Impact of Early Glycemic Variability on Mortality and Neurologic Outcome of Very Low Birth Weight Infants: Data from a Continuous Glucose Monitoring System*

BACKGROUND: Glycemic variability (GV) has been a matter of interest in recent years. However, glycemic variability in preterm infants has not been adequately investigated. OBJECTIVES: To evaluate the impact of glycemic variability obtained from continuous glucose monitoring on mortality and neurologie outcomes: grade 3 or 4 intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), and retinopathy of prematurity (ROP) requiring treatment among very low birth weight infants. MATERIAL AND METHODS: A prospective, single-center, open cohort study enrolled 74 very low birth weight infants with a mean birthweight of 1066 g (+l-267). A continuous glucose monitoring system (CGM) was used to measure glucose during the first week of life. The impact of glycemic variability (standard deviation SD; coefficient of variation CV; and mean amplitude of glucose excursion MAGE) on mortality and neurologie outcomes of infants was evaluated. RESULTS: Univariate analysis revea/ed that glycemic variability occurring during the first week of life was not be associated with mortality before term-equivalent age and PVL. Higher GV was associated with grade 3 or 4 IVH (CV p=0.025; MAGE p=0.032) and ROP requiring treatment (SD p=0.019; CV p=0.026; MAGE=0.029). However, logistic regression models did not show a significant association between GV occurring during the first week of life and grade 3 or 4 IVH (MAGE OR 2.64; 95% Cl 0.71-9.92) or ROP requiring treatment (MAGE OR 1.14; 95% Cl 0.57-5.32). CONCLUSIONS: Further prospective studies are needed to fully investigate the impact of GV on mortality and morbidity in premature infants. The potential benefits of reducing glucose blood fluctuations in VLBW infants need to be addressed.