IMPE Abstracts

Background: Neonatal hypoglycemia is the most common metabolic condition in neonates. It affects about 15 % of all neonates and about 50 % of neonates born with risk factors, including maternal diabetes, large- or small-for-gestational age, or prematurity. While it is known that hypoglycemia in congenital hyperinsulinism can lead to brain injury, it is still not clear to what extent transitional neonatal hypoglycemia is tolerated during the first days of life without damage. Although long being considered harmless, some population studies suggest that also transitional neonatal hypoglycemia may be associated with subtle neurodevelopmental impairment and learning difficulties, which may not become apparent until (pre-) school age. Thus, treatment thresholds and management strategies for neonatal hypoglycemia are controversially discussed. Aim of this study is to provide evidence whether or not episodes of transitional neonatal hypoglycemia < 1.7 mmol/l are a risk factor for mild brain damage.

Methods: Neurocognitive outcome in a total number of 140 children aged 7-11 years with prior severe neonatal hypoglycemia < 1.7 mmol/l or mild neonatal hypoglycemia > 1.7 mmol/l / no hypoglycemia is examined using standardized tests for cognitive, motor, and visual-motor function (WISC-V, MABC-2, DTVP) as well as standardized questionnaires to assess executive function and behavior (BRIEF, CBCL). Groups are matched for gender, birth weight, gestational age, parental socioeconomic status and risk factor for neonatal hypoglycemia. Power calculation estimated that this study has a 90% power at a significance level of 0.05 to detect a true difference of 1/2 standard deviation for the primary outcome (WISC-V full scale IQ).

Results: Since April 2022, a total number 100 children have been recruited and undergone neurocognitive testing. We plan to complete the recruitment of the remaining patients by the end of this year to have the results available at the IMPE meeting.

Conclusion: Given the high number of neonates who develop hypoglycemia each year (~120.000/year in Germany), answering the question whether and when neonatal hypoglycemia may be a risk factor for brain injury is of crucial importance to implement comprehensive guidelines for screening and management of neonatal hypoglycemia for future generations.