Early Neonatal Hyperglycemia, Risk Factors, and Adverse Outcomes in Extremely Preterm Infants: A Propensity-Matched Cohort Study

Background: Neonatal hyperglycemia (NH) is a common metabolic complication among (NH) infants. However, early risk factors and clinical outcomes of NH remain unclear. Objective: To evaluate the association of NH with clinical outcomes and neurodevelopmental(NDD) risk in EP infants. Methods: This retrospective propensity score matching (PSM) study, included EP, born between 2018-2019 at women’s wellness and research Center who met the NH criteria (blood glucose >8.3 mmol/L). Hyperglycemia severity, maternal factors, delivery room interventions, early physiological markers, neonatal morbidities, and follow-up outcomes were compared. Propensity score matching (1:1) was used to adjust for significant baseline demographics and clinical characteristics. Results: Out of 225 EP infants, 131 (58.2%) developed NH in the first week of life of infants, with mild hyperglycemia in 31.0%, moderate in 14.6%, and severe in 11.1% of cases. Before matching, infants with NH were more preterm and had lower birth weight and head circumference. Their mothers had lower rates of premature rupture of membranes (PPROM). Affected infants required more surfactant in the delivery room and had higher oxygen and mechanical ventilation needs during the first week. After matching, NH was associated with significantly higher rates of ventilator-associated pneumonia (VAP), with 23.6% vs 3.7%, OR 8.04 CI: 1.72–37.66, p=0.003, longer duration of mechanical ventilation (19.8±25.3 vs 8.9±24.8 days, MD -10.942, CI -21.470–-0.420, p=0.042), higher postnatal steroid use (18.2% vs 5.5%, OR 4.64, CI 1.56–14.37, p=0.040) After matching, NH was associated with significantly higher rates of severe retinopathy of prematurity (ROP), ( 21.6% vs 6.4%, OR 4.03 CI: 1.04–15.50, p= 0.032).and trend towards moderate to severe bronchopulmonary dysplasia (BPD) (33.3% vs 15.9%, OR 2.64, CI 0.96–7.23, p=0.054). No significant differences in mortality were observed between the groups; however, infants with NH who died were older. Conclusion: Early NH in EP infants is associated with an increased risk of ventilator-associated pneumonia, prolonged mechanical ventilation, severe ROP, and moderate to severe BPD. These findings suggest that NH may contribute to poorer short-term outcomes in this vulnerable population.