Early neonatal hyperglycemia was not independently associated with neurodevelopmental outcomes after adjustment and a causal relationship between extreme prematurity and language delay was identified but no causal effect of hyperglycemia on neurodevelopmental outcomes was found.
Gestational diabetes mellitus (GDM) is associated with adverse maternal and neonatal outcomes, but its impact on early cognitive function and neurodevelopment remains uncertain. This study evaluates cognitive and developmental outcomes in infants born to mothers with GDM compared to non-diseased mothers.
A retrospective cohort study was conducted in infants born to mothers with or without GDM. Cognitive development was assessed using the Bayley Scales of Infant Development for Chinese Revision (BSID-CR), and developmental quotient (DQ) scores were extracted for analysis. Developmental concerns were identified from infant assessment records. Logistic and linear regression analyses were applied to determine associations between GDM and early developmental outcomes, adjusting for maternal and neonatal variables.
A total of 292 infants (145 born to mothers with GDM vs. 147 controls) were eligible for study. Maternal and neonatal characteristics were comparable between the GDM and control groups. No significant differences were observed between the groups in developmental concern occurrence (32.0% vs. 33.1%,
p
= 0.837) or corrected BSID-CR DQ score [median 94 (IQR, 83–103) vs. 96 (IQR, 85–102),
p
= 0.813]. The revised logistic model showed no independent association between GDM and developmental concern occurrence (OR = 1.090, 95% CI 0.602–1.972,
p
= 0.776), and the revised linear model showed no independent association between GDM and corrected BSID-CR DQ score (
B
= −0.069, 95% CI −3.807 to 3.670,
p
= 0.971).
Infants born to mothers with GDM demonstrated comparable cognitive and developmental outcomes to controls. Moreover, GDM may not independently impact cognitive development in infancy when managed appropriately.
Dan Liu, Xiaoxia Chen, Yili Zhang et al.· Frontiers in Pediatrics· 0 citations
OBJECTIVE
To evaluate whether hypoglycemia in neonates born to mothers at risk for late preterm delivery was related to adverse effects on childhood neurodevelopment.
METHODS
This was a prospective follow-up study of children aged 6 years or older whose mothers were enrolled in the Antenatal Late Preterm Steroids multicenter randomized trial. The study was conducted at 13 centers that participated in the Maternal-Fetal Medicine Units Network cycle from 2011 to 2016. Follow-up was from 2017 to 2022. Adult consent and child assent were obtained. The primary exposure was hypoglycemia , defined as a blood glucose concentration less than 40 mg/dL within 24 hours of birth. The primary outcome, proportion of GCA (General Conceptual Ability) scores lower than 85 (-1 SD) from the DAS-II (Differential Ability Scales, 2nd Edition), was analyzed by the presence of hypoglycemia at birth, irrespective of initial trial treatment assignment (betamethasone or placebo). Secondary outcomes included GMFCS (Gross Motor Function Classification System) level, SRS-2 (Social Responsiveness Scale, 2 nd Edition) scores, and CBCL (Child Behavior Checklist) scores. Univariable and multivariable analyses were performed, the latter adjusted for prespecified variables known to be associated with the primary outcome.
RESULTS
Of 1,026 children enrolled, 1,020 (99.4%) had blood glucose data and 944 had data for the primary outcome. Of these 944, 785 (83.2%) were delivered late preterm and 208 (22.0%) had hypoglycemia, of whom 84 (40.4%) were treated. Those with hypoglycemia were more likely to have private insurance, have older mothers, receive betamethasone, and identify as White. There were no differences in the primary outcome, GCA score lower than 85 (15.9% in those with hypoglycemia vs 18.5% in those without; adjusted relative risk 1.03; 95% CI, 0.74-1.45), and no difference in secondary outcomes. Severity of hypoglycemia also was not associated with any outcomes.
CONCLUSION
In our cohort, hypoglycemia was not associated with neurodevelopmental outcomes in children born predominantly late preterm.
C. GYAMFI-BANNERMAN, Jessica A. de Voest, A. Tita et al.· Obstetrics and Gynecology· 0 citations
OBJECTIVE
To compare early neurodevelopment at 12 months corrected age between preterm infants born small for gestational age (SGA) and appropriate for gestational age (AGA) and determine whether differences relate to birthweight or gestational age.
STUDY DESIGN
Prospective cohort of preterm infants (24-36 weeks) born April 2023-February 2024 at Mercy Hospital for Women, Melbourne. Infants were classified using the GROW customised centile calculator. Neurodevelopment was assessed at 12 months corrected age using the Bayley-4 A&NZ and PEDI. Regression and mediation analyses evaluated the effects of gestation and birthweight, adjusted for sex and socioeconomic status.
RESULTS
Among 143 infants (50 SGA, 93 AGA), follow-up at 12 months was 80%. Despite comparable mean Bayley-4 scores, moderate-to-severe developmental delay occurred mainly in SGA infants (5% vs 0-1%). Birthweight, rather than gestation, mediated cognitive and motor outcomes.
CONCLUSION
Birthweight better predicts early neurodevelopment than SGA status or gestational age.
M. Alda, T. MacDonald, P. Kalinowski et al.· Journal of Perinatology· 0 citations
OBJECTIVE
To assess the association between late-onset sepsis (LOS) and neurodevelopmental disorders (NDD) at 5 years of age among children born very preterm.
METHODS
We included children from the EPIPAGE-2 cohort study, born before 32 weeks of gestation and followed at 5 years. LOS was defined as one positive blood culture after 72 hours of life, associated with antibiotic therapy ≥5 days. At 5 years, NDD were evaluated as a composite outcome including cerebral palsy, neurosensory impairment and/or coordination, cognitive and behavioural disorders. NDD were categorised as: none, mild or moderate-to-severe disorders. We used multivariable multinomial regressions after multiple imputations of missing data to assess the association between LOS and NDD at 5 years.
RESULTS
Among the 3186 children born very preterm, 697 (20.6%) had at least one episode of LOS and 1927 (60.5%) had a complete assessment at 5 years. Among children who had an LOS, 42.2% had no NDD, 38.2% had mild NDD and 19.6% had moderate-to-severe NDD. The proportion of children with three episodes of LOS was higher in the mild NDD group and in the moderate to severe NDD group than in the none NDD group (1.3% vs 0.6% and 2.8 vs 0.6%, respectively). No association was found between the occurrence of at least one episode of LOS and NDD (mild NDD adjusted OR (aOR) 1.06 (95% CI 0.82 to 1.36); moderate-to-severe NDD aOR 1.18 (95% CI 0.90 to 1.55)).
CONCLUSION
We found no significant association between LOS and mild, moderate or severe NDD at five in children born very preterm.
Virginia Leao, L. Foix‐L'Hélias, L. Marchand-martin et al.· Archives of Disease in Child...· 0 citations
Introduction Extremely preterm infants commonly develop marked early changes in plasma glucose and sodium concentrations, but their clinical relevance remains unclear. We therefore aimed to characterize plasma glucose, sodium, and calculated osmolarity, and examine their associations with short-term neonatal outcomes. Methods We conducted a retrospective single-center cohort study of 42 extremely preterm infants (22+0 - 27+6 weeks’ gestation). Levels, variability, and temporal patterns in serial plasma glucose and sodium measurements, as well as calculated plasma osmolarity, were analyzed during the first postnatal week. Associations with neonatal outcomes were assessed in adjusted analyses. Results The lowest glucose value and greater glucose variability during the first postnatal week were associated with duration of mechanical ventilation, bronchopulmonary dysplasia and the composite outcome of bronchopulmonary dysplasia or death. A larger decrease in glucose during the first 4 postnatal days was associated with necrotizing enterocolitis. Plasma sodium and calculated plasma osmolarity during the first postnatal week were associated with surgical ligation of patent ductus arteriosus but showed no consistent associations with the other outcomes studied. Discussion These exploratory findings suggest that associations with subsequent neonatal morbidity were more consistently observed for glucose-derived measures than for plasma sodium or calculated plasma osmolarity. Whether these associations are causal or reflect underlying physiological vulnerability requires further investigation.
Spyros Gialamas, Nima Naseh, Erik Groth et al.· Frontiers in Pediatrics· 0 citations
Introduction: Neonatal blood glucose levels are affected by pregnancy outcomes. Preterm infants are more prone to hypo- and hyperglycaemia compared to full-term newborns. Understanding glucose fluctuation in these infants is important for improving early diagnostic accuracy and neonatal survival rate.
Aim: To explore the glucose levels and risk factors affecting glucose homeostasis among premature neonates.
Materials and Methods: A retrospective study was conducted from January 1 to March 31, 2017, at the Maternity Teaching Hospital affiliated with Hawler Medical University in Erbil city, Iraq. A total of 212 preterm newborns treated in the Neonatal Intensive Care Unit (NICU) were included. Information concerning premature neonates (glucose status, birth weight, and health status) of 24-hour-old newborns and maternal data (ages and gestation) were collected. Statistical analysis was conducted using Statistical Package for the Social Sciences (SPSS) software; methods used are descriptive statistics and inferential tests.
Results: Mean maternal age was 26.7±6.9 years and 113 (53.3%) of women were in young age (20-29 years). A total of 179 (84.4%) of the neonates had normal random blood glucose levels. Highest percentage of maternal 139 (65.6%) were in the group of 33 to 36 weeks of Gestational Age (GA). More than half 135 of premature newborns (63.7%), were in Low Birth Weight (LBW) group. Negative significant correlation found between random blood glucose with GA (unstandardised coefficient β= -1.3; 95% CI: -2.5 to -0.196) and with birth weight of newborns unstandardised coefficient β=-8.5; 95% CI: -14.3 to -2.7). Apgar moderate scores of 4-6 at five minutes increased with increase random blood glucose levels. While Apgar good 7-10 scores group at 10 minutes inversely associated with random blood glucose, (r=-0.196, p-value=0.021).
Conclusion: Most neonates demonstrated normal blood glucose levels. However, lower GA and birth weight were associated with a higher level of glucose, likely due to physiological stress and metabolic immaturity. This may be reflected in Apgar scores, as these infants require more time to adapt to extrauterine life.
J. Jawzali, A. Hassan· Journal of Clinical and Diag...· 0 citations
