The significance of glycemic variability in conjunction with lactate metabolism levels in the clinical assessment of neonatal hypoxic-ischemic encephalopathy

The disruption of cerebral cellular energy metabolism represents the initial phase in the pathogenesis of neonatal hypoxic-ischemic encephalopathy (HIE). This study aimed to investigate the significance of glycemic variability (GV) and lactate (LAC) metabolic levels for early assessment of HIE. A retrospective study was conducted on asphyxiated neonates admitted to our hospital from January 2018 to January 2024. Neonates ultimately diagnosed with HIE were categorized into the HIE group, while those excluded from the HIE diagnosis were allocated to the control group. GV was assessed using the difference between maximum and minimum (max-min), standard deviation (SD), and coefficient of variation (CV). Lactate clearance rate (LCR) was used as an indicator of lactate metabolism. We found that GLU CV and LCR were independent risk factors for brain injury following asphyxia. The combination of GLU CV and LCR demonstrated a sensitivity of 84.2% and specificity of 78.6% in predicting HIE, and achieved a sensitivity of 90.0% and specificity of 61.1% in predicting moderate-severe HIE. Early monitoring of GV and LAC levels can serve as valuable indicators for predicting neonatal HIE and assessing disease severity.