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Newborn hypoglycemia may lower childhood test scores
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Newborns with transient hypoglycemia in the hours immediately after birth may be more likely to have lower math and reading test scores in childhood, according to research in JAMA Pediatrics.
In a retrospective, observational study analyzing the potential association between newborn glycemic screening results and academic tests scores at age 10 years, researchers found that newborns who experienced transient hypoglycemia were more likely to perform poorly on reading and math tests in the fourth grade, but cautioned that more research is still needed.
“Our study, which evaluated both at-risk and normal newborns using a universal newborn glucose screening policy, suggests early transient newborn hypoglycemia (less than 35, 40, and/or less than 45 mg/dL) vs. normoglycemia is associated with poor academic performance at 10 years,” Jeffrey R. Kaiser, MD, MA, a professor of pediatrics and obstetrics and gynecology at Baylor College of Medicine in Houston, told Endocrine Today. “Importantly, our results must be interpreted cautiously, as we did not prove transient newborn hypoglycemia causes poor academic performance. Until our results are corroborated by others, universal newborn glucose screening should not be undertaken.”
Kaiser and colleagues analyzed medical record data from 1,395 babies born at the University of Arkansas for Medical Sciences (UAMS) between Jan. 1, 1998 and Dec. 31, 1998 who had at least one recorded glucose concentration (a universal screening process was in place at UAMS during this period). Using medical records and social security numbers, the researchers matched glucose readings from all newborns in the cohort with their 2008 test scores from the Arkansas Department of Education, using logistic regression to evaluate the potential association between hypoglycemia and test proficiency in literacy and math. Researchers excluded infants with prolonged hypoglycemia or congenital abnormalities.
Within the cohort, 6.4% of newborns had a glucose level less than 35 mg/dL, 10.3% of newborns had a glucose level less than 40 mg/dL and 19.3% of newborns had a glucose level less than 45 mg/dL.
Researchers found that, after controlling for race, sex, gestational age group and socioeconomic factors, children with transient hypoglycemia as newborns were more likely to show decreased proficiency on fourth-grade achievement tests in literacy and math.
Adjusted ORs for literacy were 0.49 (95% CI, 0.28-0.83) for those with a newborn glucose level less than 35 mg/dL, 0.43 (95% CI, 0.28-0.67) for those with a newborn glucose level less than 40 mg/dL and 0.62 (95% CI, 0.45-0.85) for children with a newborn glucose level less than 45 mg/dL, while adjusted ORs for math were 0.49 (95% CI, 0.29-0.82), 0.51 (95% CI, 0.34-0.78) and 0.78 (95% CI, 0.57-1.08) for the same three glucose levels, respectively.
The average fourth-grade proficiency rate for reading was 32% for those hypoglycemic as newborns, compared with 57% for children with normoglycemic readings as newborns. The average proficiency rate for math was 46% for those with hypoglycemia as newborns, compared with 64% for those with normoglycemic readings, according to researchers.
In an editorial accompanying the research, Christopher J.D. McKinlay, MBChB, PhD, and Jane E. Harding, MBChB, DPhil, both of the University of Aukland, note that the study has several limitations, including little information about management strategies for hypoglycemia and no rates of breastfeeding, as well as no information about potential subsequent episodes of newborn hypoglycemia in the cohort.
“Despite extensive adjustment for perinatal and socioeconomic factors, the possibility of residual confounding remains in the study by Kaiser and colleagues, and causation cannot be proved,” McKinlay and Harding wrote. “Nevertheless, the associations observed are large and potentially clinically important.” – Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.
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