MedicalResearch.com Interview with:
Jeffrey R. Kaiser, MD, MA
Professor of Pediatrics and Obstetrics and Gynecology
Section of Neonatology
Baylor College of Medicine
Texas Children’s Hospital
Houston, TX 77030
Medical Research: What is the background for this study? What are the main findings?
Dr. Kaiser: The continuous utero-placental-umbilical infusion of glucose ends at birth, and levels decrease during the first 1–2 hours stimulating counterregulatory hormones and promoting successful glucose homeostasis in healthy newborns. This is important because the newborn brain principally uses glucose for energy, and prolonged and severe hypoglycemia has been linked with poor long-term neurodevelopment. Most previous newborn hypoglycemia-outcome studies, however, are problematic because they did not control for maternal educational level and socioeconomic status, factors that are highly associated with childhood neurodevelopment and academic success. Further, little is known about whether newborn transient hypoglycemia (1 low value followed by a second normal value), frequently considered to be a normal physiological phenomena with no serious sequelae, is associated with poor academic achievement. To address this knowledge gap, we compared initial newborn glucose values from the universal glucose-screening database, available only at the University of Arkansas for Medical Sciences (UAMS), to their matched student achievement-test scores in 4th grade (10 years later).
After controlling for gestational-age group, race, gender, multifetal gestation, insurance, maternal education, and gravidity, we observed transient hypoglycemia in a heterogeneous cohort of newborns born at a university hospital was associated with lower fourth-grade achievement-test scores—real-world assessments that predict high school graduation, college attendance, and long-term adult economic success.
Medical Research: What should clinicians and patients take away from your report?
Dr. Kaiser: It is currently recommended by National pediatric bodies to only screen newborns with symptomatic hypoglycemia and those at high risk of developing hypoglycemia. Our study, which evaluated both at risk and normal newborns, however, suggests early transient newborn hypoglycemia is associated with poorer academic performance at 10 years. Importantly, our results must be interpreted cautiously, as we did not prove transient newborn hypoglycemia causes poor academic performance. Until our results are corroborated by others, universal newborn glucose screening should not be undertaken.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Kaiser: High-quality multicenter long-term follow-up studies should be performed to direct future newborn hypoglycemia screening and treatment guidelines.
Jeffrey R. Kaiser et al. Association Between Transient Newborn Hypoglycemia and Fourth-Grade Achievement Test ProficiencyA Population-Based Study. JAMA Pediatrics, 2015 DOI:10.1001/jamapediatrics.2015.1631
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Jeffrey R. Kaiser, MD, MA (2015). Transient Neonatal Hypoglycemia Linked To Poorer Educational Attainment Ten Years Later