SavedAdd your journal

Journals / Çocuk Dergisi / 2026 / Cilt: 23 Sayı: 2

An Insidious Threat for Cerebral Oxygenation: Neonatal Hypoglycemia

Beyin Oksijenasyonu için Sinsi Tehdit: Neonatal Hipoglisemi

Beril Yaşa(University of Health Sciences Istanbul Basaksehir Çam and Sakura City Hospital, Pediatrics, Neonatal Clinic)0000-0001-7871-3121
İlker Gönen(University of Health Sciences Istanbul Basaksehir Çam and Sakura City Hospital, Pediatrics, Neonatal Clinic)0000-0001-9630-1390
Özge Sağlam(University of Health Sciences Istanbul Kanuni Sultan Süleyman Training and Research Hospital, Pediatrics, Neonatal Clinic)0000-0003-1650-4951
Emre Dincer(University of Health Sciences Istanbul Kanuni Sultan Süleyman Training and Research Hospital, Pediatrics, Neonatal Clinic)0000-0003-1429-3206
Halime Sema Can Büker(University of Health Sciences Istanbul Basaksehir Çam and Sakura City Hospital, Pediatrics, Neonatal Clinic)0000-0003-2276-432X
Merih Çetinkaya(University of Health Sciences Istanbul Basaksehir Çam and Sakura City Hospital, Pediatrics, Neonatal Clinic)0000-0002-7344-8637
Pages
159–163
Publication Date
2023-06-30
🏛️Bibliographic metadata and full text access for this article are provided via DergiPark.
DergiPark Record ↗
✨

AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

Therefore, even if they are asymptomatic, long term neurological outcomes should be followed in infants with NH due to impaired cerebral perfusion.

📌 3 Key Takeaways

🎯
Objective & Hypothesis:Purpose: Neonatal hypoglycemia (NH) is frequent in neonatology practice.
📊
Key Findings & Data:Methods: This prospective study included infants who developed NH (n=50) and the control healthy term neonates (n=50).
💡
Conclusion & Impact:Therefore, even if they are asymptomatic, long term neurological outcomes should be followed in infants with NH due to impaired cerebral perfusion.
🔬Design:Research Article
📍Scope:Comprehensive Sample
⚙️Variables:Yenidoğan · Hipoglisemi · NIRS

Abstract

Purpose: Neonatal hypoglycemia (NH) is frequent in neonatology practice. This study aimed to evaluate the regional cerebral tissue oxygenation and cerebral blood flow in neonates who developed NH immediately after birth. Methods: This prospective study included infants who developed NH (n=50) and the control healthy term neonates (n=50). Infants with NH are monitored in terms of continuous regional cerebral tissue oxygenation (rcSO2 ) via near-infrared spectroscopy (NIRS) during the first 24 hours of life. Middle cerebral artery (MCA) blood flow was evaluated by doppler ultrasound at the first and 24 hours of life. The pulsatility index (PI) was measured to assess cerebral vascular resistance. Results: The mean gestational age, birth weights and hemoglobin levels of infants were similar. The mean rcSO2 was continuously higher and fractional tissue oxygen extraction (FTOE) was lower in infants with NH. The mean MCA PI values at the first and 24th hours of life were significantly higher in NH. Conclusions: This study shows that cerebral perfusion was impaired in infants with NH. They had higher rcSO2 , lower FTOE values and increased PI compared to healthy term infants. We suggest that increased PI may reflect increased vascular resistance and higher rcSO2 values associated with increased cerebral perfusion as a compensatory auto-regulatory response mechanism. Significantly lower FTOE values may dedicate decreased cerebral tissue oxygen extraction resulting from impaired cerebral perfusion even in the presence of auto-regulatory mechanisms. Therefore, even if they are asymptomatic, long term neurological outcomes should be followed in infants with NH due to impaired cerebral perfusion.

Özet

Amaç: Neonatal hipoglisemi (NH) yenidoğan pratiğinde sık karşılaşılan bir durumdur. Bu çalışma ile doğumdan sonra NH gelişen yenidoğanlarda yaşamın ilk saatlerindeki serebral doku oksijenasyonu ve serebral kan akımının değerlendirilmesi amaçlanmıştır. Yöntem: Prospektif yürütülen çalışmaya doğumdan sonra NH gelişen (n=50) ve gelişmeyen (n=50) yenidoğan bebekler dahil edildi. Her iki gruptaki bebeklerde yaşamın ilk 24 saati boyunca near-infrared spectroscopy (NIRS) ile devamlı bölgesel serebral doku oksijenasyonu (rcSO2 ) ölçüldü. Yaşamın ilk saati ve 24.saatinde bebeklerin orta serebral arter (MCA) kan akımları Doppler ultrasonografi ile değerlendirildi. NH gelişen ve gelişmeyen gruplar karşılaştırıldı. Bulgular: Bebeklerin ortalama gebelik haftası, doğum ağırlıkları ve hemoglobin düzeyleri benzerdi. NH gelişen ve gelişmeyen bebekler karşılaştırıldığında NH gelişen bebeklerde ortalama rcSO2 değerleri anlamlı yüksek ve fraksiyone doku oksijen ekstraksiyon (FTOE) değerleri anlamlı düşük bulundu. Yaşamın ilk saatinde ve 24. saatinde ölçülen, vasküler direnci gösteren serebral doppler indeksleri (Pulsatilite indeksi:PI) de NH gelişen grupta anlamlı olarak yüksekti. Sonuç: Bu çalışma ile NH gelişen yenidoğanlarda serebral dolaşımın ve oksijenasyonun bozulduğu gösterilmiştir. Hipoglisemi gelişen grupta yüksek ölçülen PI, serebral vasküler direncin arttığını göstermektedir. Bu grupta yüksek ölçülen rcSO2 değerlerinin azalmış serebral akımı kompanse etmek için gelişen serebral otoregülasyon sonucu geliştiği düşünülmektedir. FTOE düzeylerinin düşük olması ise serebral otoregülasyon mekanizmalarına rağmen NH’de serebral dolaşımın ve serebral oksijenasyonun bozulduğunu düşündürmüştür. Bu nedenle asemptomatik olsalar dahi NH gelişen bebeklerin uzun dönem nörolojik gelişimlerinin takip edilmesi gerekmektedir.

🔖

Cite This Article

Yaşa, B., Gönen, İ., Sağlam, Ö., Dincer, E., Büker, H. S. C., Çetinkaya, M. (2023). An Insidious Threat for Cerebral Oxygenation: Neonatal Hypoglycemia. Çocuk Dergisi, Cilt: 23 Sayı: 2, 159–163. https://doi.org/10.26650/jchild.2023.1280368

📄 Full Text PDF Viewer

📄

PDF görüntüleyici hazırlanıyor...

References (17)

  1. Chandran S, Rajadural VS, Haium AAA, Hussain Khalid. Current perspectives on neonatal hypoglycemia, its management, and cerebral injury risk. Dovepress. 2015;5:17-30. google scholar
  2. Adamkin DH, and committee on fetus and newborn. Postnatal glucose homeostasis in late preterm and term infants. Pediatrics. 2011;127(3):575-579. google scholar
  3. Schwaberger B, Pichler G, Binder-Heschl C, Baik N, Avian A, Urlesberger B. Transitional changes in cerebral blood volume at birth. Neonatology. 2015;108:253-258. google scholar
  4. Pichler G, Cheung PY, Aziz K, Urlesberger B, Schmolzer GM: How to monitor the brain during immediate neonatal transition and resuscitation? A systematic qualitative review of the literature. Neonatology. 2014;105:205-210. google scholar
  5. Aleksic M, Heckenkamp J, Gawenda M, Brunkwall J. Pulsatility Index determination by flowmeter measurement: a new indicator for vascular resistance? Eur Surg Res. 2004;36:345-349. google scholar
  6. Aliefendioglu D, Coban A, Hatipoglu N, Ecevit A, Arısoy AE, Mutlu GY et al. Turkish Neonatology Society Diagnosis and Treatment Guidelines, Neonatal Hypoglycemia. 2019. google scholar
  7. Volpe JJ (2001). Hypoglycemia and Brain Injury. In: Volpe JJ, ed. Neurology of the Newborn. 4th ed. Philadelphia, PA. Saunders, pp:497-520. google scholar
  8. Boluyt N, van Kempen A, Offriga M. Neurodevelopment after neonatal hypoglycemia: a systematic review and design of an optimal future study. Pediatrics. 2006:117:2231-2243. google scholar
  9. Kaiser JR, Bai S, Gibson N, Holland G, Lin TM, Swearingen CJ, et al. Association between transient newborn hypoglycemia and fourth grade achievement test proficiency: A population based study. JAMA Pediatr. 2015;169:913-921. google scholar
  10. Shah R, Harding J, Brown J, McKinlay C. Neonatal Glycemia and Neurodevelopmental Outcomes: A systematic Review and Meta-Analysis. Neonatology. 2019;115:116-126. google scholar
  11. Pryds O, Edwards A D. Cerebral blood flow in the newborn infant. Arch Dis Child Fetal Neonatal Ed. 1996;74:F63-F69. google scholar
  12. Vannucci CR, Vannucci. SJ Hypoglycemic brain injury. Semin Neonatal. 2001;6:147-155. google scholar
  13. Bozzetti V, Paterlini G, van Bel F, Visser GHA, Tosetti L, Gazzolo D, et al. Cerebral and somatic NIRS- determined oxygenation in IUGR preterm infants during transition. J Matern Fetal Neonatal Med. 2016;29:443-446. google scholar
  14. Burns CM, Rutherford MA, Boardman JP, Cowan FM. Patterns of cerebral injury and neurodevelopmental outcomes after asymptomatic neonatal hypoglycemia. Pediatrics. 2008;122(1):65-74. google scholar
  15. Kinnala A, Rikalainen H, Lapinleimu H, Parkkola R, Kormano M, Kero P. Cerebral magnetic resonance imaging and ultrasonography findings after neonatal hypoglycemia. Pediatrics 1999;103(4 Pt 1):724-729. google scholar
  16. Lucas A, Morley R, Cole TJ. Adverse neurodevelopmental outcome of moderate neonatal hypoglycemia. BMJ. 1998;297(66-59):1304-1308. google scholar
  17. McKinlay CJD, Alsweiler JM, Anstice NS, Burakevych N, Chakraborty A, Chase JG, et al. Association of neonatal hypoglycemia with neurodevelopmental outcomes at 4.5 years. JAMA Pediatr. 2017;171(19):972-983. google scholar