Neurodevelopmental Consequences of Neonatal Hypoglycemia

Hypoglycemia is the most common metabolic problem in neonates. Inadequately treated hypoglycemia can cause irreversible brain injury. Identification and prompt treatment of hypoglycemia is thus critical to prevent long-term neurodevelopmental sequelae. However, controversies persist regarding the optimal approach to screen for, define, and treat hypoglycemia in neonates. Distinguishing between healthy newborns with physiologic transitional neonatal hypoglycemia and those newborns with pathologic etiologies of hypoglycemia is of paramount importance because robust evidence supports the association between severe, recurrent, or prolonged hypoglycemia and brain injury. Practically, however, this can prove challenging. Studies evaluating the relationship between transient, asymptomatic neonatal hypoglycemia and long-term neurodevelopment have yielded conflicting results. These studies have employed numerical glucose thresholds to define neonatal hypoglycemia. However, the risk of hypoglycemic injury differs based on availability of alternative fuels, including ketones and lactate, and degree of plasma oxygenation.