Neurophysiological changes associated with dysglycemia in term neonates with neonatal encephalopathy.

OBJECTIVE

To investigate the relationship between hypo/hyperglycemia and EEG measures in term neonates with neonatal encephalopathy (NE) treated with therapeutic hypothermia (TH).

METHODS

Ninety-six neonates underwent concurrent continuous glucose monitoring (CGM) and EEG for 48 h within the first 72 h of life. Five-minute epochs of hypoglycemia (≤2.6 mmol/L; ≤47 mg/dL) and hyperglycemia (>10.1 mmol/L; >182 mg/dL) were identified. Continuous EEG data was segmented into 5-min epochs corresponding to 5-min CGM data. Visual EEG background score and 22 computational EEG measures were estimated and their relationship to dysglycemia was assessed after adjusting for hypoxia-ischemia severity and multiple testing.

RESULTS

Among the 96 neonates, 12 had hypoglycemia, 16 had hyperglycemia, including 1 with both during the recording period. In the adjusted analyses, hyperglycemic epochs were associated with worse visual background scores (1.2, 95 %CI 0.51-1.89, q = 0.003) and 11 computational EEG measures. In contrast, hypoglycemic epochs were not associated with a significant change in visual background scores (-0.28, 95 %CI -0.66 - -0.10, q = 0.549), and were only associated with one computational EEG measure.

CONCLUSIONS

Hyperglycemia is temporally associated with changes in brain function in term neonates with NE treated with TH.

SIGNIFICANCE: This temporal relationship suggests high glucose levels may contribute directly to brain injury after NE.