Normoglycaemia key to improved neurological outcome after paediatric stroke

By Lucy Piper

Achieving normal blood glucose concentrations may be important in preventing poor neurological outcomes in children following acute arterial ischemic stroke, a review indicates.

The research, published in JAMA Neurology, showed that hyperglycaemia (≥200 mg/dL), present in 18.1% of 94 children in the 5 days following an acute arterial ischemic stroke, independently increased the risk of poor neurological outcomes 3 months later nearly fourfold.

A poor neurological outcome was defined as a Pediatric Stroke Outcome Measure score of 1 or above.

Commenting on the findings in a related editorial, Lauren Beslow (Yale University, New Haven, Connecticut, USA) points out: "While additional study is required to understand fully whether the association of hyperglycemia with outcome is related to elevated blood glucose levels or to other factors that are associated with elevated blood glucose (eg, more severe illness or steroid use), treating physicians must pay attention to hyperglycemia, which could be a possible target for future interventions."

She also notes that despite the association of hyperglycaemia with poor neurological outcome, less than 20% of affected children received treatment.

The factor most closely associated with poor neurological outcome was an infarct size of 4% or greater of brain volume, increasing the risk 5.6-fold.

This was expected and the researchers believe that infarct volume should be considered in future studies assessing neurological outcome.

However, contrary to expectations and findings in adult patients, hypertension, hypotension and fever in the 5 days following acute ischemic stroke were not significantly associated with poor neurological outcome or infarct size at 3 months.

Hypotension requiring treatment was associated with poor outcomes in univariable analysis, but not multivariable analysis, the team comments.

These abnormal vital signs were nevertheless common and Beslow believes perhaps more common than was previously thought.

Lori Jordan (Vanderbilt University Medical Center, Nashville, Tennessee, USA) and colleagues report that among 98children, aged an average of 6 years, 65.3% had hypertension (systolic blood pressure above the 95th percentile for two consecutive recordings and two consecutive days), 68.4% had hypotension (systolic and/or diastolic below the 5th percentile for two consecutive recordings) and 37.8% had fever.

"This study acts as a reminder to those who care for children with stroke that vital sign changes and abnormal laboratory values could be critical, particularly because they may be modifiable", says Beslow.

"Blood pressure, temperature, and blood glucose levels should be focuses for future study efforts in addition to efforts to prevent recurrence and promote recovery."

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