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Neonatal hypoglycemia: pre-emptive monitoring and treatment may result in normal neurodevelopmental outcome

Pediatric Research volume 93, pages 1456–1457 (2023)Cite this article

In this issue, Kennedy et al.1 report on caudate volumes and neurodevelopmental outcomes at 9–10 years of age in the “Children with hypoglycemia and their later development” (CHYLD) study in children with and without a history of neonatal hypoglycemia. Smaller caudate volume in this cohort is reported to be associated with greater parent-reported emotional and behavioral difficulties, and poorer prosocial behavior. However, neonatal hypoglycemia was not found to be a mediator in this relationship, except in the case of visual memory, where only those children without neonatal hypoglycemia showed significant associations with caudate volume. Children with neonatal hypoglycemia did not show significant associations between caudate volume and visual memory outcomes.

Neonatal hypoglycemia has previously been demonstrated by numerous reports to be associated with posterior-predominant brain injury, resulting in a triad of neurodevelopmental impairment, cortical visual loss, and epilepsy. Brain MRI in the neonatal period has been reported to demonstrate a specific posterior-predominant brain injury pattern, particularly in the parieto-occipital white matter and pulvinar nucleus of the thalamus.2,3 Follow-up imaging later in life demonstrates gliosis and volume loss in these same regions.4 Children with a history of neonatal hypoglycemia have been reported to have lower developmental scores at 8 years of life compared to children without.5 Early diffusion restriction in the calcarine cortex on brain MRI is associated with abnormal visual evoked potentials in the first week of life and increased risk for long-term cortical visual impairment, including blindness or homonymous hemianopsia.6 Long-term consequences also include increased risk for epilepsy, including infantile spasms or focal epilepsy from occipital gliosis, and can be intractable in infancy or early childhood.4,7

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References

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  1. Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

    Emily W. Y. Tam

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E.W.Y.T. is the sole author of this manuscript, including drafting, and final approval.

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Correspondence to Emily W. Y. Tam.

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Tam, E.W.Y. Neonatal hypoglycemia: pre-emptive monitoring and treatment may result in normal neurodevelopmental outcome. Pediatr Res 93, 1456–1457 (2023). https://doi.org/10.1038/s41390-023-02511-7

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