Abstract
Objective This study aimed to evaluate if early (within the first 3 hours after birth) transient
neonatal hypoglycemia (TNH) is associated with poor academic performance in infants
at-risk for hypoglycemia.
Study Design This was a retrospective cohort study of at risk-infants (late preterm infants, small
and large for gestational age infants, and infants of diabetic mothers [IDMs]) who
were born in 1998 and 1999 at the University of Arkansas for Medical Sciences and
had ≥1 recorded glucose concentration. The outcome measure was proficiency on 4th
grade literacy and mathematics achievement tests. Three glucose concentration cutoffs
for defining hypoglycemia (<35, <40, and <45 mg/dL) were investigated. Logistic regression
models were developed to examine the association between early TNH and achievement
test proficiency based on perinatal factors.
Results Among 726 infants, 472 had one, 233 had two, and 21 had three risk factor(s). Early
TNH (glucose concentration <35, <40, and <45 mg/dL) was observed in 6.3, 11.6, and
20.5% of the study cohort, respectively. Irrespective of the cutoff used, the frequency
of early TNH (number of patients with early TNH in a risk category divided by the
total number of patients in that category) was significantly greater among infants
with multiple risk factors. After controlling for perinatal factors, early TNH (cutoffs
<35 and <40 mg/dL) was significantly associated with decreased probability of proficiency
in literacy but not mathematics. Despite that early TNH was more common in IDMs and
infants with three risk factors, the category or number of risk factors did not impact
academic proficiency.
Conclusion Early TNH (<35 and <40 mg/dL) was associated with lower adjusted probability of proficiency
on 4th grade literacy achievement tests in at-risk infants. The impact of early TNH
on academic performance was similar irrespective of category or number of risk factors.
Key Points
Transient hypoglycemia was associated with lower proficiency on 4th grade tests in
at-risk infants.
The category of risk factors among at-risk infants did not impact 4th grade academic
proficiency.
The number of risk factors among at-risk infants did not impact 4th grade academic
proficiency.
Keywords hypoglycemia - infant of diabetic mothers - large for gestational age - small for
gestational age - late preterm
