Neonatal glycemia and neurodevelopmental outcomes at 2 years

Christopher J.D. McKinlay, Jane M. Alsweiler, Judith M. Ansell, Nicola S. Anstice, J. Geoffrey Chase, Gregory D. Gamble, Deborah L. Harris, Robert J. Jacobs, Yannan Jiang, Nabin Paudel, Matthew Signal, Benjamin Thompson, Trecia A. Wouldes, Tzu Ying Yu, Jane E. Harding, CHYLD Study Group, Jane E. Harding, Jane Alsweiler, J. Geoffrey Chase, Deborah HarrisBen Thompson, Trecia Wouldes, H Feldman, William Hay, D Wilson, Robert F. Hess, Judith Ansell, Coila Bevan, Jessica Brosnahan, Ellen Campbell, Tineke Crawford, Kelly Fredell, Gregory D. Gamble, Claire Hahnhaussen, Safayet Hossin, Yannan Jiang, Anna Gsell, Karen Frost, Kelly Jones, Sapphire Martin, Christopher J.D. McKinlay, Grace McKnight, Christina McQuoid, Janine Paynter, Jenny Rogers, Kate Sommers, Heather Stewart, Anna Timmings, Jess Wilson, Rebecca Young, Sandy Yu, Nicola Anstice, Jo Arthur, Susanne Bruder, Arijit Chakraborty, Rob Jacobs, Gill Matheson, Nabin Paudel, Max Berry, Arun Nair, Ailsa Tuck, Alexandra Wallace, P Weston, Aaron Le Compte, Matthew Signal

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152 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)1507-1518
Number of pages12
JournalNew England Journal of Medicine
Volume373
Issue number16
DOIs
Publication statusPublished - 15 Oct 2015
Externally publishedYes

Keywords

  • neonatal hypoglycemia
  • neurodevelopment
  • Prospective cohort study
  • neonates

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