Christopher J. D. McKinlay|Jane Alsweiler|Nicola Anstice|Nataliia Burakevych|Arijit Chakraborty|J. Geoffrey Chase|Gregory D. Gamble|Deborah L. Harris|Robert J. Jacobs|Yannan Jiang|Nabin Paudel|R Diego|Benjamin Thompson|Trecia Wouldes|Jane E Harding
Association of Neonatal Glycemia With Neurodevelopmental Outcomes at 4.5 Years
University of Auckland|University of Auckland|University of Auckland|University of Auckland|University of Auckland|University of Waterloo|University of Canterbury|University of Auckland|University of Auckland|University of Auckland|University of Auckland|University of Auckland|University of Auckland|University of Auckland|University of Waterloo|University of Auckland|University of Auckland
hypoglycemia common neonatal transition may cause permanent neurological impairment optimal intervention thresholds unknownto test hypothesis neurodevelopment 45 years related severity frequency neonatal hypoglycemiathe children hypoglycemia later development chyld study prospective cohort investigation moderate late preterm term infants born risk hypoglycemia clinicians masked neonatal interstitial glucose concentrations outcome assessors masked neonatal glycemic status setting regional perinatal center hamilton new zealand study conducted december 2006 november 2010 dates followup september 2011 june 2015 participants 614 neonates born 32 weeks gestation least 1 risk factor hypoglycemia including diabetic mother preterm small large acute illness blood masked interstitial glucose concentrations measured 7 days birth infants hypoglycemia wholeblood glucose concentration 47 mgdl treated maintain blood glucose concentration least 47 mgdlneonatal hypoglycemic episode defined least 1 consecutive blood glucose concentration less 47 mgdl severe episode 36 mgdl recurrent 3 episodes interstitial episode defined interstitial glucose concentration less 47 mgdl least 10 minutescognitive function executive function visual function motor function assessed 45 years primary outcome neurosensory impairment defined poor performance one domainsin total 477 604 eligible children 790 assessed mean sd age time assessment 45 01 years 228 478 female exposed neonatal hypoglycemia 280 587 increased risk neurosensory impairment risk difference rd 001 95 ci 007 010 risk ratio rr 096 95 ci 077 121 however hypoglycemia associated increased risk low executive function rd 005 95 ci 001 010 rr 232 95 ci 117 459 visual motor function rd 003 95 ci 001 006 rr 367 95 ci 115 1169 highest risk children exposed severe recurrent clinically undetected interstitial episodes hypoglycemianeonatal hypoglycemia associated increased risk combined neurosensory impairment 45 years associated dosedependent increased risk poor executive function visual motor function even detected clinically may thus influence later learning randomized trials needed determine optimal screening intervention thresholds based assessment neurodevelopment least school age