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Early hypoglycemia is not an independent risk factor for 2-year neurodevelopmental impairment in

Martina Palazzo1, Margherita Bonanni2, Alessio Correani1

  • 1Department of Odontostomatologic and Specialized Clinical Sciences, Polytechnic University of Marche, Ancona, Italy.

Brain & Development
|July 3, 2025
PubMed

Insights

Early hypoglycemia in preterm infants (gestational age <32 weeks) was not linked to neurodevelopmental issues at 2 years. Strict glucose monitoring in clinical settings ensures positive outcomes for these vulnerable infants.

Area of Science:

  • Neonatalogy
  • Developmental Pediatrics
  • Perinatal Medicine

Background:

  • Hypoglycemia, defined as blood glucose <40 mg/dL within the first 6 hours of life (HOL), is a concern in preterm infants.
  • Preterm infants, especially those appropriate-for-gestational age (AGA) with gestational age (GA) <32 weeks, are at higher risk for adverse neurodevelopmental outcomes.
  • The independent impact of early hypoglycemia on long-term neurodevelopment in this specific population remains incompletely understood.

Purpose of the Study:

  • To determine if hypoglycemia within the first 6 HOL is an independent risk factor for 2-year neurodevelopmental impairment.
  • To assess the association between early hypoglycemia and cognitive (COG) and motor (MOT) development at 2 years of age.
  • To evaluate neurodevelopmental outcomes in appropriate-for-gestational age (AGA) preterm infants (GA <32 weeks) with and without early hypoglycemia.

Main Methods:

  • Retrospective analysis of 598 AGA preterm infants (GA: 24-31 weeks).
  • Comparison of infants with early hypoglycemia (Glyc<40 [Birth-6HOL]) versus those without (Glyc≥40 [Birth-6HOL]).
  • Propensity score matching and logistic regression analyses were used to evaluate 2-year COG and MOT impairments (Bayley-III score <85).

Main Results:

  • 129 infants (21.6%) experienced early hypoglycemia (Glyc<40 [Birth-6HOL]).
  • After adjustments, early hypoglycemia was not significantly associated with increased risk of 2-year COG (ExpB: 1.150, p=0.656) or MOT (ExpB: 0.982, p=0.834) impairment.
  • No significant differences in 2-year neurodevelopmental scores were observed between 79 matched infant pairs.

Conclusions:

  • Early hypoglycemia (≤6 HOL) was not an independent risk factor for 2-year cognitive or motor impairment in preterm AGA infants (GA 24-31 weeks).
  • Effective glycemic monitoring and standardized management protocols in clinical settings appear to mitigate risks associated with early hypoglycemia.
  • These findings support current clinical practices for managing blood glucose levels in vulnerable preterm infants.
Abstract

Keywords:
Appropriate for gestational ageHypoglycemiaNeurodevelopmental impairmentPreterm infant

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