Neonatal Glycemia and Neurodevelopmental Outcomes at 2 Years

Abstract

Background Neonatal hypoglycemia is common and can cause neurologic impairment, but evidence supporting thresholds for intervention is limited. Methods We performed a prospective cohort study involving 528 neonates with a gestational age of at least 35 weeks who were considered to be at risk for hypoglycemia; all were treated to maintain a blood glucose concentration of at least 47 mg per deciliter (2.6 mmol per liter). We intermittently measured blood glucose for up to 7 days. We continuously monitored interstitial glucose concentrations, which were masked to clinical staff. Assessment at 2 years included Bayley Scales of Infant Development III and tests of executive and visual function. Results Of 614 children, 528 were eligible, and 404 (77% of eligible children) were assessed; 216 children (53%) had neonatal hypoglycemia (blood glucose concentration, <47 mg per deciliter). Hypoglycemia, when treated to maintain a blood glucose concentration of at least 47 mg per deciliter, was not associated with an increased risk of the primary outcomes of neurosensory impairment (risk ratio, 0.95; 95% confidence interval [CI], 0.75 to 1.20; P = 0.67) and processing difficulty, defined as an executive-function score or motion coherence threshold that was more than 1.5 SD from the mean (risk ratio, 0.92; 95% CI, 0.56 to 1.51; P = 0.74). Risks were not increased among children with unrecognized hypoglycemia (a low interstitial glucose concentration only). The lowest blood glucose concentration, number of hypoglycemic episodes and events, and negative interstitial increment (area above the interstitial glucose concentration curve and below 47 mg per deciliter) also did not predict the outcome. Conclusions In this cohort, neonatal hypoglycemia was not associated with an adverse neurologic outcome when treatment was provided to maintain a blood glucose concentration of at least 47 mg per deciliter. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and others.)

‘We just dilute sugar and give’ health workers’ reports of management of paediatric hypoglycaemia in a referral hospital in Malawi

“…This may be one of the several explanations [12,16–18] why low and hypoglycaemia are common in children in sub-Saharan African hospitals [1,12]. The potential long-term neurological outcomes following hypoglycaemia in acute paediatric illness as described in neonates [19,20] have not been investigated to date.…”

Developmental Outcomes of Preterm Infants With Neonatal Hypoglycemia

“…More recent studies show conflicting data on long-term developmental outcomes in both term and preterm-born children with neonatal hypoglycemia. 9,10 Several studies have examined the actual level and/or duration of hypoglycemia that is harmful to the infant brain, with inconclusive findings. However, existing reviews generally conclude that welldesigned studies are scarce and more research is needed.…”

“…16 Despite this, most clinicians define hypoglycemia as a plasma glucose level of ≤40 to 45 mg/dL, 7,9,15,17 although some studies have used higher glucose cutoffs. 2,4,10 The conflicting results of developmental outcomes may be partially due to this inconsistency in the definition of hypoglycemia.…”

Risk factors associated with hypoglycemia in neonates

“…Estudios recientes refuerzan el concepto que este valor es el límite para el desarrollo (26) de complicaciones neurológicas a largo plazo .…”