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Original Investigation |

Association Between Transient Newborn Hypoglycemia and Fourth-Grade Achievement Test Proficiency A Population-Based Study

Jeffrey R. Kaiser, MD, MA1,2; Shasha Bai, PhD3; Neal Gibson, PhD4; Greg Holland, PhD4; Tsai Mei Lin, MS5; Christopher J. Swearingen, PhD3,6; Jennifer K. Mehl, MD7; Nahed O. ElHassan, MD8
[+] Author Affiliations
1Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
2Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
3Section of Biostatistics, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock
4Arkansas Research Center, University of Central Arkansas, Conway
5Health Statistics Branch, Center for Public Health Practice, Arkansas Department of Health, Little Rock
6currently with Samumed, LLC, San Diego, California
7Department of Pediatrics, Baylor College of Medicine, Houston, Texas
8Section of Neonatology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock
JAMA Pediatr. 2015;169(10):913-921. doi:10.1001/jamapediatrics.2015.1631.
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Importance  Prolonged neonatal hypoglycemia is associated with poor long-term neurocognitive function. However, little is known about an association between early transient newborn hypoglycemia and academic achievement.

Objective  To determine if early (within the first 3 hours of life) transient hypoglycemia (a single initial low glucose concentration, followed by a second value above a cutoff) is associated with subsequent poor academic performance.

Design, Setting, and Participants  A retrospective population-based cohort study of all infants born between January 1, 1998, and December 31, 1998, at the University of Arkansas for Medical Sciences who had at least 1 recorded glucose concentration (a universal newborn glucose screening policy was in effect) was conducted. Medical record data from newborns with normoglycemia or transient hypoglycemia were matched with their student achievement test scores in 2008 from the Arkansas Department of Education and anonymized. Logistic regression models were developed to evaluate the association between transient hypoglycemia and school-age achievement test proficiency based on perinatal factors. Common hypoglycemia cutoffs of a glucose level less than 35 mg/dL (primary) and less than 40 and 45 mg/dL (secondary) were investigated. All 1943 normoglycemic and transiently hypoglycemic infants (23-42 weeks’ gestation) were eligible for inclusion in the study. Infants with prolonged hypoglycemia, congenital anomalies, or chromosomal abnormalities were excluded from the study.

Exposure  Hypoglycemia as a newborn.

Main Outcomes and Measures  The primary outcome was proficiency on fourth-grade literacy and mathematics achievement tests at age 10 years. We hypothesized a priori that newborns with early transient hypoglycemia would be less proficient on fourth-grade achievement tests compared with normoglycemic newborns.

Results  Perinatal data were matched with fourth-grade achievement test scores in 1395 newborn-student pairs (71.8%). Transient hypoglycemia (glucose level <35, <40, and <45 mg/dL) was observed in 6.4% (89 of 1395), 10.3% (143 of 1395), and 19.3% (269 of 1395) of newborns, respectively. After controlling for gestational age group, race, sex, multifetal gestation, insurance status, maternal educational level and socioeconomic status, and gravidity, transient hypoglycemia was associated with decreased probability of proficiency on literacy and mathematics fourth-grade achievement tests. For the 3 hypoglycemia cutoffs, the adjusted odds ratios (95% CIs) for literacy were 0.49 (0.28-0.83), 0.43 (0.28-0.67), and 0.62 (0.45-0.85), respectively, and the adjusted odds ratios (95% CIs) for mathematics were 0.49 (0.29-0.82), 0.51 (0.34-0.78), and 0.78 (0.57-1.08), respectively.

Conclusions and Relevance  Early transient newborn hypoglycemia was associated with lower achievement test scores at age 10 years. Given that our findings are serious and contrary to expert opinion, the results need to be validated in other populations before universal newborn glucose screening should be adopted.

Figures in this Article

Figures

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Figure 1.
Initial Newborn Glucose Concentrations From 1395 Matched Newborn-Student Pairs

To convert glucose concentration to millimoles per liter, multiply by 0.0555.

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Figure 2.
Literacy and Mathematics Achievement Test Scores for Hypoglycemic and Normoglycemic Newborns by Hypoglycemia Cutoffs (Glucose Level <35, <40, and <45 mg/dL)

Test scores are unadjusted. To convert glucose concentration to millimoles per liter, multiply by 0.0555.

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