1. In this prospective cohort study neonatal hypoglycemia was not significantly associated with lower educational achievement throughout childhood.

2. Teachers were significantly less likely to rate children exposed to hypoglycemia as below or well below the curriculum level for reading versus a non-exposed cohort.

Evidence Rating Level: 2 (Good)

Study Rundown: Neonatal hypoglycemia is a common metabolic disorder, often asymptomatic, that affects approximately 15% of newborns. While it is known that neonatal hypoglycemia is associated with an increased risk of poor executive and visual-motor function, its implications for academic performance and learning are unknown in children. This prospective longitudinal cohort study investigated if the impact of neonatal hypoglycemia and subsequent adverse neurocognitive outcomes were associated with a decreased educational performance for children born at a perinatal center in New Zealand. The primary outcome was low educational achievement and secondary outcomes were related to memory and executive function, visual-motor function, psychosocial adaptation, and general health. 480 children between the ages of 9 and 10 were assessed for the primary outcome, educational performance, between 2016-2020. Exposure to neonatal hypoglycemia, compared with no exposure, was found to have no significant association with low educational achievement or any of the secondary outcomes. Teachers were also found to be less likely to rate children with an exposure to hypoglycemia as below or well below their respective curriculum level for reading versus a non-exposed cohort. A major strength of this study was its ability to detect clinically important associations through a sufficient sample size and detailed measures of neonatal glycemic exposure. A limitation, however, was that 18% of eligible children were not assessed at 9 to 10 years of age for educational achievement, which could introduce bias.

Click to read the study in JAMA

Click to read an accompanying editorial in JAMA

Relevant Reading: Association between transient newborn hypoglycemia and fourth-grade achievement test proficiency: a population-based study

In-Depth [prospective cohort]: This study investigated if there were associations between neonatal hypoglycemia and low educational achievement during mid-childhood, between the ages of 9 to 10 years. Infants born at or after 32 weeks’ gestation, who were concurrently involved with neonatal studies between 2006 to 2010 were recruited and assessed. 480 children were recruited for follow-up at a mean age of 9.4 years, with a total of 468 children ultimately assessed for the primary outcome of educational achievement between 2016-2020. Of the 468 children assessed, 296 experienced a hypoglycemic event. Hypoglycemia was defined as a blood glucose concentration less than 47mg/dL with at least 1 hypoglycemic event. Between 9 to 10 years, children underwent an in-depth assessment that targeted academic achievement, executive function, visual-motor function, psychosocial adaptation and general health. Exposure to neonatal hypoglycemia compared to no exposure was not found to be significantly associated with low educational achievement (138/296 [47%] vs 82/172 [48%], respectively). The adjusted risk difference was -2% [95% CI, -11% to 8%]; with an adjusted risk ratio of 0.95 [95%CI, 0.78-1.15]. The upper limit of the 95%CI for the risk difference and risk ratio outcome was an 8% increase and 1.15, respectively, hence a potentially clinically relevant increase in risk for low educational achievement cannot be ruled out. Teachers were also found to be significantly less likely to rate children exposed to hypoglycemia as below or well below the curriculum level for reading (68/281 [24%] vs 49/157 [31%], respectively) in comparison to children not exposed to neonatal hypoglycemia. Additionally, no significant differences were found between the exposure groups and non-exposure groups relating to any of the secondary outcomes including low achievement in reading comprehension, mathematics, learning support, executive and/or fine motor function, and physical, and psychosocial well-being.

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