Purpose: Birth asphyxia and Hypoxic Ischemic Encephalopathy (HIE) are major problems in developing countries such as India. Therapeutic Hypothermia (TH) is well established for treating moderate (Sarnat Stage II) HIE in developed countries but its use in developing countries has raised some concerns (Thayyil, Costello et al. 2009). In October 2015, an Infant Cooling Program was started at the NICE institute in Hyderabad, India using equipment (Blanketrol III) and protocols that were used in the NICHD trials in USA (Shankaran, Laptook et al. 2005). A US team (Connecticut Children’s Medical Center) conducted an onsite training of the Hyderabad team - and audited results over 22 months. Aims: To describe the pre discharge morbidity and mortality of infants treated with TH in Hyderabad, India and to determine the clinical correlates of infants who develop hyperglycemia during therapeutic hypothermia used for treatment of moderate hypoxic ischemic encephalopathy. Methods: An audit was done after 22 months of TH initiation in India. Infants started on TH between Oct-2015 and Sept-2017 were included irrespective of the comorbid status. We compared infants with and without hyperglycemia treated with therapeutic hypothermia. Results: In 22 months, 56 infants with moderate HIE (stage II -seizures in all patients) were treated, with 52 infants completing 72 h. of TH (4 stopped early because of other systemic concerns). All infants were out-born. Mean gestational age was 37.8 ±1.1 wk., and birth weight 2782 ± 378 gm. Two died (1 male and 1 female) and 54 (96%) survived to discharge with mortality similar to developed countries. Comorbidities with TH-elevated CRP (71%), respiratory distress (59%), pneumonia (27%) coagulopathy (84%) and liver transaminases (84%) were higher than reported. Comparisons with reports from developed countries are shown in Table 1. In contrast to reports from developed countries of hypoglycemia, hyperglycemia defined as persistent blood glucose level of > 125 mg/dl was seen in 21 (38%) infants on TH. Hyperglycemia was most commonly noted on day 2 and 3 of TH and in 8 (38%) cases was severe enough to need Insulin therapy. Comparisons of clinical correlates of infants with hyperglycemia with those without hyperglycemia are shown. (Table 2) Conclusion: TH is a useful therapy in India with survival similar to that in developed countries. Morbidity patterns were different with a high incidence of hyperglycemia that has not been reported from studies in the developed countries. Hyperglycemia in this set-up was associated with higher inflammatory markers of CRP, higher neurological Thompson Scores on Day 2 and 3 of TH and higher occurrence of PPHN. Both babies who died had hyperglycemia early in their course. In developing countries, hyperglycemia appears to be an important marker of illness severity and warrants further investigation.
Hyperglycemia - an Unexpected Complication in Term Infants with Stage II HIE Treated with Therapeutic Hypothermia (TH) in a Developing Country
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Sudha BODA, Naveed Hussain, Padmanabh Reddy, Venkata Raju; Hyperglycemia - an Unexpected Complication in Term Infants with Stage II HIE Treated with Therapeutic Hypothermia (TH) in a Developing Country. Pediatrics August 2019; 144 (2_MeetingAbstract): 550. 10.1542/peds.144.2MA6.550
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