ESPE Abstracts

Introduction: The neonatal threshold for hypoglycaemia is debatable and makes its treatment challenging. Neonatal hypoglycaemia can be transient and yet pose a significant risk of neuroglycopaenia, especially with severe and recurrent hypoglycaemia in Congenital Hyperinsulinism. Untreated hypoglycaemia induced cerebral injury can be identified by magnetic resonance (MR) brain scan changes affecting cerebral white matter, occipital lobes and posterior parietotemporal regions. It is recognized that a proportion of MR scan changes of hypoglycaemia may be due to missed and untreated early life hypoglycaemia, but the frequency is not known.

Methods: We present retrospective MR scan data in children in a single centre, collected over a ten year period (2010-2020) to identify potential cases of missed and untreated early life hypoglycaemia. Specific criteria were used to identify hypoglycaemic brain changes. Scan search from an electronic radiology repository involved the term “hypoglycaemia“ in the scan report. Early life hypoglycaemia was confirmed or rejected by review of electronic hospital records.

Results: A total of 107 MR scan and hospital records of patients with potential hypoglycaemia were reviewed, of whom 52 (48.5%) showed evidence of hypoglycaemic brain changes. We categorized them age group wise in relation to their initial presentation warranting admission, evidence of hypoglycaemia, MR findings, and further evaluation. Among these 52 patients with MR evidence of hypoglycemia, representation in different age groups were as follows: newborn 11, infants 12, 1-5 yrs 19 and >5 yrs 10. Evidence of hypoglycaemia was documented in 26 patients (50%), with 8 experiencing hypoglycaemia in the neonatal period and the rest beyond the neonatal period. The remaining 26 patients (50%) did not have documented hypoglycemia in their medical records despite the MR Brain changes. This absence of hypoglycemia prior to scan was definite in 17(33%), probable in another 5 (9.5%), and unavailable in 4 (7.5%) patients based on the details obtained from medical records

Conclusion: Nearly half the children with hypoglycaemia specific brain MR scan changes may have unrecognized and untreated hypoglycaemia, implying the need for heightened awareness of early life hypoglycemia. Our study suggests the need to investigate similar scan changes in other cohorts to understand the true extent of hypoglycaemic brain injury in children.