Temporal Trends of Blood Glucose in Children with Cerebral Malaria

Kennedy M. Chastang Howard University, Washington, District of Columbia;

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Rami Imam The George Washington University School of Medicine, Washington, District of Columbia;

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Meredith G. Sherman Global Health Initiative, Children’s National Medical Center, Washington, District of Columbia;

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Ronke Olowojesiku Department of Pediatrics, Children’s National Medical Center, Washington, District of Columbia;

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Amina M. Mukadam University of Washington, Seattle, Washington;

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Karl B. Seydel Michigan State University, East Lansing, Michigan;
Blantyre Malaria Project, Blantyre, Malawi;

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Alice M. Liomba Blantyre Malaria Project, Blantyre, Malawi;

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John R. Barber Division of Biostatistics and Study Methodology, Children’s National Research Institute, Washington, District of Columbia;

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Douglas G. Postels Blantyre Malaria Project, Blantyre, Malawi;
Division of Neurology, Children’s National Medical Center, Washington, District of Columbia

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ABSTRACT.

Hypoglycemia, defined as a blood glucose < 2.2 mmol/L, is associated with death in pediatric cerebral malaria (CM). The optimal duration of glucose monitoring in CM is unknown. We collected data from 1,674 hospitalized Malawian children with CM to evaluate the association between hypoglycemia and death or neurologic disability in survivors. We assessed the optimal duration of routine periodic measurements of blood glucose. Children with hypoglycemia at admission had a 2.87-fold higher odds (95% CI: 1.35–6.09) of death and, if they survived, a 3.21-fold greater odds (95% CI: 1.51–6.86) of sequelae at hospital discharge. If hypoglycemia was detected at 6 hours but not at admission, there was a 7.27-fold higher odds of death (95% CI: 1.85–8.56). The presence of newly developed hypoglycemia after admission was not independently associated with neurological sequelae in CM survivors. Among all new episodes of blood sugar below a treatment threshold of 3.0 mmol/L, 94.7% occurred within 24 hours of admission. In those with blood sugar below 3.0 mmol/L in the first 24 hours, low blood sugar persisted or recurred for up to 42 hours. Hypoglycemia at admission or 6 hours afterward is strongly associated with mortality in CM. Children with CM should have 24 hours of post-admission blood glucose measurements. If a blood glucose less than the treatment threshold of 3.0 mmol/L is not detected, routine assessments may cease. Children who have blood sugar values below the treatment threshold detected within the first 24 hours should continue to have periodic glucose measurements for 48 hours post-admission.

Author Notes

Address correspondence to Douglas G. Postels, Division of Neurology, Children’s National Medical Center, 111 Michigan Ave. NW, Washington, DC, 20010. E-mail: dpostels@childrensnational.org

Financial support: This work was supported by internal funding through Children’s National Research Institute (Washington, DC) to K. C. This work was supported by the W.T. Gill Fellowship of The George Washington University (Washington, DC) to R. I. This work was also supported by internal funding though Children’s National Global Health Initiative (Washington, DC) to M. G. S. and R. O.

Authors’ addresses: Kennedy M. Chastang, Howard University, Washington, DC, USA, E-mail: kennedy.chastang@bison.howard.edu. Rami Imam, The George Washington University School of Medicine, Washington, DC, E-mail: ramiimam@gwmail.gwu.edu. Meredith G. Sherman, Global Health Initiative, Children’s National Medical Center, Washington, DC, E-mail: msherman@childrensnational.org. Ronke Olowojesiku, Department of Pediatrics, Children’s National Medical Center, Washington, DC, E-mail: rolowojesi@childrensnational.org. Amina M. Mukadam, University of Washington, Seattle, WA, E-mail: amukadam@uw.edu. Karl B. Seydel, Michigan State University, East Lansing, MI, and Blantyre Malaria Project, Blantyre, Malawi, E-mail: seydel@msu.edu. Alice M. Liomba, Blantyre Malaria Project, Blantyre, Malawi, E-mail: wanguialice@gmail.com. John R. Barber, Division of Biostatistics and Study Methodology, Children’s National Research Institute, Washington, DC, E-mail: jbarber@childrensnational.org. Douglas G. Postels, Blantyre Malaria Project, Blantyre, Malawi, and Division of Neurology, Children’s National Medical Center, Washington, DC, E-mail: dpostels@childrensnational.org.

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