Multiple-Factor Analysis Of Hypoglycemia On Brain Injury In Preterm Infants With Acidosis

Objective: To explore the effect of perinatal hypoglycemia on brain injury in preterm infants with acidosis.Methods: One hundred and fifty-three cases of preterm infants with acidosis were analyzed retrospectively . Short term brain injury includes death result from severe encephalopathy and moderate to severe encephalopathy with or without seizures . Hypoglycemia was defined as an initial blood glucose≤2.6mmol/L.Results:(1) One hundred and sixteen preterm infants (75.8%) were manifested with different extend of brain injury,including10 (8.6%) with severe hypoxic ischemic encephalopathy (HIE) who died ,106 (91.4%) with moderate to severe HIE .(2) Of all the infants,107 (70.0%)were diagnosed hypoglycemia. one hundred and two (87.9%)of hypoglycemic infants and 14 (12.1%) of the other 46 infants with normal blood glucose were determined to develop brain injury (OR=46.6, P<0.01). (3) Among the infants with brain injury, groups hypoglycemia and normal blood glucose have no significant difference (P>0.05) in cardiopulmonary resuscitation (62[60.8%] vs 6[42.9%]), intubation (31[30.4%] vs 2[14.3%]), 5-min Apgar score (7.02±2.24 vs 6.36±1.82), arterial blood pH (7.14±0.15 vs 7.11±0.083), base deficit (9.15±4.74 vs 9.81±3.55 mmol/L) and lactic acid (6.42±3.24 vs 7.31±2.56 mmol/L)(4) Cutoffs of birth weight, arterial blood pH, 5-min Apgar score and lactic acid were determined via Receiver Operating Characteristic (ROC) curve, with results 1775g , 7.15 , 6 and 6.15 mmol/L respectively .(5) Logistic regression analysis was applied to find out multiple risk factors of brain injury, consisting of blood glucose≤2.6mmol/L (OR=10.1), arterial blood pH≤7.185 (OR=21.4), 5-min Apgar score≤6 (OR=8.5), intubation±cardiopulmonary resuscitation (OR=14.5), birth weight≤1775g (OR=13.4), lactic acid≥6.15 mmol/L (OR=7.4). The equation was logistic(brain injury) =-38.763+2.315X1 +3.061X2+ 2.139X3+ 2.676X4+ 2.598X5 +2.005X6 (χ2=32.461, P<0.001).Conclusions:(1) High incidence rate of hypoglycemia and brain injury in preterm infant with acidosis(2) Low birth weight, small gestational age, infant of diabetic mother, emergent caesarean section, asphyxia and hypothermia are high risk factors of hypoglycemia in preterm infant with acidosis. (3) Hypoglycemia, birth weight≤1775g , arterial blood pH≤7.185, lactic acid≥6.15 mmol/L, 5-min Apgar score≤6, intubation±cardiopulmonary resuscitation(CPR) are important risk factors of brain injury in perinatal preterm infant with acidosis.(4) Hypoglycemia combined with hypoxia-ischemia is more deleterious to the immature brain than either condition alone.