Association of Neonatal Glycemia with Neurodevelopmental Outcomes at 4.5 Years
Christopher J. D. McKinlay,Jane M Alsweiler,Nicola Anstice,Nataliia Burakevych,Arijit Chakraborty,Arijit Chakraborty,J. Geoffrey Chase,Gregory D. Gamble,Deborah L. Harris,Robert J. Jacobs,Yannan Jiang,Nabin Paudel,Ryan J. San Diego,Benjamin Thompson,Benjamin Thompson,Trecia A. Wouldes,Jane E. Harding +16 more
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TLDR
Neonatal hypoglycemia was not associated with increased risk of combined neurosensory impairment at 4.5 years but was associated with a dose-dependent increasedrisk of poor executive function and visual motor function, even if not detected clinically, and may thus influence later learning.Abstract:
Importance Hypoglycemia is common during neonatal transition and may cause permanent neurological impairment, but optimal intervention thresholds are unknown. Objective To test the hypothesis that neurodevelopment at 4.5 years is related to the severity and frequency of neonatal hypoglycemia. Design, Setting, and Participants The Children With Hypoglycemia and Their Later Development (CHYLD) Study is a prospective cohort investigation of moderate to late preterm and term infants born at risk of hypoglycemia. Clinicians were masked to neonatal interstitial glucose concentrations; outcome assessors were masked to neonatal glycemic status. The setting was a regional perinatal center in Hamilton, New Zealand. The study was conducted from December 2006 to November 2010. The dates of the follow-up were September 2011 to June 2015. Participants were 614 neonates born from 32 weeks’ gestation with at least 1 risk factor for hypoglycemia, including diabetic mother, preterm, small, large, or acute illness. Blood and masked interstitial glucose concentrations were measured for up to 7 days after birth. Infants with hypoglycemia (whole-blood glucose concentration Exposures Neonatal hypoglycemic episode, defined as at least 1 consecutive blood glucose concentration less than 47 mg/dL, a severe episode ( Main Outcomes and Measures Cognitive function, executive function, visual function, and motor function were assessed at 4.5 years. The primary outcome was neurosensory impairment, defined as poor performance in one or more domains. Results In total, 477 of 604 eligible children (79.0%) were assessed. Their mean (SD) age at the time of assessment was 4.5 (0.1) years, and 228 (47.8%) were female. Those exposed to neonatal hypoglycemia (280 [58.7%]) did not have increased risk of neurosensory impairment (risk difference [RD], 0.01; 95% CI, −0.07 to 0.10 and risk ratio [RR], 0.96; 95% CI, 0.77 to 1.21). However, hypoglycemia was associated with increased risk of low executive function (RD, 0.05; 95% CI, 0.01 to 0.10 and RR, 2.32; 95% CI, 1.17 to 4.59) and visual motor function (RD, 0.03; 95% CI, 0.01 to 0.06 and RR, 3.67; 95% CI, 1.15 to 11.69), with highest risk in children exposed to severe, recurrent, or clinically undetected (interstitial episodes only) hypoglycemia. Conclusions and Relevance Neonatal hypoglycemia was not associated with increased risk of combined neurosensory impairment at 4.5 years but was associated with a dose-dependent increased risk of poor executive function and visual motor function, even if not detected clinically, and may thus influence later learning. Randomized trials are needed to determine optimal screening and intervention thresholds based on assessment of neurodevelopment at least to school age.read more
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Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children
Scott L. Weiss,Mark J. Peters,Waleed Alhazzani,Michael S. D. Agus,Heidi R. Flori,David Inwald,Simon Nadel,Luregn J. Schlapbach,Robert C. Tasker,Andrew C. Argent,Joe Brierley,Joseph Carcillo,Enitan D. Carrol,Christopher L. Carroll,Ira M. Cheifetz,Karen Choong,Jeffry J. Cies,Andrea T. Cruz,Daniele De Luca,Daniele De Luca,Akash Deep,Saul N. Faust,Claudio Flauzino De Oliveira,Mark W. Hall,Paul Ishimine,Etienne Javouhey,Koen F. M. Joosten,Poonam Joshi,Oliver Karam,Martin C. J. Kneyber,Joris Lemson,Graeme MacLaren,Nilesh M. Mehta,Morten Hylander Møller,Christopher J. L. Newth,Trung C. Nguyen,Akira Nishisaki,Mark E. Nunnally,Margaret M. Parker,Raina Paul,Adrienne G. Randolph,Suchitra Ranjit,Lewis H. Romer,Halden F. Scott,Lyvonne N Tume,Judy T. Verger,Judy T. Verger,Eric A. Williams,Joshua Wolf,Hector R. Wong,Jerry J. Zimmerman,Niranjan Kissoon,Pierre Tissieres,Pierre Tissieres +53 more
TL;DR: A large cohort of international experts was able to achieve consensus regarding many recommendations for the best care of children with sepsis, acknowledging that most aspects of care had relatively low quality of evidence resulting in the frequent issuance of weak recommendations.
Journal ArticleDOI
Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children
Scott L. Weiss,Mark J. Peters,Waleed Alhazzani,Michael S. D. Agus,Heidi R. Flori,David Inwald,Simon Nadel,Luregn J. Schlapbach,Robert C. Tasker,Andrew C. Argent,Joe Brierley,Joseph Carcillo,Enitan D. Carrol,Christopher L. Carroll,Ira M. Cheifetz,Karen Choong,Jeffry J. Cies,Andrea T. Cruz,Daniele De Luca,Daniele De Luca,Akash Deep,Saul N. Faust,Claudio Flauzino De Oliveira,Mark W. Hall,Paul Ishimine,Etienne Javouhey,Koen F. M. Joosten,Poonam Joshi,Oliver Karam,Martin C. J. Kneyber,Joris Lemson,Graeme MacLaren,Graeme MacLaren,Nilesh M. Mehta,Morten Hylander Møller,Christopher J. L. Newth,Trung C. Nguyen,Akira Nishisaki,Mark E. Nunnally,Margaret M. Parker,Raina Paul,Adrienne G. Randolph,Suchitra Ranjit,Lewis H. Romer,Halden F. Scott,Lyvonne N Tume,Judy T. Verger,Judy T. Verger,Eric A. Williams,Joshua Wolf,Hector R. Wong,Jerry J. Zimmerman,Niranjan Kissoon,Pierre Tissieres,Pierre Tissieres +54 more
TL;DR: A large cohort of international experts was able to achieve consensus regarding many recommendations for the best care of children with sepsis, acknowledging that most aspects of care had relatively low quality of evidence resulting in the frequent issuance of weak recommendations.
Journal ArticleDOI
Neonatal Glycaemia and Neurodevelopmental Outcomes: A Systematic Review and Meta-Analysis
TL;DR: Neonatal hypoglycaemia may have important long-lasting adverse effects on neurodevelopment that may become apparent at later ages and carefully designed randomized trials are required to determine the optimal management of neonates at risk of hypoglycemia with long-term follow-up at least to school age.
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Antenatal corticosteroids: an assessment of anticipated benefits and potential risks.
TL;DR: In this article, the benefits of using antenatal corticosteroids for periviable deliveries in high-resource environments were evaluated. But, the randomized controlled trial data also did not strongly support the optimal interval from pregnancy onset to delivery of 1-7 days.
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Lower versus Traditional Treatment Threshold for Neonatal Hypoglycemia
A. A. M. W. van Kempen,P. F. Eskes,D. H. G. M. Nuytemans,JH van der Lee,Lea M. Dijksman,N. van Veenendaal,F. J. P. C. M. van der Hulst,R. M. J. Moonen,Luc J. I. Zimmermann,E. P. van't Verlaat,M. van Dongen-van Baal,B. A. Semmekrot,H. G. Stas,R. H. T. van Beek,J. J. Vlietman,P. H. Dijk,J. U. M. Termote,R. C. J. de Jonge,A. C. de Mol,M. W. A. Huysman,Joke H. Kok,Martin Offringa,Nicole Boluyt +22 more
TL;DR: In otherwise healthy newborns with asymptomatic moderate hypoglycemia, a lower glucose treatment threshold was noninferior to a traditional threshold with regard to psychomotor development at 18 months.
References
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Global motion perception is independent from contrast sensitivity for coherent motion direction discrimination and visual acuity in 4.5-year-old children
Arijit Chakraborty,Nicola Anstice,Robert J. Jacobs,Nabin Paudel,Linda L. LaGasse,Barry M. Lester,Trecia A. Wouldes,Jane E. Harding,Benjamin Thompson,Benjamin Thompson +9 more
TL;DR: Assessing the relationships between global motion perception, contrast sensitivity for coherent motion direction discrimination (henceforth referred to as contrast sensitivity) and habitual visual acuity in a large group of 4.5-year-old children indicates that global motion Perception for high contrast stimuli is independent of contrast sensitivity and visual acute and can be used to assess motion integration mechanisms in children.