Neonatal Glycemia and Neurodevelopmental Outcomes at Two years

Sarah Vo, Mercer University College of Pharmacy

Neonatal hypoglycemia is considered to be low blood sugar level in newborn babies.  It is suggested that babies require blood sugar for energy, which most is used by the brain.  Severe or persistent low blood sugar level is said to affect the baby’s mental function and in rare cases, heart failure or seizures may occur. [1]

Neonatal hyperglycemia is considered to be a common complication among preterm infants, small gestational age infants, and infants of diabetic mothers.  Persistent or recurrent hypoglycemia is suggested to cause neonatal permanent brain injury, cognitive impairment, vision disturbance, or cerebral palsy. [2]

Title: Neonatal Glycemia and Neurodevelopmental Outcomes at Two years [3]
Design Prospective cohort; N = 528
Objective To investigate the relation between the duration, frequency, and severity of low glucose concentrations in the neonatal period and neuropsychological development at two years
Study Groups At risk infants for neonatal hypoglycemia with a gestational age of at least 35 weeks
Methods Blood glucose was intermittently measured for up to seven days.

Interstitial glucose concentrations were continuously monitored, which were masked to clinical staff.

Hypoglycemia, defined as blood glucose concentration < 45 mg/L, was treated with any combination of additional feeding, buccal dextrose gel, and intravenous dextrose to maintain a blood glucose concentration of at least 47 mg/dL.

Evaluation at two years was done by Bayley Scales of Infant Development III and tests of executive and visual function were performed.

Duration Unknown
Primary Outcome Measure Neurosensory impairment and processing difficulty
Baseline Characteristics Neonatal hypoglycemia (n = 216) No neonatal hypoglycemia (n = 188)
Female (%) n = 116 n = 76
Primary risk factor for neonatal hypoglycemia (%) Maternal diabetes n = 80 n = 43
Late preterm: gestational ages of 35 or 36 week n = 71 n = 58
Small: < 10th percentile or < 2.5 kg n = 39 n = 21
Large: > 90th percentile of > 4.5 kg n = 17 n = 25
Results Neurosensory impairment (n = 404) Processing difficulty (n = 369)
Risk ratio 0.95 0.92
Confidence interval, 95% 0.75 to 1.20 0.56 to 1.51
P value 0.67 0.74
Adverse Events Common Adverse Events: not applicable
Serious Adverse Events: not applicable
Percentage that Discontinued due to Adverse Events: not applicable
Study Author 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/dL.

The study concluded that exposure to early neonatal hypoglycemia was not associated with adverse outcomes at two years old.  The risk of neurosensory impairment or processing difficulty was not higher among children with neonatal hypoglycemia, when treated, than among those without neonatal hypoglycemia.

Data suggested that rapid correction of hypoglycemia to higher blood glucose concentrations many be associated with neurosensory impairment.  Because the study was observational and unknown confounders cannot be excluded, interpretation of these data should be cautioned.

References

  1. Lee KG. Low blood sugar – newborns.  S. National Library of Medicine.  2013.  https://www.nlm.nih.gov/medlineplus/ency/article/007306.htm.  Accessed October 20, 2015.
  2. Su J, Wang L. Research advances in neonatal hypoglycemic brain injury. Transl Pediatr 2012;1(2):108-115. doi: 10.3978/j.issn.2224-4336.2012.04.06
  3. McKinlay CJD,Alsweiler JM, Ansell JM, et al. Neonatal glycemia and neurodevelopmental outcomes at 2 years. N Engl J Med 2015;373:1507-1518
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