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.

  • 1.

    World Health Organization , 2022. World Malaria Report 2022. Geneva, Switzerland: WHO.

  • 2.

    Dvorin JD , 2017. Getting your head around cerebral malaria. Cell Host Microbe 22: 586588.

  • 3.

    Wang W , Qian H , Cao J , 2015. Stem cell therapy: a novel treatment option for cerebral malaria? Stem Cell Res Ther 6: 141.

  • 4.

    van Hensbroek MB , Palmer A , Jaffar S , Schneider G , Kwiatkowski D , 1997. Residual neurologic sequelae after childhood cerebral malaria. J Pediatr 131: 125129.

    • Search Google Scholar
    • Export Citation
  • 5.

    Idro R , Carter JA , Fegan G , Neville BGR , Newton CRJC , 2006. Risk factors for persisting neurological and cognitive impairments following cerebral malaria. Arch Dis Child 91: 142148.

    • Search Google Scholar
    • Export Citation
  • 6.

    Oluwayemi OI , Brown BJ , Oyedeji OA , Adegoke SA , Adebami OJ , Oyedeji GA , 2013. Clinical and laboratory predictors of outcome in cerebral malaria in suburban Nigeria. J Infect Dev Ctries 7: 600607.

    • Search Google Scholar
    • Export Citation
  • 7.

    Nickerson JP , Tong KA , Raghavan R , 2009. Imaging cerebral malaria with a susceptibility-weighted MR sequence. AJNR Am J Neuroradiol 30: e85e86.

    • Search Google Scholar
    • Export Citation
  • 8.

    Molyneux ME , Taylor TE , Wirima JJ , Borgstein A , 1989. Clinical features and prognostic indicators in paediatric cerebral malaria: a study of 131 comatose Malawian children. QJM 71: 441459.

    • Search Google Scholar
    • Export Citation
  • 9.

    Njim T , Tanyitiku BS , 2019. Prognostic models for the clinical management of malaria and its complications: a systematic review. BMJ Open 9: e030793.

    • Search Google Scholar
    • Export Citation
  • 10.

    World Health Organization , 2012. Management of Severe Malaria: A Practical Handbook, 3rd edition. Geneva, Switzerland: WHO.

  • 11.

    Krishna S et al., 1994. Lactic acidosis and hypoglycaemia in children with severe malaria: pathophysiological and prognostic significance. Trans R Soc Trop Med Hyg 88: 6773.

    • Search Google Scholar
    • Export Citation
  • 12.

    Nadjm B , Mtove G , Amos B , Hildenwall H , Najjuka A , Mtei F , Todd J , Reyburn H , 2013. Blood glucose as a predictor of mortality in children admitted to the hospital with febrile illness in Tanzania. Am J Trop Med Hyg 89: 232237.

    • Search Google Scholar
    • Export Citation
  • 13.

    Roe JK , Pasvol G , 2009. New developments in the management of malaria in adults. QJM 102: 685693.

  • 14.

    Ramos S et al., 2022. A hypometabolic defense strategy against malaria. Cell Metab 34: 11831200.e12.

  • 15.

    Madrid L et al., 2017. Continuous determination of blood glucose in children admitted with malaria in a rural hospital in Mozambique. Malar J 16: 184.

    • Search Google Scholar
    • Export Citation
  • 16.

    Bila R , Varo R , Madrid L , Sitoe A , Bassat Q , 2018. Continuous glucose monitoring in resource-constrained settings for hypoglycaemia detection: looking at the problem from the other side of the coin. Biosensors (Basel) 8: 43.

    • Search Google Scholar
    • Export Citation
  • 17.

    Nhampossa T et al., 2016. Hypoglycemia and risk factors for death in 13 years of pediatric admissions in Mozambique. Am J Trop Med Hyg 94: 218226.

    • Search Google Scholar
    • Export Citation
  • 18.

    Barennes H , Sayavong E , Pussard E , 2016. High mortality risk in hypoglycemic and dysglycemic children admitted at a referral hospital in a non malaria tropical setting of a low income country. PLoS One 11: e0150076.

    • Search Google Scholar
    • Export Citation
  • 19.

    Willcox ML , Forster M , Dicko MI , Graz B , Mayon-White R , Barennes H , 2010. Blood glucose and prognosis in children with presumed severe malaria: is there a threshold for “hypoglycaemia”? Trop Med Int Health 15: 232240.

    • Search Google Scholar
    • Export Citation
  • 20.

    Wiens MO , Pawluk S , Kissoon N , Kumbakumba E , Ansermino JM , Singer J , Ndamira A , Larson C , 2013. Pediatric post-discharge mortality in resource poor countries: a systematic review. PLoS One 8: e66698.

    • Search Google Scholar
    • Export Citation
  • 21.

    Wiens MO et al., 2015. Postdischarge mortality in children with acute infectious diseases: derivation of postdischarge mortality prediction models. BMJ Open 5: e009449.

    • Search Google Scholar
    • Export Citation
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