Long-term effects of neonatal hypoglycemia on brain growth and psychomotor development in small-for-gestational-age preterm infants,☆☆

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Abstract

Objective: To investigate the effects of neonatal hypoglycemia on physical growth and neurocognitive function. Study design: A systematic detection of hypoglycemia (<2.6 mmol/L or 47 mg/dL) was carried out in 85 small-for-gestational-age preterm neonates. Prospective serial evaluations of physical growth and psychomotor development were performed. Retrospectively, infants were grouped according to their glycemic status. Results: The incidence of hypoglycemia was 72.9%. Infants with repeated episodes of hypoglycemia had significantly reduced head circumferences and lower scores in specific psychometric tests at 3.5 years of age. Hypoglycemia also caused reduced head circumferences at 18 months and lower psychometric scores at 5 years of age. Infants with moderate recurrent hypoglycemia had lower scores at 3.5 and 5 years of age compared with the group of infants who had 1 single severe hypoglycemic episode. Conclusion: Recurrent episodes of hypoglycemia were strongly correlated with persistent neurodevelopmental and physical growth deficits until 5 years of age. Recurrent hypoglycemia also was a more predictable factor for long-term effects than the severity of a single hypoglycemic episode. Therefore repetitive blood glucose monitoring and rapid treatment even for mild hypoglycemia are recommended for small-for-gestational-age infants in the neonatal period. (J Pediatr 1999;134:492-8)

Section snippets

Population

From a population of preterm infants being studied for long-term outcome, we selected retrospectively a group born prematurely and SGA with similar antenatal, perinatal, and sociodemographic risk factors. Infants with blood glucose levels <2.6 mmol/L (47 mg/dL) were compared with those who remained euglycemic for physical growth parameters and psychometric tests obtained prospectively. The 85 babies with birth weights below the 10th percentile2 and preterm (≤34 weeks) were born between March

Incidence of Hypoglycemia

The incidence of hypoglycemia in the population of SGA preterm infants was 73% (62 of 85). The other 27% (23 of 85) children were considered to have been euglycemic and constituted our control population. Within the cohort of hypoglycemic neonates, 58% (36 of 62) had serious hypoglycemia (>0.6 to 1.6 mmol/L, >11 to 29 mg/dL), and 21% (13 of 62) had severe episodes (≤0.6 mmol/L, ≤11 mg/dL). Fig 1 shows the recurrence of hypoglycemia within each of the cutoff limits.

. Distribution of hypoglycemic

DISCUSSION

Prematurity and intrauterine growth retardation are risk factors associated with an increased frequency of hypoglycemia, demonstrating the difficulty in adapting to extrauterine life for these infants with deficient glycogen stores. We found that hypoglycemia in SGA infants was far more common than reported previously.23 Studies of the incidence of hypoglycemia differ greatly depending on the population. For term infants hypoglycemia varies from 0.7% to 11.4%.23, 24 Increased incidences of

References (30)

  • O Pryds et al.

    Increased cerebral blood flow and plasma epinephrine in hypoglycemic preterm neonates

    Pediatrics

    (1990)
  • A Lucas et al.

    Adverse neurodevelopmental outcome of moderate neonatal hypoglycaemia

    Br Med J

    (1988)
  • LO Lubchenco et al.

    Intrauterine growth in length and head circumference as estimated from live births of gestational ages from 26 to 42 weeks

    Pediatrics

    (1966)
  • A Prader et al.

    Physical growth of Swiss children from birth to 20 years of age

    Helv Paediat Acta

    (1989)
  • GS Sykes et al.

    Birth asphyxia

    Br Med J

    (1982)
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    Reprint requests: J.-M. Matthieu, Service de Pédiatrie, Clinique Infantile, CHUV, CH-1011 Lausanne, Switzerland.

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