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. 2022 Mar 22;327(12):1158-1170.
doi: 10.1001/jama.2022.0992.

Association of Neonatal Hypoglycemia With Academic Performance in Mid-Childhood

Rajesh Shah  1 , Darren W T Dai  1 , Jane M Alsweiler  2 , Gavin T L Brown  3 , J Geoffrey Chase  4 , Gregory D Gamble  1 , Deborah L Harris  1   5 , Peter Keegan  6 , Samson Nivins  1 , Trecia A Wouldes  7 , Benjamin Thompson  8   9   10 , Jason Turuwhenua  9   11 , Jane E Harding  1 , Christopher J D McKinlay  1 ; Children With Hypoglycaemia and Their Later Development (CHYLD) Study Team
Collaborators, Affiliations

Association of Neonatal Hypoglycemia With Academic Performance in Mid-Childhood

Rajesh Shah et al. JAMA. .

Abstract

Importance: Neonatal hypoglycemia is associated with increased risk of poor executive and visual-motor function, but implications for later learning are uncertain.

Objective: To test the hypothesis that neonatal hypoglycemia is associated with educational performance at age 9 to 10 years.

Design, setting, and participants: Prospective cohort study of moderate to late preterm and term infants born at risk of hypoglycemia. Blood and masked interstitial sensor glucose concentrations were measured for up to 7 days. Infants with hypoglycemic episodes (blood glucose concentration <47 mg/dL [2.6 mmol/L]) were treated to maintain a blood glucose concentration of at least 47 mg/dL. Six hundred fourteen infants were recruited at Waikato Hospital, Hamilton, New Zealand, in 2006-2010; 480 were assessed at age 9 to 10 years in 2016-2020.

Exposures: Hypoglycemia was defined as at least 1 hypoglycemic event, representing the sum of nonconcurrent hypoglycemic and interstitial episodes (sensor glucose concentration <47 mg/dL for ≥10 minutes) more than 20 minutes apart.

Main outcomes and measures: The primary outcome was low educational achievement, defined as performing below or well below the normative curriculum level in standardized tests of reading comprehension or mathematics. There were 47 secondary outcomes related to executive function, visual-motor function, psychosocial adaptation, and general health.

Results: Of 587 eligible children (230 [48%] female), 480 (82%) were assessed at a mean age of 9.4 (SD, 0.3) years. Children who were and were not exposed to neonatal hypoglycemia did not significantly differ on rates of low educational achievement (138/304 [47%] vs 82/176 [48%], respectively; adjusted risk difference, -2% [95% CI, -11% to 8%]; adjusted relative risk, 0.95 [95% CI, 0.78-1.15]). Children who were exposed to neonatal hypoglycemia, compared with those not exposed, were significantly less likely to be rated by teachers as being below or well below the curriculum level for reading (68/281 [24%] vs 49/157 [31%], respectively; adjusted risk difference, -9% [95% CI, -17% to -1%]; adjusted relative risk, 0.72 [95% CI, 0.53-0.99; P = .04]). Groups were not significantly different for other secondary end points.

Conclusions and relevance: Among participants at risk of neonatal hypoglycemia who were screened and treated if needed, exposure to neonatal hypoglycemia compared with no such exposure was not significantly associated with lower educational achievement in mid-childhood.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Shah reported receipt of a doctoral scholarship from the University of Auckland. Dr Turuwhenua reported intellectual property licensure to the University of Auckland from Objective Acuity Limited (this intellectual property is broadly relevant to the techniques applied in this work); in addition, Dr Turuwhenua has patent WO2018104894A1 pending with Auckland UniServices Limited. No other disclosures were reported.

Figures

Figure.
Figure.. Flow of Participants in the CHYLD Study in Mid-Childhood
CHYLD indicates Children With Hypoglycaemia and Their Later Development.
See this image and copyright information in PMC

Comment in

References

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