Enliven: Pediatrics and Neonatal Biology

Objective: Pediatric studies have shown that glycemic dysregulation is associated with adverse neurologic outcomes in premature neonates. Elevated
peripheral glucose levels are often coupled with low central glucose levels, which can harm neurologic development. We hypothesized that elevated
peripheral blood glucose levels at birth would be associated with periventricular leukomalacia (PVL), a rare but severe type of white matter brain injury
that is a precursor to cerebral palsy.

Methods: We conducted a case-control study comparing premature infants diagnosed with PVL to age-matched controls with normal cranial
ultrasounds. Peripheral glucose levels were obtained via heel sticks prior to any postnatal intervention. Standard statistics including T-tests, chi square
and logistic regression were performed using STATA version 11 (Chicago, IL).

Results: Forty-seven infants were identified, including 16 with ultrasound evidence of PVL and 31 age-matched controls. The neonates with PVL had
a mean gestational age (GA) of 27.99 ± 3.66 (mean ± SD, n = 16), average birth weight of 1121.25±607.7 grams, average cord pH of 7.24 ±0.18 and
average birth glucose of 80.43 ± 26.6 mg/dL. The age-matched controls had a mean GA of 27.83 ± 3.46, mean birth weight of 1105.32 ± 477.3, average
cord pH of 7.26 ± 0.14, and average birth glucose of 72.35 ±16.3 mg/dL. The difference between blood glucose levels between PVL and control groups
was not statistically significant. However, logistic regression modeling revealed an odds ratio of 0.24 (95% CI: 0.063-0.902) for abnormal ultrasound
findings associated with glucose less than 85 mg/dL. The positive predictive value was 62% and the negative predictive value was 79%.

Conclusion: Peripheral glucose levels at or below 85 mg/dL at birth was associated with a decreased rate of PVL in preterm infants. These findings
suggest that glycemic autoregulation might have a protective neurologic effect on premature infants. Additionally, birth heel-stick glucose levels may
prove to be a valuable risk stratification tool for preterm infants.