Higher glycemic variability in very low birth weight newborns is associated with greater early neonatal mortality

Abstract

Objective: To determine the association between mean glycemia and its variability with perinatal mortality in preterm newborns hospitalized in an intensive care unit (ICU). Methods: Patients admitted to the ICU within the first 12 hours of life, with birth weight <1500 g, at least three blood glucose measurements/day and lack of insulin treatment were evaluated. Association of mean glycemia and its standard deviation (SD) with death during initial 7 days of life was evaluated. Multivariate logistic regression analysis was performed twice, using continuous glucose concentrations and by means of a quintile-based approach correcting for nonnormal distribution and nonlinear effects. Results: A total of 95 newborns were enrolled. Eleven patients (11.5%) died during the initial 7 days of life, overall mortality equaled 22%. Multivariate analysis showed that 5 minute Apgar score and SD of glucose concentrations were significantly associated with increased mortality in both models. Odds ratios (ORs) equaled 0.44; 95% confidence interval (95% CI) 0.27–0.74 and OR 1.34; 95% CI 1.03–2.03 for the continuous model and 0.50 95% CI 0.34–0.75 and OR 1.82 95% CI 1.07–3.11 for the quintile-based model. In both cases, mean glycemia was removed during the stepwise model-building procedure. Conclusions: Higher glycemic variability may be associated with greater odds of perinatal mortality.

Keywords::

• Hyperglycemia
• hypoglycemia
• intensive care
• neonates

Acknowledgements

The study was funded by the TEAM programme “Polish Registry for Pediatric and Adolescent Diabetes – nationwide genetic screening for monogenic diabetes” financed by the activity 1.2 of the Operational Programme “Innovative Economy” and coordinated by the Foundation for Polish Science. Wojciech Fendler received support from the Foundation for Development of Polish Pharmacy and Medicine and from the European Fund of Regional Development.

Declaration of Interest: The authors report no conflict of interest.