Glucose Derangements and Brain Function in Neonatal Encephalopathy

Hypoglycemia and hyperglycemia are common in neonates with encephalopathy and may be independently associated with unfavourable outcomes. This thesis describes how glucose derangements detected with continuous interstitial glucose monitoring commenced soon after birth are associated with brain function on amplitude-integrated electroencephalography (aEEG) and continuous EEG (cEEG) in the context of neonatal encephalopathy. We hypothesize that hypoglycemia, hyperglycemia and glucose variability in neonatal encephalopathy are associated with abnormal brain background activity and increased electrographic seizures on aEEG and cEEG. In neonates with encephalopathy, epochs of hyperglycemia, but not hypoglycemia, were common and temporally associated with worse aEEG background scores, less sleep-wake cycling, and more electrographic seizures, including after adjusting for clinical markers of hypoxia-ischemia. Epochs of hyperglycemia also were associated with worse cEEG background scores, including after adjusting for hypoxia-ischemia severity. Our data support the hypothesis that proactive avoidance of hyperglycemia may be a neuroprotective strategy in infants with neonatal encephalopathy.M.Sc