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Published on: November 20, 2015
Child Neurodevelopmental Outcomes After Late Preterm Hypoglycemia
Cynthia Gyamfi-Bannerman1, Jessica A de Voest, Alan T N Tita
1Columbia University, New York, New York; the University of California, San Diego, La Jolla, and Stanford University, Stanford, California; the George Washington University Biostatistics Center, Washington, DC; the University of Alabama at Birmingham, Birmingham, Alabama; the University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, the University of Texas Medical Branch, Galveston, and the University of Texas at Austin, Austin, Texas; the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; the University of North Carolina at Chapel Hill, Chapel Hill, and Duke University, Durham, North Carolina; Brown University, Providence, Rhode Island; the University of Utah Health Sciences Center, Salt Lake City, Utah; Eastern Virginia Medical School at Old Dominion University, Norfolk, Virginia; The Ohio State University, Columbus, and MetroHealth Medical Center-Case Western Reserve University, Cleveland, Ohio; the University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado; and Northwestern University, Chicago, Illinois.
Insights
Neonatal hypoglycemia in late preterm infants did not impact childhood neurodevelopmental outcomes. This study found no significant differences in cognitive, motor, social, or behavioral assessments between infants with and without hypoglycemia.
Area of Science:
- Neonatal Medicine
- Pediatric Neurology
- Developmental Pediatrics
Background:
- Hypoglycemia is a common neonatal complication, particularly in late preterm infants.
- Previous research suggests potential links between neonatal hypoglycemia and adverse neurodevelopmental outcomes.
- The impact of hypoglycemia on neurodevelopment in late preterm infants requires further investigation.
Purpose of the Study:
- To investigate the association between neonatal hypoglycemia and neurodevelopmental outcomes in children born to mothers at risk for late preterm delivery.
- To evaluate cognitive, motor, social, and behavioral development in children with a history of neonatal hypoglycemia.
Main Methods:
- Prospective follow-up study of children aged 6+ years from a multicenter randomized trial.
- Primary exposure: hypoglycemia (blood glucose <40 mg/dL within 24 hours of birth).
- Primary outcome: General Conceptual Ability (GCA) scores below 85 on the DAS-II; secondary outcomes included motor, social, and behavioral assessments.
Main Results:
- No significant difference in GCA scores below 85 between infants with and without hypoglycemia (15.9% vs 18.5%; aRR 1.03).
- No significant differences observed in secondary neurodevelopmental outcomes (motor, social, behavioral).
- Severity of hypoglycemia was not associated with any assessed outcomes.
Conclusions:
- Neonatal hypoglycemia was not associated with adverse neurodevelopmental outcomes in this cohort of predominantly late preterm infants.
- Findings suggest that transient hypoglycemia in late preterm neonates may not have long-term neurodevelopmental consequences.
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.
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