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

Research output: Contribution to journalArticle

4 Citations (Scopus)

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

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Premature Infants
Hyperglycemia
Fasting
Wechsler Scales
Glucose
Very Low Birth Weight Infant
Photon Absorptiometry
Neurologic Examination
Glucose Tolerance Test
Growth
Body Composition
Intelligence
Gestational Age
Cluster Analysis
Blood Glucose
Linear Models
Head
Parturition
Newborn Infant
Insulin

Cite this

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. https://doi.org/10.1016/j.jpeds.2017.09.081
Tottman, Anna C ; Alsweiler, Jane M. ; Bloomfield, Frank H ; Gamble, Greg G ; Jiang, Yannan ; Leung, Myra ; Poppe, Tanya ; Thompson, Benjamin ; Wouldes, Trecia A ; Harding, Jane E. ; Biggs, Janene ; Bevan, Coila ; Black, Joanna M. ; Fredell, Kelly ; Huth, Sabine ; Kevan, Christine. / Long-Term Outcomes of Hyperglycemic Preterm Infants Randomized to Tight Glycemic Control. In: Journal of Pediatrics. 2018 ; Vol. 193. pp. 68-75.
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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.",
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Tottman, AC, Alsweiler, JM, Bloomfield, FH, Gamble, GG, Jiang, Y, Leung, M, Poppe, T, Thompson, B, Wouldes, TA, Harding, JE, Biggs, J, Bevan, C, Black, JM, Fredell, K, Huth, S & Kevan, C 2018, 'Long-Term Outcomes of Hyperglycemic Preterm Infants Randomized to Tight Glycemic Control', Journal of Pediatrics, vol. 193, pp. 68-75. https://doi.org/10.1016/j.jpeds.2017.09.081

Long-Term Outcomes of Hyperglycemic Preterm Infants Randomized to Tight Glycemic Control. / Tottman, Anna C; Alsweiler, Jane M.; Bloomfield, Frank H; Gamble, Greg G; Jiang, Yannan; Leung, Myra; Poppe, Tanya; Thompson, Benjamin; Wouldes, Trecia A; Harding, Jane E.; Biggs, Janene; Bevan, Coila; Black, Joanna M.; Fredell, Kelly; Huth, Sabine; Kevan, Christine.

In: Journal of Pediatrics, Vol. 193, 02.2018, p. 68-75.

Research output: Contribution to journalArticle

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

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.

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.

U2 - 10.1016/j.jpeds.2017.09.081

DO - 10.1016/j.jpeds.2017.09.081

M3 - Article

VL - 193

SP - 68

EP - 75

JO - Journal of Pediatrics

JF - Journal of Pediatrics

SN - 0022-3476

ER -