A recent study published in Obstetrics & Gynecology found that neonatal hypoglycemia in the late preterm period was not associated with adverse neurodevelopmental outcomes in children assessed at age 6 years or older. The study drew from the Antenatal Late Preterm Steroids (ALPS) multicenter randomized trial, which was conducted at 13 centers from 2011 to 2016, with follow-up spanning 2017 to 2022.
The analysis evaluated 1,026 enrolled children whose mothers had been at risk for late preterm delivery. Of these, 1,020 (99.4%) had blood glucose data available, and 944 had data for the primary neurodevelopmental outcome.
The primary exposure was hypoglycemia, defined as a blood glucose concentration below 40 mg/dL within 24 hours of birth. Of the 944 children with outcome data, 785 (83.2%) were delivered late preterm and 208 (22.0%) had hypoglycemia, of whom 84 (40.4%) received treatment.
Children with hypoglycemia were more likely to have private insurance, have older mothers, have received antenatal betamethasone, and identify as White. The primary outcome was the proportion of children scoring below 85 on the General Conceptual Ability (GCA) scale of the Differential Ability Scales, 2nd Edition (DAS-II), representing performance more than 1 standard deviation below the mean.
No significant difference in the primary outcome was identified. GCA scores below 85 occurred in 15.9% of children with hypoglycemia vs. 18.5% of those without hypoglycemia (adjusted relative risk 1.03; 95% CI, 0.74–1.45). Severity of hypoglycemia was also not associated with any outcomes.
Cynthia Gyamfi-Bannerman, MD, MS, the study’s corresponding author, states that the findings suggest that hypoglycemia in infants born after 34 weeks may not be associated with adverse neurodevelopment. Previously, there had been some association between preterm hypoglycemia and possible cognitive impairment, but these findings indicate that this may not be true at later gestational ages.
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In terms of secondary neurodevelopmental outcomes, no significant differences were identified across any of the measures, including Gross Motor Function Classification System (GMFCS) level, Social Responsiveness Scale, 2nd Edition (SRS-2) scores, and Child Behavior Checklist (CBCL) scores.
The study’s results have practical relevance for patients at risk for late preterm delivery, particularly in the context of the original ALPS trial, in which betamethasone exposure was associated with an increased likelihood of neonatal hypoglycemia. Gyamfi-Bannerman noted that this study, together with a prior ALPS follow-up examining the neurodevelopmental effects of antenatal corticosteroids, provides reassurance on both fronts.
For a better understanding of the implications of these findings, it is essential to consider the broader context of neonatal care and the importance of balancing the risks and benefits of different treatments.
Gyamfi-Bannerman indicated that the results are not intended to alter immediate neonatal triage protocols, which are designed to assess infants at birth who may require treatment for hypoglycemia. Instead, the findings should be used to inform patient counseling and clinical practice, particularly for patients at risk for late preterm delivery.
The study’s findings can be accessed through the journal’s website, providing further insight into the relationship between neonatal hypoglycemia and neurodevelopmental outcomes.
