hyperglycemia during the first postnatal month was associated with greater immaturity, and did not show an independent association with adverse neurodevelopmental outcomes at 3 years of age.

Keywords: Age 3 years; Developmental quotient; Extremely preterm infants; First month; Hyperglycemia; Neurodevelopment.