Quantitative imaging in medicine and surgery · 2026
Microstructural white matter changes in infants with transient neonatal hypoglycemia revealed by diffusion tensor imaging: a preliminary cross-sectional study.
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Xuan De-Sheng, Zhao Xin, Liu Yan-Chao, Xing Qing-Na, Shang Hong-Lei, Wang Xue-Yuan, Zhou Liang, Zhang Xiao-An
Аннотация
BACKGROUND: Neonatal hypoglycemia (NH) is a common metabolic disorder that has been closely linked to abnormal neurodevelopment and brain injury. However, microstructural alterations in white matter among infants with transient NH remain poorly characterized. This study employed diffusion tensor imaging (DTI) to investigate whether transient NH induces microstructural white matter injury and to examine its correlation with blood glucose fluctuations.
METHODS: In this retrospective cohort study, we enrolled 20 infants with transient NH and 22 sex- and gestational age (GA)-matched normoglycemic controls. All participants underwent 3-T DTI and had more than 13 blood glucose measurements within the first 48 hours of life between February 16, 2020, and October 17, 2023. To compare fractional anisotropy (FA) values between the two groups of regions of interest (ROIs), statistical significance was assessed using the Wilcoxon rank-sum test. Perinatal history and relevant clinical data were analyzed, and their association with FA values was assessed using partial correlation analysis, controlling for potential confounders.
RESULTS: FA values in the splenium of the corpus callosum (sCC)-a marker of white matter integrity-were significantly lower in infants with transient NH compared to the control group (P=0.03). After adjustment for confounders, a significant positive correlation was observed between the lowest blood glucose (LBG) levels and sCC FA values across the cohort (P=0.013, r=0.408).
CONCLUSIONS: Our findings indicate that FA values are sensitive to microstructural white matter alterations in infants with NH, potentially serving as an early indicator of subtle brain changes that warrant further investigation as a biomarker. The sCC appears to be particularly vulnerable to hypoglycemic injury, suggesting a potential pattern of early neurologic impairment. Furthermore, our findings indicate that the degree of white matter alteration is associated with the severity of hypoglycemia, as indicated by the lowest recorded blood glucose level.
METHODS: In this retrospective cohort study, we enrolled 20 infants with transient NH and 22 sex- and gestational age (GA)-matched normoglycemic controls. All participants underwent 3-T DTI and had more than 13 blood glucose measurements within the first 48 hours of life between February 16, 2020, and October 17, 2023. To compare fractional anisotropy (FA) values between the two groups of regions of interest (ROIs), statistical significance was assessed using the Wilcoxon rank-sum test. Perinatal history and relevant clinical data were analyzed, and their association with FA values was assessed using partial correlation analysis, controlling for potential confounders.
RESULTS: FA values in the splenium of the corpus callosum (sCC)-a marker of white matter integrity-were significantly lower in infants with transient NH compared to the control group (P=0.03). After adjustment for confounders, a significant positive correlation was observed between the lowest blood glucose (LBG) levels and sCC FA values across the cohort (P=0.013, r=0.408).
CONCLUSIONS: Our findings indicate that FA values are sensitive to microstructural white matter alterations in infants with NH, potentially serving as an early indicator of subtle brain changes that warrant further investigation as a biomarker. The sCC appears to be particularly vulnerable to hypoglycemic injury, suggesting a potential pattern of early neurologic impairment. Furthermore, our findings indicate that the degree of white matter alteration is associated with the severity of hypoglycemia, as indicated by the lowest recorded blood glucose level.