Children with Hypoglycaemia and their Later Development

Abstract

Neonatal hypoglycaemia is common and potentially impairs neurodevelopment. Uncertainty exists over the blood glucose concentration that defines neonatal hypoglycaemia, neurodevelopmental outcomes of at-risk children, and neurodevelopmental differences between at-risk children who do and do not experience hypoglycaemia. We aimed to describe the neurodevelopmental outcomes of 2-year-olds born at risk of neonatal hypoglycaemia, to test whether hypoglycaemia was associated with poorer outcomes, and to examine relationships between neurodevelopmental outcome and other health and sociodemographic variables. Children born at risk of hypoglycaemia (infant of a diabetic mother, small (<10th centile or < 2500g), large (>90th centile or > 4500g), late preterm (35 or 36 weeks’ gestation) or other) were assessed at 24 ±1 months’ corrected age. Assessments included Bayley III, executive function tasks, BRIEF-P and health and sociodemographic information by parental questionnaire. We assessed 404 (77%) children from the neonatal cohort. Children who had and had not experienced neonatal hypoglycaemia had similar neurodevelopmental outcomes. However, children born small and to diabetic mothers achieved worse Bayley-III, executive function and BRIEF-P scores than large or preterm children. Girls and breastfed babies were more likely to experience hypoglycaemia but had better outcomes. Socioeconomic status was strongly associated with 2-year neurodevelopmental outcome. We found interactions between gender and risk factor, socioeconomic status and preschool attendance, with boys, but not girls, of diabetic mothers and low socioeconomic groups achieving worse, and those who attended preschool better, results than other groups, suggesting a greater vulnerability to environmental factors for boys. Assessed executive functions were related but separable and only weakly associated with parent-report but strongly related to language development. Children born at risk of neonatal hypoglycaemia are at risk of adverse neurodevelopmental outcome independent of whether or not they actually experience hypoglycaemia. This risk is higher in those born small, to diabetic mothers, not breast fed, and to low socioeconomic status families, with boys more vulnerable to poor outcome than girls. Executive function can be assessed at 2 years and appears to comprise separate but related constructs, most strongly related to language development. This cohort may benefit from continued monitoring, with early intervention service referrals where needed.