Je Harding

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

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.

O-104 Two Year Outcomes Of Children Treated With Dextrose Gel For Neonatal Hypoglycaemia: Follow Up Of A Randomised Trial

Background Neonatal hypoglycaemia is linked to poor developmental outcome. Dextrose gel reverses hypoglycaemia, but its long term effects are unknown. Aim To determine two year outcomes of children randomised to dextrose or placebo gel for treatment of neonatal hypoglycaemia1. Methods At risk babies who became hypoglycaemic (<2.6 mM) were randomised to 40% dextrose or placebo gel. Children were assessed at two years’ corrected age for neurological function and general health (paediatrician assessed); cognitive, language, behaviour and motor skills (Bayley III); executive function; and vision (clinical examination and global motion perception). Primary outcomes were neurosensory disability (cognitive, language or motor score below -1 SD or cerebral palsy or blind or deaf) and processing problem (executive function or global motion perception worse than 1.5 SD). Data are mean (SD), n (%), or relative risk (RR), 95% confidence interval. Results 184 children were assessed; 90/118 (76%) randomised to dextrose and 94/119 (79%) to placebo gel. Mean birth weight was 3093 (803) g and gestation 37.7 (1.6) wk. 67 children (36%) had neurosensory disability (1 severe, 9 moderate, 57 mild) with similar rates in both groups (dextrose 35 (39%) vs placebo 32 (34%), RR 1.14, 0.78–1.67). Processing difficulty was also similar in both groups (dextrose 8 (10%) vs placebo 16 (18%), RR 0.52, 0.23–1.15). Discussion Neurosensory disability is common amongst children treated for neonatal hypoglycaemia. Treatment with dextrose gel does not change the incidence of disability or processing problems. Reference Harris DL, et al. Dextrose gel for neonatal hypoglycaemia (the Sugar Babies Study). Lancet 2013;382:2077–83