Hypoglycaemia is the most common metabolic disorder in newborns It affects up to 15% of all babies and is the only known common preventable cause of brain damage in infancy. However, the relationship between the frequency and severity of neonatal hypoglycaemia and later performance is not known.
CHYLD (Children with Hypoglycaemia and their Later Development) is a large multi-disciplinary cohort study following the development of children who were identified as being at risk of developing neonatal hypoglycaemia. Babies in the study were managed according to standard clinical guidelines. They were assessed at 2 and 4.5 years of age, and will be assessed again at 9-10 years of age to understand how neonatal hypoglycaemia relates to later development, learning-related skills and academic achievements.
CHYLD 2 year study findings
At 2 years, there was no relationship between neonatal low glucose concentrations and developmental outcome. 37% had some evidence of neurosensory impairment, but there was no relationship between the occurrence, severity or frequency of neonatal low glucose concentrations and developmental outcome. Interestingly, high glucose concentrations and less glucose stability in the first 48 hours was associated with relatively large increases (40-70%) in the risk of impairment, particularly cognitive delay.
CHYLD 4.5 years study findings
At 4.5 years, there was a 2-3 fold increased risk of poor executive function and visual-motor integration, with greater impairment in children with severe or recurrent hypoglycaemia. There was a 4-fold increase in the risk of executive function difficulty in children who had experienced undetected and therefore untreated low neonatal glucose concentrations.
CHYLD 9-10 study
The findings so far suggest that neonatal hypoglycaemia impairs specific skills that only become apparent at later ages, and that current thresholds for diagnosis and treatment may need to be revised. It’s therefore important to determine whether neonatal hypoglycaemia affects performance at school age.
The next part of the study (CHYLD 9-10) will investigate whether neonatal hypoglycaemia has an impact on skills that are important for learning and school performance.
The overall findings of the CHYLD study will help to determine the relationship between the duration, frequency and severity of low glucose concentrations in different groups of at-risk newborn babies and their later developmental outcomes, including academic achievement. In the short term, this will help guide clinical practice. In the longer term, it will provide an evidence base to design intervention studies that may prevent developmental impairment.
For more information about the study, or to make an enquiry, email the study team at CHYLD@auckland.ac.nz
McKinlay, C.J.D., Alsweiler, J.M., Anstice, N.S., Burakevych, N., Chakraborty, A., Chase, J.G., Gamble, G.D., Harris, D.L., Jacobs, R.J., Jiang, Y., Paudel, N., San Diego, R.J., Thompson, B., Wouldes, T.A., Harding, J.E. (2017). Association of neonatal glycemia with neurodevelopmental outcomes at 4.5 years. JAMA Pediatrics, 171 (10), 972-983. DOI: 10.1001/jamapediatrics.2017.1579
McKinlay, C.J.D., Alsweiler, J.M., Ansell, J.M., Anstice, N.S., Chase, J.G., Gamble, G.D., Harris, D.L., Jacobs, R.J., Jiang, Y., Paudel, N., Signal, M., Thompson, B., Wouldes, T.A., Yu, T.-Y., Harding, J.E. (2015). Neonatal glycemia and neurodevelopmental outcomes at 2 years. New England Journal of Medicine, 373 (16), 1507-1518. DOI:10.1056/NEJMoa1504909
Burakevych N, McKinlay CJD, Alsweiler JM, Wouldes TA, Harding JE for the CHYLD Study team. Pre-school screening for developmental and emotional health: Comparison with neurodevelopmental assessment. Journal of Paediatrics and Child Health 52, 600-607, 2016. doi:10.1111/jpc.13169
Burakevych N, McKinlay CJD, Alsweiler JM, Wouldes TA, Harding JE for the CHYLD Study team. BAYLEY-III motor scale and neurological examination at 2 years do not predict motor skills at 4.5 years. Developmental Medicine and Child Neurology 59: 216-223, 2017. DOI: 10.1111/dmcn.13232.
Harris, D. L., Weston, P. J., & Harding, J. E. (2014). Mothers of babies enrolled in a randomized trial immediately after birth report a positive experience. Journal of Perinatology 10.1038/jp.2013.183
Yu, T. Y., Jacobs, R. J., Anstice, N. S., Paudel, N., Harding, J. E., Thompson, B., & CHYLD Study Team (2013). Global Motion Perception in 2-Year-Old Children: A method for psychophysical assessment and relationships with clinical measures of visual function. Investigative Ophthalmology and Visual Science, 54 (13), 8408-8419. DOI: 10.1167/iovs.13-13051
Harris, D. L., Weston, P. J., Harding, J. E., Signal, M., & Chase, J. G. (2013). Dextrose gel for neonatal hypoglycaemia (the Sugar Babies Study): A randomised, double-blind, placebo-controlled trial. The Lancet, 382 (9910), 2077-208310.1016/S0140-6736(13)61645-1