Prognosis of Infants of Diabetic Mothers in Relation to Neonatal Hypoglycaemia

Abstract

SUMMARY A prospective follow‐up study was conducted to determine whether neonatal hypoglycaemia in infants of diabetic mothers affects subsequent neurological and intellectual performance. 37 such infants (25 hypoglycaemic and 12 non‐hypoglycaemic) were examined for physical, neurological and developmental performance at an average age of 41/2 years. 11 children were abnormal, with generalised retardation and neurological abnormalities, or delays in particular areas of development; three children were possibly abnormal; and 23 children were normal. Abnormality at follow‐up could not be related to neonatal blood glucose level, to the duration of hypoglycaemia or to any other measurement made in the neonatal period, nor to any factor relating to the maternal diabetes. Compared with the normal children, the abnormal group had slightly smaller head‐circumferences at birth relative to their gestational age, but at follow‐up there was no difference in head size. At follow‐up the children of diabetic mothers tended to be shorter than average. The poor prognosis of the infants in this study was not due to brain damage caused by neonatal hypoglycaemia. RÉSUMÉ Pronostic d'avenir des nourrissons de mères diabétiques: relation avec l'hypoglycémic néonatale Une étude longitudinale a été menée pour déterminer si l'hypoglycémie néonatale chez les enfants de mères diabétiques altère ultérieurement les possibilités neurologiques et intellectuelles. 37 enfants (25 hypoglycémiques et 12 non hypoglycémiques) ont été examinés à l'âge moyen de quatre ans et demi sur les plans physique, neurologique et de développement. 11 enfants étaient anormaux avec retard général et anomalie neurologique ou délai dans un domaine particulier de développement; 3 enfants étaient peut‐être normaux. 23 enfants étaient sûrement normaux. Les anomalies ainsi apparues ne peuvent être reliées ni au taux de glycémie à la naissance, ni à la durée de l'hypoglycémie, ni à aucune autre mesure effectuée durant la période néonatale, ni à aucune caractéristique du diabète maternel. Comparés aux enfants normaux, les enfants anormaux presentaient à la naissance un tour de tête légèrement plus petit pour l'âge de gestation mais il n'a pas été observé ultérieurement de différence du tour de tête. Lors de la surveillance, les enfants de mère diabétique étaient un peu plus petits que la moyenne. Le pronostic sévère pour les enfants dans cette étude ne peut être dûà une lésion cérébrale provoquée par une hypoglycémic néo‐natale. ZUSAMMENFASSUNG Die Prognose der Kinder diabetischer Mütter: Beziehimgen zur neonatalen Hypoglykämie Es wurde eine prospektive Nachuntersuchung unternommen um zu bestimmen, ob die neonatalen Hypoglykämien der Kinder diabetischer Mütter die spätere neurologische und intellektuelle Leistungsfähigkeit beeinträchtigt. 37 Kinder (25 hypoglykämisch, 12 nicht hypoglykämisch) wurden im Alter von durchschnittlich 41/2 Jahren bezüglich ihrer physischen und neurologischen Leistungsfähigkeit und ihres Entwicklingszustands untersucht. 11 Kinder waren abnorm mit...

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

“…Three out of 4 of these studies were at high risk of bias in one or more domains. One study reported higher rates of low language/literacy in those exposed to neonatal hypoglycaemia compared with those not so exposed but results were imprecise and not statistically significant (37 infants, 16 vs. 0%; OR = 5.23, 95% CI = 0.26–105.50; p = 0.28) [14]. This study had an uncertain to high risk of bias.…”

“…Two of these 3 studies were at high risk of bias in one or more domains. The risk of epilepsy in early childhood did not differ between those exposed and not exposed to neonatal hypoglycaemia (4 studies, 772 infants, 4.2 vs. 2.1%; OR = 1.93, 95% CI = 0.76–4.85; p = 0.16, I 2 = 0%) [13, 14, 20, 22]. Three of these 4 studies were at high risk of bias in one or more domains.…”

“…Four out of the 6 studies contributing data to this meta-analysis were at high risk of bias in one or more domains (Table 2). In 2 studies, exposure to neonatal hypoglycaemia was associated with increased risk of visual-motor impairment (508 infants; 4.6 vs. 1.5%; OR = 3.46, 95% CI = 1.13–10.57; p = 0.03; I 2 = 0%) [13, 14]. One of these studies was at high risk of bias for confounding but contributed few data to the meta-analysis [14].…”

“…In 2 studies, exposure to neonatal hypoglycaemia was associated with increased risk of visual-motor impairment (508 infants; 4.6 vs. 1.5%; OR = 3.46, 95% CI = 1.13–10.57; p = 0.03; I 2 = 0%) [13, 14]. One of these studies was at high risk of bias for confounding but contributed few data to the meta-analysis [14]. In 1 study, there was an association between neonatal hypoglycaemia and executive dysfunction (463 infants; 10.6 vs. 4.7%; OR = 2.50, 95% CI = 1.20–5.22; p = 0.01).…”

“…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.…”