Long-Term Outcomes of Hyperglycemic Preterm Infants Randomized to Tight Glycemic Control

Anna C Tottman, Jane M. Alsweiler, Frank H Bloomfield, Greg G Gamble, Yannan Jiang, Myra Leung, Tanya Poppe, Benjamin Thompson, Trecia A Wouldes, Jane E. Harding, Janene Biggs, Coila Bevan, Joanna M. Black, Kelly Fredell, Sabine Huth, Christine Kevan

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Abstract

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.

Original languageEnglish
Pages (from-to)68-75.e1
Number of pages8
JournalJournal of Pediatrics
Volume193
DOIs
Publication statusPublished - Feb 2018
Externally publishedYes

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Tottman, A. C., Alsweiler, J. M., Bloomfield, F. H., Gamble, G. G., Jiang, Y., Leung, M., ... Kevan, C. (2018). Long-Term Outcomes of Hyperglycemic Preterm Infants Randomized to Tight Glycemic Control. Journal of Pediatrics, 193, 68-75.e1. https://doi.org/10.1016/j.jpeds.2017.09.081