Early blood glucose profile and neurodevelopmental outcome at two years in neonatal hypoxic-ischaemic encephalopathy

Background: To examine the blood glucose profile and the relationship between blood glucose levels and neurodevelopmental outcome in term infants with hypoxic-ischaemic encephalopathy. Methods: Blood glucose values within 72 hours of birth were collected from 52 term infants with hypoxic-ischaemic encephalopathy. Hypoglycaemia [ 150 mg/dL (8.3 mmol/L)] were correlated to neurodevelopmental outcome at 24 months of age. Results: Four fifths of the 468 blood samples were in the normoglycaemic range (392/468:83.8%). Of the remaining 76 samples, 51.3% were in the hypoglycaemic range and (48.7%) were hyperglycaemic. A quarter of the hypoglycaemic samples (28.2%:11/39) and a third of the hyperglycaemic samples (32.4%:12/37) were recorded within the first 30 minutes of life. Mean (SD) blood glucose values did not differ between infants with normal and abnormal outcomes [4.89(2.28) mmol/L and 5.02(2.35) mmol/L, p value = 0.15] respectively. In term infants with hypoxic-ischaemic encephalopathy, early hypoglycaemia (between 0-6 hours of life) was associated with adverse outcome at 24 months of age [OR = 5.8, CI = 1.04-32)]. On multivariate analysis to adjust for grade of HIE this association was not statistically significant. Late hypoglycaemia (6-72 hours of life) was not associated with abnormal outcome [OR = 0.22, CI (0.04-1.14)]. The occurrence of hyperglycaemia was not associated with adverse outcome. Conclusion: During the first 72 hours of life, blood glucose profile in infants with hypoxic-ischaemic encephalopathy varies widely despite a management protocol. Early hypoglycaemia (0-6 hours of life) was associated with severe HIE, and thereby; adverse outcome

Fatores de risco maternos associados à acidose fetal Maternal risk factors associated with fetal acidosis

OBJETIVOS: avaliar os fatores de risco maternos associados à acidose fetal. MÉTODOS: estudo tipo caso-controle composto por 188 recém-nascidos, sendo que 47 compuseram o grupo casos (pH de artéria umbilical <7,0) e 141 os de controles (pH de artéria umbilical <7,1 <7,3) nascidos imediatamente após cada caso. Consideraram-se fatores de inclusão: recém-nascidos de gestações únicas e sem malformação congênita. Analisaram-se variáveis maternas e fetais. Foram realizadas a Odds Ratio bruta e ajustada, teste t de Student, teste do qui-quadrado e análise multivariada através da regressão logística nãocondicional pelo método Enter. Assumiu-se como nível de significância estatística um p<0,05. RESULTADOS: no grupo de casos foi observado maior percentual de cesarianas, de recém-nascidos pré-termo, que apresentaram quase cinco vezes mais necessidade de cuidados intensivos e vinte cinco vezes mais chance de Apgar no 5º minuto <7. Não foram observadas associação entre os grupos e a apresentação fetal, idade materna, história de abortos anteriores, escolaridade materna e frequência ao pré-natal. Após a análise multivariada persistiram como fator de risco complicações relacionadas com a placenta e cordão. Os recémnascidos cujos partos associaram-se a complicações da placenta ou do cordão umbilical apresentaram três vezes mais chance de acidemia fetal. CONCLUSÕES: os recém-nascidos acidóticos estiveram relacionados à maior percentual de cesarianas, de prematuridade, necessidade de cuidados de tratamento intensivo e índice de Apgar <7 no 5º minuto. Após a análise multivariada, persistiram como fator de risco para acidemia fetal as complicações relacionadas ao descolamento prematuro de placenta e cordão umbilical.<br>OBJECTIVES: to assess maternal risk factors associated with fetal acidosis. METHODS: a case-control type study was conducted of 188 neonates, of whom 47 comprised the case group (umbilical arterial pH <7.0) and 141 the control (umbilical arterial pH E7.1 <7.3). The study included only single-gestation neonates without congenital malformations. Both maternal and fetal variables were taken into consideration. Statistical analysis involved the calculation of the raw and adjusted Odds Ratio, Student's t-test, the chi-squared test and multivariate analysis using Enter-method non-conditional logistic regression. The level of statistical significance was set at p<0.05. RESULTS: in the case group higher percentages of caesarian sections and pre-term births were observed, involving almost five times as much intensive care and twenty-five times more likelihood of Apgar in the 5th minute <7. No association was observed between the groups and fetal presentation, mother's age, history of miscarriage, years of schooling of mother or attendance at prenatal sessions. After multivariate analysis, the only risk factors that remained significant were complications relating to the placenta or the umbilical cord. Deliveries involving complications relating to the placenta or the umbilical cord were three times more likely to involve fetal acidemia. CONCLUSIONS: acidemia among neonates was associated with a higher percentage of caesarians, premature births, a need for intensive care and treatment and an Apgar index of <7 in the 5th minute. After multivariate analysis, complications relating to premature displacement of the placenta and the umbilical cord were the only remaining risk factors associated with fetal acidemia