TY - JOUR
T1 - Long-Term Outcomes of Hyperglycemic Preterm Infants Randomized to Tight Glycemic Control
AU - Tottman, Anna C
AU - Alsweiler, Jane M.
AU - Bloomfield, Frank H
AU - Gamble, Greg G
AU - Jiang, Yannan
AU - Leung, Myra
AU - Poppe, Tanya
AU - Thompson, Benjamin
AU - Wouldes, Trecia A
AU - Harding, Jane E.
AU - Biggs, Janene
AU - Bevan, Coila
AU - Black, Joanna M.
AU - Fredell, Kelly
AU - Huth, Sabine
AU - Kevan, Christine
N1 - Funding Information:
Supported by the Health Research Council of New Zealand Programme ( 12-095 ) and the A+ trust project ( 5486 ). A.T. received research support from the University of Auckland Senior Health Researcher Scholarship and a Gravida : National Centre for Growth and Development doctoral scholarship . The authors declare no conflicts of interest.
Funding Information:
Supported by the Health Research Council of New Zealand programme grant (12-095) and the A+ trust project grant (5486). A.T. received research support from the University of Auckland Senior Health Researcher Scholarship and a Gravida: National Centre for Growth and Development doctoral scholarship. The authors declare no conflicts of interest.
Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2018/2
Y1 - 2018/2
N2 - 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.
AB - 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.
KW - blood glucose
KW - hyperglycemia
KW - insulin
KW - neonate
KW - neurodevelopment
UR - http://www.scopus.com/inward/record.url?scp=85035812731&partnerID=8YFLogxK
UR - http://www.mendeley.com/research/longterm-outcomes-hyperglycemic-preterm-infants-randomized-tight-glycemic-control
U2 - 10.1016/j.jpeds.2017.09.081
DO - 10.1016/j.jpeds.2017.09.081
M3 - Article
SN - 0022-3476
VL - 193
SP - 68
EP - 75
JO - Journal of Pediatrics
JF - Journal of Pediatrics
ER -