title: Neonatal Glycemia and Neurodevelopmental Outcomes at 2 Years.
abstract: BACKGROUND
  Neonatal hypoglycemia is common and can cause neurologic impairment, but evidence supporting thresholds for intervention is limited.
  
  
  METHODS
  We performed a prospective cohort study involving 528 neonates with a gestational age of at least 35 weeks who were considered to be at risk for hypoglycemia; all were treated to maintain a blood glucose concentration of at least 47 mg per deciliter (2.6 mmol per liter). We intermittently measured blood glucose for up to 7 days. We continuously monitored interstitial glucose concentrations, which were masked to clinical staff. Assessment at 2 years included Bayley Scales of Infant Development III and tests of executive and visual function.
  
  
  RESULTS
  Of 614 children, 528 were eligible, and 404 (77% of eligible children) were assessed; 216 children (53%) had neonatal hypoglycemia (blood glucose concentration, <47 mg per deciliter). Hypoglycemia, when treated to maintain a blood glucose concentration of at least 47 mg per deciliter, was not associated with an increased risk of the primary outcomes of neurosensory impairment (risk ratio, 0.95; 95% confidence interval [CI], 0.75 to 1.20; P=0.67) and processing difficulty, defined as an executive-function score or motion coherence threshold that was more than 1.5 SD from the mean (risk ratio, 0.92; 95% CI, 0.56 to 1.51; P=0.74). Risks were not increased among children with unrecognized hypoglycemia (a low interstitial glucose concentration only). The lowest blood glucose concentration, number of hypoglycemic episodes and events, and negative interstitial increment (area above the interstitial glucose concentration curve and below 47 mg per deciliter) also did not predict the outcome.
  
  
  CONCLUSIONS
  In this cohort, neonatal hypoglycemia was not associated with an adverse neurologic outcome when treatment was provided to maintain a blood glucose concentration of at least 47 mg per deciliter. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and others.).
authors.affiliation: From the Liggins Institute (C.J.D.M., J.M. Alsweiler, J.M. Ansell, G.D.G., D.L.H., Y.J., J.E.H.), the Department of Paediatrics (J.M. Alsweiler), the School of Optometry and Vision Science (N.S.A., R.J.J., N.P., B.T., T.-Y.Y.), and the Department of Psychological Medicine (T.A.W.), University of Auckland, Auckland, the Department of Mechanical Engineering, University of Canterbury, Christchurch (J.G.C., M.S.), and the Neonatal Intensive Care Unit, Waikato District Health Board, Hamilton (D.L.H.) - all in New Zealand; and the School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada (B.T.).
authors.forename: Christopher J D
authors.initials: CJ
authors.lastname: McKinlay
authors.forename: Jane M
authors.initials: JM
authors.lastname: Alsweiler
authors.forename: Judith M
authors.initials: JM
authors.lastname: Ansell
authors.forename: Nicola S
authors.initials: NS
authors.lastname: Anstice
authors.forename: J Geoffrey
authors.initials: JG
authors.lastname: Chase
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Gamble
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Harris
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Jacobs
authors.forename: Yannan
authors.initials: Y
authors.lastname: Jiang
authors.forename: Nabin
authors.initials: N
authors.lastname: Paudel
authors.forename: Matthew
authors.initials: M
authors.lastname: Signal
authors.forename: Benjamin
authors.initials: B
authors.lastname: Thompson
authors.forename: Trecia A
authors.initials: TA
authors.lastname: Wouldes
authors.forename: Tzu-Ying
authors.initials: TY
authors.lastname: Yu
authors.forename: Jane E
authors.initials: JE
authors.lastname: Harding
mesh_terms: D001786:Blood Glucose / Q000032:analysis*; D002657:Child Development; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005947:Glucose / Q000627:therapeutic use*; D006801:Humans; D007003:Hypoglycemia / Q000503:physiopathology* / Q000517:prevention & control / Q000523:psychology / Q000628:therapy; D007231:Infant, Newborn / Q000097:blood*; D008297:Male; D011446:Prospective Studies; D012306:Risk
chemical_list: D001786:Blood Glucose; D005947:Glucose