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We measured glucose and lactate concentrations before TH and on days 2 and 3 in infants with mild, moderate, and severe hypoxic-ischemic encephalopathy (HIE). Neurodevelopment was assessed at 2\u00a0years. Participants were grouped according to the neurodevelopmental outcome into favorable (FO) or unfavorable (UFO). Eighty-eight infants were evaluated at follow-up, 34 for the FO and 54 for the UFO group. Severe hypo- (&lt;\u20092.6\u00a0mmol\/L) and hyperglycemia (&gt;\u200910\u00a0mmol\/L) occurred in 18% and 36% from the FO and UFO groups, respectively. Glucose-to-lactate ratio on day 1 was the strongest predictor of unfavorable metabolic outcome (OR 3.27 <jats:inline-formula><jats:alternatives><jats:tex-math>$$\\pm$$<\/jats:tex-math><mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\">\n                  <mml:mo>\u00b1<\/mml:mo>\n                <\/mml:math><\/jats:alternatives><\/jats:inline-formula> 1.81, <jats:italic>p<\/jats:italic>\u2009=\u20090.032) when adjusted for other clinical and metabolic variables, including Sarnat score.<\/jats:p><jats:p><jats:italic>Conclusion<\/jats:italic>: Glucose-to-lactate ratio on day 1 may represent a new risk marker for infants with HIE undergoing TH.<jats:table-wrap><jats:table><jats:tbody>\n                    <jats:tr>\n                      <jats:td colspan=\"2\"><jats:bold>What is Known:<\/jats:bold><jats:italic>\u2022\u00a0Glucose and lactate are key metabolic fuels during neonatal hypoglycemia. This suggests that their concentrations may influence the neurodevelopmental outcome of neonates experiencing hypoxic-hischemic encephalopathy (HIE).<\/jats:italic><\/jats:td>\n                    <\/jats:tr>\n                    <jats:tr>\n                      <jats:td colspan=\"2\"><jats:bold>What is New:<\/jats:bold><jats:italic>\u2022\u00a0We describe the relative availbility of glucose and lactate before and during theraputic hypothermia in neonates with HIE.<\/jats:italic><\/jats:td>\n                    <\/jats:tr>\n                  <\/jats:tbody><\/jats:table><\/jats:table-wrap><\/jats:p>","DOI":"10.1007\/s00431-022-04694-3","type":"journal-article","created":{"date-parts":[[2022,12,9]],"date-time":"2022-12-09T05:02:56Z","timestamp":1670562176000},"page":"837-844","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Glucose-to-lactate ratio and neurodevelopment in infants with hypoxic-ischemic encephalopathy: an observational study"],"prefix":"10.1007","volume":"182","author":[{"given":"Alfonso","family":"Galderisi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mattia","family":"Tordin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agnese","family":"Suppiej","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Cainelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugenio","family":"Baraldi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Trevisanuto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,12,9]]},"reference":[{"key":"4694_CR1","doi-asserted-by":"publisher","unstructured":"Parmentier CEJ, de Vries LS, van der Aa NE, Eijsermans RMJC, Harteman JC, Lequin MH, Swanenburg de Veye HFN, Koopman C, Groenendaal F (2022) Hypoglycemia in infants with hypoxic-ischemic encephalopathy is associated with additional brain injury and worse neurodevelopmental outcome. 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