ESPE Abstracts

Introduction: Neonatal hypoglycemia (NH) affects about 15% of all neonates and about 50% of neonates born with risk factors, including maternal diabetes, large- or small for gestational age, or prematurity. Although it is known that hypoglycemia in congenital hyperinsulinism can lead to brain injury, it is still not clear to what extent transitional NH is tolerated during the first days of life without brain damage. Thus, treatment thresholds and management strategies are controversially discussed. Aim of this study was to obtain evidence on whether episodes of severe transitional NH with blood glucose ≤30 mg/dl are a risk factor for mild brain damage.

Material and Methods: Between 04/2022 - 02/2023, neurocognitive outcomes were examined in a total number of 140 healthy children aged 7-11 years with a history of severe NH ≤30 mg/dl (n=70) or mild NH >30 mg/dl / without NH (n=70) using standardized tests for cognitive, motor, and visual-motor functions (WISC-V, MABC-2, DTVP) as well as standardized questionnaires to assess executive functions and behavior (BRIEF, CBCL). Groups were matched for gender, birth weight, gestational age, parental socioeconomic status, and primary risk factors for NH. Statistical analysis included student’s t-test, Mann-Whitney-U test, Pearson's chi-squared test and Fisher’s Exact test where applicable.

Results: The groups did not differ with respect to any potential confounders of the neurodevelopmental outcomes assessed. Children with at least one episode of NH ≤30 mg/dl had significantly lower mean total IQ scores of 5 points (p =. 037) with significantly lower scores on the subscales ‘verbal comprehension’ (p =. 045) and ‘processing speed’ (p =. 026). They had significantly lower scores for total motor function (p =. 013), mainly due to poorer fine motor skills (p =. 007) and for general visual perception (p =. 009), driven by a decrease in visual-motor integration (p <.001). In the questionnaires, parents of children with NH ≤30 mg/dl reported that they showed poorer working memory performance (BRIEF, p =. 032) and increased attention problems (CBCL, p =. 006) compared to the control group.

Conclusion: In this study, severe NH ≤30 mg/dl was associated with poorer total IQ scores, fine motor function, and visual-motor integration in mid-childhood compared to a control group. In addition, children with severe NH may be more prone to attention problems and ADHD. Treatment thresholds should therefore be set high enough to avoid any episodes of NH ≤30 mg/dl.