Value Of Blood Glucose Variation Rate Combined With Arterial Serum Lactic Acid Level In Clinical Assessment Of Neonatal Hypoxic Ischemic Encephalopathy

Objective: To investigate the relationship between glycemic variability(GV),lactic(LAC),lactic clearance rate(LCR)and the condition and prognosis of hypoxic ischemic encephalopathy(HIE)in neonates,to explore the value of GV combined with LAC detection in the early prediction,severity and prognosis evaluation of HIE in neonates.Methods: 133 cases of asphyxia neonates born in the obstetrics department of the Affiliated Hospital of Yangzhou or outside the hospital and transferred to the neonatal intensive care unit(NICU)of the Affiliated Hospital of Yangzhou immediately after birth from September 2017 to September 2021 were selected as subjects.65 cases of asphyxia neonates with a final diagnosis of HIE according to the inclusion and exclusion criteria were the HIE group,and the remaining 50 asphyxia neonates with an excluded HIE diagnosis were the control group.The asphyxia neonates in the HIE group were further divided into mild HIE group,moderate HIE group and severe HIE group according to the clinical grading,and into good prognosis group and poor prognosis group according to the recent prognosis.GV indicators including glucose difference(GLU max-min),mean glucose(Glu ave),standard deviation(GLU SD),coefficient of variation(GLU CV),and LAC indicators including initial LAC value,LAC value after 6 hours of treatment,and LCR were collected from each group to analyze and compare the differences in GV and LAC indicators among the groups.The relationship between each indicator and the condition and prognosis of HIE was evaluated by multifactorial analysis with a binary logistic regression model,and the value of each indicator for early prediction,severity and prognosis of HIE was evaluated by the Receiver operating characteristic curve(ROC curve).Results:1.Compared to the non-HIE group,the GV indicators(GLU max-min,GLU SD,GLU CV)and LAC values after 6 hours of treatment were significantly increased(P< 0.05)while the LCR levels were significantly lower(P < 0.05)in the HIE group.According to the binary logistic regression analysis,LCR and GLU SD and GLU CV were independent risk factors for HIE,and the area under curve(AUC)for combined prediction of HIE was the largest at 0.84,and the Jorden index was the largest when the cut-off value was 0.53,with a sensitivity of 81.36% and specificity of 76.79%.2.Compared with the mild HIE group,neonates in the moderate and severe HIE groups had significantly higher GLU max-min,GLU SD,and GLU CV(P < 0.05),and significantly higher LAC and significantly lower LCR levels after 6 hours of treatment(P < 0.05).Compared with neonates in the moderate HIE group,neonates with HIE in the severe group had significantly higher LAC,significantly lower LCR levels,and significantly higher GLU max-min,GLU SD,and GLU CV after 6 hours of treatment(P < 0.05).3.Compared with the good prognosis group,neonates in the poor prognosis group had significantly higher GLU max-min,GLU SD,and GLU CV(P < 0.05)and significantly higher LAC and lower LCR levels after 6 hours of treatment(P < 0.05).The results of binary logistic regression analysis based on prognosis showed that LCR and GLU CV were independent risk factors for predicting HIE prognosis,and the AUC of the combined prediction probability curve of the two was the largest at 0.88,and the Jorden index was 0.59,with a sensitivity of 62.5% and specificity of 97.56%.Conclusion: Early GV and LCR can provide reference for neonatal HIE prediction and severity assessment;changes in neonatal blood LCR and blood glucose levels can assess the prognosis of neonates with HIE to some extent;among them,GLU CV and LCR have the greatest diagnostic efficacy,and their combined prediction is an important index for clinical assessment of neonatal HIE.