Original Article
Hypoglycemia is Associated with Increased Risk for Brain Injury and Adverse Neurodevelopmental Outcome in Neonates at Risk for Encephalopathy

https://doi.org/10.1016/j.jpeds.2011.12.047Get rights and content

Objective

To investigate the contribution of hypoglycemia in the first 24 hours after birth to brain injury in term newborns at risk for neonatal encephalopathy.

Study design

A prospective cohort of 94 term neonates born between 1994 and 2010 with early postnatal brain magnetic resonance imaging studies were analyzed for regions of brain injury. Neurodevelopmental outcome was assessed at 1 year of age.

Results

Hypoglycemia (glucose <46 mg/dL) in the first 24 hours after birth was detected in 16% of the cohort. Adjusting for potential confounders of early perinatal distress and need for resuscitation, neonatal hypoglycemia was associated with a 3.72-fold increased odds of corticospinal tract injury (P = .047). Hypoglycemia was also associated with 4.82-fold increased odds of 1-point worsened neuromotor score (P = .038) and a 15-point lower cognitive and language score on the Bayley Scales of Infant Development (P = .015).

Conclusion

Neonatal hypoglycemia is associated with additional risks in the setting of neonatal encephalopathy with increased corticospinal tract injury and adverse motor and cognitive outcomes.

Section snippets

Methods

Term neonates born between 1994 and 2010 at the University of California San Francisco (UCSF) at risk for neonatal encephalopathy were included in this prospective cohort study. Inclusion criteria include an umbilical artery pH <7.1, umbilical artery base deficit >10, or a 5-minute Apgar score ≤5. Newborns were excluded if their gestational age at birth was <36 weeks or there were suspected or confirmed congenital malformations, inborn errors of metabolism, or congenital infections based on

Results

A total of 94 subjects were enrolled during the period of 1994-2010. Hypoglycemia was detected in the first 24 hours after birth in 15 (16%) of the 94 subjects. The clinical demographics of this cohort separated into children with and without hypoglycemia detected in the first 24 hours after birth (Table I). Newborns with hypoglycemia demonstrated higher encephalopathy scores in the first 24 hours after birth and had a higher rate of neonatal seizures during the hospital course. Umbilical

Discussion

In this cohort study of MRI after neonatal encephalopathy, an independent association was found between hypoglycemia in the first 24 hours after birth and increased risk of injury to the corticospinal tract. The classic parieto-occipital pattern of brain injury after isolated neonatal hypoglycemia was not observed. In addition, associations were found between hypoglycemia in the first 24 hours after birth and motor and cognitive impairment at 1-year follow-up.

Recent literature suggests a

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    This article was supported by the National Institutes of Health (grants 5R13 NS040925, P50 NS35902, UL1 RR024131, NINDS 1K23NS066137 [to H.G.]). E.T. is a Cerebral Palsy International Research Foundation Ethel & Jack Hausman Clinical Research Scholar. The authors declare no conflicts of interest.

    Contributed equally to the study.

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