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@ARTICLE{Hoermann:1038463,
author = {Hoermann, H. and van Faassen, M. and Roeper, M. and
Hagenbeck, C. and Herebian, D. and Muller Kobold, AC. and
Dukart, Jürgen and Kema, IP. and Mayatepek, E. and
Meissner, T. and Kummer, S.},
title = {{A}ssociation of {F}etal {C}atecholamines {W}ith {N}eonatal
{H}ypoglycemia},
journal = {JAMA pediatrics},
volume = {178},
number = {6},
issn = {2168-6203},
address = {Chicago, Ill.},
publisher = {American Medical Association},
reportid = {FZJ-2025-01459},
pages = {577-585},
year = {2024},
abstract = {Importance: Perinatal stress and fetal growth restriction
increase the risk of neonatal hypoglycemia. The underlying
pathomechanism is poorly understood. In a sheep model,
elevated catecholamine concentrations were found to suppress
intrauterine insulin secretion, followed by hyperresponsive
insulin secretion once the adrenergic stimulus
subsided.Objective: To determine whether neonates with risk
factors for hypoglycemia have higher catecholamine
concentrations in umbilical cord blood (UCB) and/or amniotic
fluid (AF) and whether catecholamines are correlated with
postnatal glycemia.Design, setting, and participants: In a
prospective cohort study of 328 neonates at a tertiary
perinatal center from September 2020 through May 2022 in
which AF and UCB were collected immediately during and after
delivery, catecholamines and metanephrines were analyzed
using liquid chromatography with tandem mass spectrometry.
Participants received postnatal blood glucose (BG)
screenings.Exposure: Risk factor for neonatal
hypoglycemia.Main outcomes and measures: Comparison of
catecholamine and metanephrine concentrations between
at-risk neonates and control participants, and correlation
of concentrations of catecholamines and metanephrines with
the number and severity of postnatal hypoglycemic
episodes.Results: In this study of 328 neonates (234 in the
risk group: median [IQR] gestational age, 270 [261-277]
days; and 94 in the control group: median [IQR] gestational
age, 273 [270-278] days), growth-restricted neonates showed
increased UCB median (IQR) concentrations of norepinephrine
(21.10 [9.15-42.33] vs 10.88 [5.78-18.03] nmol/L; P < .001),
metanephrine (0.37 [0.13-1.36] vs 0.12 [0.08-0.28] nmol/L; P
< .001), and 3-methoxytyramine (0.149 [0.098-0.208] vs 0.091
[0.063-0.149] nmol/L; P = .001). Neonates with perinatal
stress had increased UCB median (IQR) concentrations of
norepinephrine (22.55 [8.99-131.66] vs 10.88 [5.78-18.03]
nmol/L; P = .001), normetanephrine (1.75 [1.16-4.93] vs 1.25
[0.86-2.56] nmol/L; P = .004), and 3-methoxytyramine (0.120
[0.085-0.228] vs 0.091 [0.063-0.149] nmol/L; P = .008) (P <
.0083 was considered statistically significant).
Concentrations of UCB norepinephrine, metanephrine, and
3-methoxytyramine were negatively correlated with AF
C-peptide concentration (rs = -0.212, P = .005; rs = -0.182,
P = .016; and rs = -0.183, P = .016, respectively [P < .017
was considered statistically significant]). Concentrations
of UCB norepinephrine, metanephrine, and 3-methoxytyramine
were positively correlated with the number of hypoglycemic
episodes (BG concentration of 30-45 mg/dL) (rs = 0.146, P =
.01; rs = 0.151, P = .009; and rs = 0.180, P = .002,
respectively). Concentrations of UCB metanephrine and
3-methoxytyramine were negatively correlated with the lowest
measured BG concentration (rs = -0.149, P = .01; and rs =
-0.153, P = .008, respectively).Conclusions and relevance:
Neonates at risk for hypoglycemia displayed increased
catecholamine and metanephrine concentrations that were
correlated with postnatal hypoglycemic episodes and lower BG
levels; these results are consistent with findings in a
sheep model that fetal catecholamines are associated with
neonatal β-cell physiology and that perinatal stress or
growth restriction is associated with subsequent neonatal
hyperinsulinemic hypoglycemia. Improving the
pathomechanistic understanding of neonatal hypoglycemia may
help to guide management of newborns at risk for
hypoglycemia.},
cin = {INM-7},
ddc = {610},
cid = {I:(DE-Juel1)INM-7-20090406},
pnm = {5252 - Brain Dysfunction and Plasticity (POF4-525)},
pid = {G:(DE-HGF)POF4-5252},
typ = {PUB:(DE-HGF)16},
pubmed = {38557708},
UT = {WOS:001197556000001},
doi = {10.1001/jamapediatrics.2024.0304},
url = {https://juser.fz-juelich.de/record/1038463},
}