Developmental Outcomes of Preterm Infants With Neonatal Hypoglycemia

Abstract

BACKGROUND AND OBJECTIVES: Neonatal hypoglycemia has been associated with abnormalities on brain imaging and a spectrum of developmental delays, although historical and recent studies show conflicting results. We compared the cognitive, academic, and behavioral outcomes of preterm infants with neonatal hypoglycemia with those of normoglycemic controls at 3 to 18 years of age.

Neonatal Glycaemia and Neurodevelopmental Outcomes: A Systematic Review and Meta-Analysis

“…All studies were conducted in developed countries, including Europe, the USA, Canada, and New Zealand. Four studies were conducted in the 1970s [14, 15, 20, 22], 2 in the 1990s [17, 21], 1 in the 2000s [16] and 4 in the 2010s [13, 18, 19, 23]. In 10 studies the study population comprised infants at risk of hypoglycaemia; 1 study included all the infants born at the hospital.…”

“…In 10 studies the study population comprised infants at risk of hypoglycaemia; 1 study included all the infants born at the hospital. Only 4 studies (5 publications) each had uncertain or low risk of bias in one or more domains, and each adjusted results for potential confounding [3, 13, 18, 19, 23]. No study was at low risk of bias across all domains.…”

“…There are several possible reasons for this including the difficulty of recruiting large cohorts around the time of birth, and the cost and complexity of long-term neurodevelopmental follow-up throughout childhood. Of note, only 3 of the included studies contributed data beyond 5 years of age [18, 21, 23]. Another limitation is the lack of adjustment for potential confounding factors, with only half of the included studies attempting to control for this potential source of bias.…”

Modern Management of Preterm Infants Prevents Adverse Developmental Outcomes From Hypoglycemia

“…If evolution of NICU care of the preterm infant has decreased the incidence, severity, and duration of neonatal hypoglycemia, it is not surprising that in this issue of Pediatrics, Goode and colleagues 10 provide new evidence from a multicenter study with 743 infants of ∼32 weeks' gestation that shows no significant differences in intellectual/cognitive skills or academic achievement from 3 to 18 years of age between preterm infants with and without documented hypoglycemia (defined by 3 low glucose ranges or as ≤45 mg/dL). Although low glucose concentrations were not prevented in this cohort, it is not likely that these infants or those without hypoglycemia did not receive current, standard intravenous dextrose infusions and early enteral feedings.…”

“…These infants had similar outcomes as those without any documented low glucose concentrations. 11 Furthermore, many of the risks of overtreating hypoglycemia in the more preterm patients in the study by Goode and colleagues, 10 such as separation from the mother, admission to the NICU, reduction of breastfeeding, or placement of intravenous catheters, are more likely to be present in very preterm infants. Clinicians should be reassured, therefore, that the current broad range of clinical practices using early intravenous dextrose and enteral feeding will not result in later life adverse neurodevelopmental, cognitive, and academic outcomes due to mild and transient hypoglycemia.…”