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- Zamir, Itay, et al.
(författare)
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Early-life hyperglycemia in extremely preterm infants affects neurodevelopment at 6 years of age
- 2016
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Ingår i: European Journal of Pediatrics. - : Springer. - 0340-6199 .- 1432-1076. ; 175:11, s. 1440-1440
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Tidskriftsartikel (refereegranskat)abstract
- Background and aims:Hyperglycemia is common during early life in extremely preterm infants. It has been suggested to increase the risk of later neurological problems. This study investigated the relation between early-life hyperglycemia and neurological outcomes at 6 years of age in children born extremely preterm.Methods: The study is based on the EXPRESS study cohort, including all 707 infants liveborn before 27 weeks gestational age in Sweden between 2004–2007. Detailed laboratory data was extracted from the hospital records. During a follow-up at 6 years of age, the children performed the Wechsler Intelligence Scale for Children (WISC-IV) test.Results WISC-IV scores were available for 371 of 494 surviving children. The number of days with severe hyperglycemia (≥1 plasma glucose measurement ≥ 16 mmol/l) during the first 21 days of life was significantly correlated with lower WISC-IV scores, adjusted for gestational age (β=-0.114; p=0.032). Children who had severe hyperglycemia at least one day during the first 21 days of life had significantly lower mean WISC-IV score than children who did not have severe hyperglycemia, adjusted for gestational age (78.9 vs. 85.08, respectively; p=0.02; Figure 1). The results remained significant after adjusting for morbidityrelated variables in those infants without severe neurodevelopmental impairment.Conclusions Severe hyperglycemia during the first 3 weeks of life in extremely preterm infants is associated with lower intelligence at 6 years of age. Prevention of severe hyperglycemia in these infants may therefore be important. Further research is needed to explore the effect of hyperglycemia on neurodevelopment as well as its mechanism.
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- Kotecha, Dipak, et al.
(författare)
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Integrating new approaches to atrial fibrillation management : the 6th AFNET/EHRA Consensus Conference.
- 2018
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Ingår i: Europace. - : Oxford University Press (OUP). - 1099-5129 .- 1532-2092. ; 20:3, s. 395-407
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Tidskriftsartikel (refereegranskat)abstract
- There are major challenges ahead for clinicians treating patients with atrial fibrillation (AF). The population with AF is expected to expand considerably and yet, apart from anticoagulation, therapies used in AF have not been shown to consistently impact on mortality or reduce adverse cardiovascular events. New approaches to AF management, including the use of novel technologies and structured, integrated care, have the potential to enhance clinical phenotyping or result in better treatment selection and stratified therapy. Here, we report the outcomes of the 6th Consensus Conference of the Atrial Fibrillation Network (AFNET) and the European Heart Rhythm Association (EHRA), held at the European Society of Cardiology Heart House in Sophia Antipolis, France, 17-19 January 2017. Sixty-two global specialists in AF and 13 industry partners met to develop innovative solutions based on new approaches to screening and diagnosis, enhancing integration of AF care, developing clinical pathways for treating complex patients, improving stroke prevention strategies, and better patient selection for heart rate and rhythm control. Ultimately, these approaches can lead to better outcomes for patients with AF.
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- Naseh, Nima, et al.
(författare)
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Early Hyperglycemia in Very Preterm Infants Is Associated with Reduced White Matter Volume and Worse Cognitive and Motor Outcomes at 2.5 Years
- 2022
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Ingår i: Neonatology. - : S. Karger. - 1661-7800 .- 1661-7819. ; 119:6, s. 745-752
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Hyperglycemia in very preterm infants is associated with increased morbidity and mortality. We aimed to investigate potential associations between early hyperglycemia, neonatal cerebral magnetic resonance imaging (MRI), and neurodevelopment at 2.5 years.Methods: The study population included 69 infants with gestational age (GA) 22.3-31.9 weeks (n = 29 with GA <28 weeks), born 2011-2014. Plasma glucose concentrations during the first week were checked according to clinical routines. Hyperglycemia was defined as glucose concentrations above 8.3 mmol/L (150 mg/dL) and above 10 mmol/L (180 mg/dL), respectively, categorized as the highest glucose days 0-2, number of days above 8.3 and 10 mmol/L, and prolonged (yes/no) 2 days or more above 8.3 and 10 mmol/L. The MRI analysis included morphological assessment, regional brain volumes, and assessment of apparent diffusion coefficient (ADC). Neurodevelopmental impairment (NDI) developed in 13 of 67 infants with available outcomes, of which 57 were assessed with the Bayley-III. Univariate and multiple linear and logistic regressions were performed with adjustments for GA, birth weight z-scores, and illness severity expressed as days on mechanical ventilation.Results: Hyperglycemia above 8.3 mmol/L and 10 mmol/L was present in 47.8% and 31.9% of the infants. Hyperglycemia correlated independently with lower white matter volume, but not with other regional brain volumes, and was also associated with lower ADC values in white matter. Hyperglycemia also correlated with lower Bayley-III cognitive and motor scores in infants with GA <28 weeks, but there was no significant effect on NDI.Conclusion: Early hyperglycemia is associated with white matter injury and poorer neurodevelopment in very preterm infants.
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