Association of Neonatal Hypoglycemia With Academic Performance in Mid-Childhood

Rajesh Shah, Darren W. T. Dai, Jane M. Alsweiler, et al

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

Key Points

Question Among children born at risk of neonatal hypoglycemia, do those who experience hypoglycemia have worse academic performance in mid-childhood?

Findings In this prospective cohort study that included 480 participants at risk of neonatal hypoglycemia who were screened and treated if needed to maintain blood glucose concentration of at least 47 mg/dL (2.6 mmol/L), children who were and were not exposed to neonatal hypoglycemia did not significantly differ in rates of low educational performance at 9 to 10 years’ corrected age, based on standardized tests of reading comprehension or mathematics (47% vs 48%).

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