Inappropriately high plasma insulin levels in suspected perinatal asphyxia

The aim of this study was to determine differences in levels of the major h ormones responsible for glucose homeostasis (insulin and glucagon) in babie s with acute neonatal encephalopathy secondary to perinatal asphyxia and to correlate these with outcome. In a prospective observational study, plasma insulin, C-peptide, glucagon and serum glucose levels were determined usin g standard techniques st specified times in term babies with a diagnosis on admission of perinatal asphyxia or acute neonatal encephalopathy. The sett ing comprised two university-affiliated, regional, tertiary level neonatal intensive care units. Thirty-one babies with a diagnosis of perinatal asphy xia or acute neonatal encephalopathy were entered into the study over 15 mo nths and neurodevelopmental outcomes at 18 months of age for 28 babies were available for analysis. Babies with a poor neurodevelopmental outcome had significantly higher insulin and C-peptide levels than those who had a good outcome. Glucose delivery, serum glucose and glucagon levels did not diffe r significantly between the babies with a poor outcome and those with a goo d outcome. In conclusion, babies with significant foetal or neonatal asphyx ia frequently have inappropriately high plasma insulin levels. This, either alone or in combination with other hormonal disturbances, may lead to the hypoglycaemia often associated with severe asphyxia and may predict a poor outcome.