新生儿过渡性低血糖对18月龄发育商的影响

Effect of Neonatal Transitional Hypoglycemia on Neurodevelopmental Outcomes at 18 Months Age

目的探讨院内新生儿过渡性低血糖对18月龄发育商的影响。方法纳入生后日龄48 h低血糖的住院新生儿共58例,给予规范管理,进行AEEG、MRI检查,出院后随访,至18月龄采用贝利婴幼儿发展量表(BSID)评估发育商。结果(1)发生低血糖时间的中位数为3.86 h(0.5~44 h),平均持续时间为(2.03±0.67)h,平均静脉血糖为(1.62±0.37)m mol/L。(2)第1次a E E G结果 :背景活动异常3例;睡眠-清醒周期消失2例、不成熟7例;惊厥波2例。第2次aEEG检查睡眠-清醒周期不成熟2例,其余正常。(3)45例行头颅MRI检查,7例异常。18月时BSID评估,MDI、PDI分别为93.91±6.35,95.86±7.27;血糖值与MDI、PDI的Spearman相关性分析结果显示,r分别为0.061和0.656,P均>0.05,无统计学意义;散点图中各点呈现杂乱无序。结论新生儿过渡性低血糖经过规范的血糖监测、合适的干预后,18月时发育商正常,且与血糖水平无相关性。远期预后需要进一步长期随访。

Objective To investigate the impact of neonatal transitional hypoglycemia on neurodevelopment in the infants at 18-months age. Methods Fifty-eight hospitalized infants with hypoglycemia were enrolled within 48 h after birth.The infants were given standardized management,aEEG detection,MRI scan,and assessed by using the Bayley Infant Development Scale（BSID） to 18 months after discharge. Results The median of hypoglycemia occurrence time after birth is 3.86 h（0.5～44 h）,with the duration of 2.03±0.67 h,and venous blood glucose concentration was 1.62±0.37 mmol/L.The first aEEG findings included disappeared sleep-wake cycles in 2 cases,immatures in 7 cases,and convulsions in 2 cases.The repeated aEEG examination revealed immature sleep-wake cycle in 2 cases. Brain MRI scans showed 7 abnormalities of 45 cases. BSID assessment of the infants at 18 months age demonstrated 93.91±6.35 of MDI and 95.86±7.27 of PDI. Spearman correlation analysis between blood glucose and MDI,PDI showed no obvious correlation（r ：0.061,0.656,P〈0.05）.The scatter diagram of each point presented mess disorder.Conclusions Developmental quotients of neonatal transitional hypoglycemia infants were normal at 18 months and were not associated with lowed blood glucose levels if they were received standardized blood glucose management after born. Long-term prognosis need further following-up.