486 - The relationship between glucose levels and seizures in neonatal encephalopathy

Poster Number: 486
Publication Number: 486.343

Carlos I. Salazar Cerda, The Hospital for Sick Children, Toronto, ON, Canada; Emily W. Tam, Hospital for Sick Children, Toronto, ON, Canada; Jessy Parokaran Varghese, The Hospital for Sick Children, Kitchener, ON, Canada; Daphne Kamino, The Host, Toronto, ON, Canada; Vann Chau, The Hospital for Sick Children, Toronto, ON, Canada; Cecil D. Hahn, The Hospital for Sick Children, Toronto, ON, Canada; Elana Pinchefsky, CHU Sainte-Justine, Montreal, PQ, Canada

Background: Glucose derangements result in worsening of brain function in neonatal encephalopathy (NE), but its temporal relationship with seizures is not well understood.

Objective: The relationship between glucose derangements and neonatal seizures in term NE was studied using continuous glucose monitoring (CGM) and brain monitoring through conventional video electroencephalography (cEEG).

Design/Methods: Prospective cohort study of newborns ≥36 weeks PMA recruited within 6 hours of life using glucose monitoring with CGM, measuring interstitial glucose values every 5 minutes. cEEG was started as soon after birth as possible and continued for 48 hours to identify electrographic seizures. Multi-level mixed-effects logistic regression modeling was used to understand the between subject and within subject relationship between glucose levels and the occurrence of seizures in 5-minute epochs, adjusting for 5-minute Apgar score and umbilical artery pH.

Results: Of 103 subjects enrolled, 21(20.3%) demonstrated electrographic seizures. Newborns with seizures had mean glucose 7.19± 4.12 mmol/L. Newborns without seizures had mean glucose 4.92± 1.58 mmol/L. Using the Mann-Whitney rank sum test, infants with seizures had statistically significant higher mean (P= < 0.001) and maximum glucose levels (P= < 0.001), as well as difference in glucose standard deviation (P=0.002) compared to newborns without seizures, and no statistically difference in minimum glucose levels (P=0.46). Multi-level mixed-effects logistic regression analysis demonstrated that between subjects a 1 mmol/L HIGHER glucose level was associated with 1.96-fold higher odds of electrographic seizures (95%CI 1.04-3.66, P=0.035), while within each subject a 1 mmol/L LOWER glucose level was associated with 1.19-fold higher odds of electrographic seizures (95%CI 1.15-1.23, P < 0.001), after adjusting for 5-minute Apgar score and umbilical artery pH.Conclusion(s): In term NE, higher glucose levels are associated with neonatal seizures when comparing between subjects. Within subjects, glucose levels are lower during seizures, which may be a reflection of higher glucose consumption during seizures. These results support closer EEG monitoring of infants with NE and hyperglycemia, to facilitate timely seizure identification and management.