Mid-childhood Outcomes of Children Born at Risk of Neonatal Hypoglycaemia

Abstract

Background: Neonatal hypoglycaemia is a common and readily treatable risk factor for neurologic impairment in children. Although associations between prolonged symptomatic neonatal hypoglycaemia and brain injury are well established, the effect of asymptomatic transitional hypoglycaemia on long-term neurodevelopment is uncertain. Primary objective: To assess the effect of transitional neonatal hypoglycaemia, including its severity and frequency, on neurocognitive function and general health at mid-childhood in the CHYLD (Children with HYpoglycaemia and their Later Development) Study. Methods: The CHYLD Study is a prospective cohort study of preterm and term children (≥32 weeks’ gestation) born at risk of neonatal hypoglycaemia. Infants were screened after birth and treated to maintain blood glucose concentration (BGC) ≥2.6 mmol/L according to a common protocol. Masked interstitial glucose monitoring was undertaken to further assess glycaemic status. At 9 to 10 years’ corrected age a school-based assessment was undertaken of all children remaining in the CHYLD Study that included tests of academic achievement, executive function, and visual-motor function. Caregivers completed questionnaires about psychosocial adaptation and general health, and teachers reported on education and learning. The primary outcome was low academic achievement. Results: A total of 587 (96% of the original cohort) children were eligible for mid-childhood follow-up, of whom 480 (82% of those eligible) were recruited and completed one or more assessments at 9 to 10 years’ corrected age. There were no significant differences between children who were or were not exposed to neonatal hypoglycaemia in academic achievement, executive function, visual perception, fine motor skills, visual-motor integration, psychosocial adaptation, and general health. Conclusion: Among moderate-to-late preterm and term infants at risk of transitional neonatal hypoglycaemia, screening and treating to maintain BGC ≥2.6 mmol/L appears to be safe in the longer term for major neurocognitive outcomes, at least when compared to at-risk infants who do not experience neonatal hypoglycaemia.