-
This article is a collaboration between MedPage Today® and:
Newborns with low glucose levels may
have low achievement test scores once they are in grade school,
according to a small, population-based study.
Jeffrey R. Kaiser, MD, of Baylor College of Medicine in Houston, and colleagues found that transient hypoglycemia (<35 mg/dL) in a newborn was associated with the decreased likelihood of proficiency on literary achievement testing (adjusted odds ratio 0.49, 95% CI 0.28 to 0.83) and mathematics achievement testing (adjusted OR 0.49, 95% CI 0.29 to 0.82) as a fourth grader.
Even when employing higher cutoffs for transient hypoglycemia (<40 mg/dL and <45 mg/dL), similar results were observed for deficiencies in literary scores (OR 0.43, 95% CI 0.28 to 0.67 and OR 0.62, 9% CI 0.45 to 0.85, respectively) and math scores (OR 0.51, CI 0.29 to 0.82 and OR 0.78, CI 0.57 to 1.08, respectively), they wrote in JAMA Pediatrics.
Currently, the American Academy of Pediatrics (AAP) recommends only screening for glucose levels in infants small for gestational age, infants born to mothers with diabetes, and late preterm infants.
Kaiser characterized the results of his group's study as preliminary data, and emphasized that these early results should not change current practice.
"This is an important study because it's the first that says maybe there's something out there, but we have to be very cautious and not just change things based upon one study," he told MedPage Today. "Until somebody else replicates our study, we should still do things the way the AAP recommends."
Jay Reeve, PhD, and assistant professor, department of psychology at Florida State University in Tallahassee, said that from a child development standpoint, the results did not come as a complete surprise. Previous studies have demonstrated the link between adequate early nutrition, including consistent blood sugar levels, and academic achievement.
"We need to continue to pay close attention to the health of very young children, perhaps even upping our game with universal screening, since infant health can have such profound long-term consequences on child development," Reeve, who was not involved in the study, told MedPage Today via e-mail.
"I see relations also to the Adverse Childhood Experiences studies, which demonstrated pretty incontrovertibly that the elevated cortisol levels associated with anxiety have major, long term impacts on behavioral health when experienced repeatedly in childhood," added Reeve, who is also president and CEO of the Apalachee Center in Tallahassee.
Kaiser explained that the impetus for the study was a discussion about the University of Arkansas in Little Rock, where glucose levels in newborns were routinely checked during the first 3 hours of life. The institution had been doing this since the 1970s, but was considering stopping the practice after calling 10 major hospitals around the country who "laughed" at them, according to Kaiser.
"So I'm ... thinking to myself 'Wait a second, we have data from 40 to 50 years of babies with glucose levels,'" Kaiser told MedPage Today. "Instead of stopping [the practice], I raised my hand and said 'Hey, we've got to study this.'"
Using testing data from the No Child Left Behind initiative, his group matched 72% of infant data from 1998 to state achievement test scores 10 years later.
The authors used logistic regression models to determine this association, and controlled for gestational age, race, sex, multifetal gestation, insurance status, maternal educational level and socioeconomic status, and gravidity.
They found that increased probability of test proficiency was associated with female sex, singleton birth, full-term status, white and other race, private insurance, maternal education level exceeding high school, and primiparous birth.
Overall, transient hypoglycemia only occurred in a relatively small portion of all newborns. Less than 20% (19.3%) of newborns had a glucose level <45 mg/dL, with 10.3% registering <35 mg/dL and 6.4% at <35 mg/dL.
A smaller portion of hypoglycemic newborns (<30 mg/dL) were proficient in both fourth-grade literacy and math testing compared to normoglycemic newborns (≥35 mg/dL). The literacy test proficiency rate was 57% for normoglycemic newborns and 32% for hypoglycemic newborns, and 64% and 46% for math, respectively.
The researchers matched data from 1,395 newborns, with a mean gestational age of 36.8 weeks. Demographic characteristics of the sample were 94.7% black or white race and 50.3% male and a large majority (81.5%) with Medicaid or no insurance. There were 4.9% of mothers with diabetes mellitus. Infants with prolonged hypoglycemia, congenital anomalies, or chromosomal abnormalities were excluded.
Limitations to the study included its retrospective observational nature, and that glucose concentrations were collected at the discretion of bedside nurses. The authors also noted that information about signs of hypoglycemia was inconsistently available from medical records and that they could not account for potential confounders, such as 10 years of environmental influences, that may have contributed to test scores.
In an accompanying editorial, Christopher J.D. McKinlay, MBchB, PhD, and Jane E. Harding, MBchB, DPhil, both of the University of Auckland in New Zealand, pointed out there were no data on breastfeeding and that the duration of transitional hypoglycemia was brief. They also warned of the potential adverse effects for universal screening, such as pain-induced stress from repeated heal lancing.
"In the absence of evidence from randomized controlled trials (RCTs), clinicians should follow published guidelines [...] which recommend glucose screening only in at-risk infants," they wrote. "However, the data presented by Kaiser and colleagues emphasize that neonatal hypoglycemia is not a trivial matter."
Kaiser agreed, saying that the next steps would be to do an RCT assessing treatment outcomes for infants with low sugar levels. He also hoped that another hospital would replicate this study to see if the results were similar.
"We need another study or two to say 'We found the same thing,' and then perhaps, we'll start screening all newborns for low sugars," Kaiser stated.
Jeffrey R. Kaiser, MD, of Baylor College of Medicine in Houston, and colleagues found that transient hypoglycemia (<35 mg/dL) in a newborn was associated with the decreased likelihood of proficiency on literary achievement testing (adjusted odds ratio 0.49, 95% CI 0.28 to 0.83) and mathematics achievement testing (adjusted OR 0.49, 95% CI 0.29 to 0.82) as a fourth grader.
Even when employing higher cutoffs for transient hypoglycemia (<40 mg/dL and <45 mg/dL), similar results were observed for deficiencies in literary scores (OR 0.43, 95% CI 0.28 to 0.67 and OR 0.62, 9% CI 0.45 to 0.85, respectively) and math scores (OR 0.51, CI 0.29 to 0.82 and OR 0.78, CI 0.57 to 1.08, respectively), they wrote in JAMA Pediatrics.
Currently, the American Academy of Pediatrics (AAP) recommends only screening for glucose levels in infants small for gestational age, infants born to mothers with diabetes, and late preterm infants.
Kaiser characterized the results of his group's study as preliminary data, and emphasized that these early results should not change current practice.
"This is an important study because it's the first that says maybe there's something out there, but we have to be very cautious and not just change things based upon one study," he told MedPage Today. "Until somebody else replicates our study, we should still do things the way the AAP recommends."
Jay Reeve, PhD, and assistant professor, department of psychology at Florida State University in Tallahassee, said that from a child development standpoint, the results did not come as a complete surprise. Previous studies have demonstrated the link between adequate early nutrition, including consistent blood sugar levels, and academic achievement.
"We need to continue to pay close attention to the health of very young children, perhaps even upping our game with universal screening, since infant health can have such profound long-term consequences on child development," Reeve, who was not involved in the study, told MedPage Today via e-mail.
"I see relations also to the Adverse Childhood Experiences studies, which demonstrated pretty incontrovertibly that the elevated cortisol levels associated with anxiety have major, long term impacts on behavioral health when experienced repeatedly in childhood," added Reeve, who is also president and CEO of the Apalachee Center in Tallahassee.
Kaiser explained that the impetus for the study was a discussion about the University of Arkansas in Little Rock, where glucose levels in newborns were routinely checked during the first 3 hours of life. The institution had been doing this since the 1970s, but was considering stopping the practice after calling 10 major hospitals around the country who "laughed" at them, according to Kaiser.
"So I'm ... thinking to myself 'Wait a second, we have data from 40 to 50 years of babies with glucose levels,'" Kaiser told MedPage Today. "Instead of stopping [the practice], I raised my hand and said 'Hey, we've got to study this.'"
Using testing data from the No Child Left Behind initiative, his group matched 72% of infant data from 1998 to state achievement test scores 10 years later.
The authors used logistic regression models to determine this association, and controlled for gestational age, race, sex, multifetal gestation, insurance status, maternal educational level and socioeconomic status, and gravidity.
They found that increased probability of test proficiency was associated with female sex, singleton birth, full-term status, white and other race, private insurance, maternal education level exceeding high school, and primiparous birth.
Overall, transient hypoglycemia only occurred in a relatively small portion of all newborns. Less than 20% (19.3%) of newborns had a glucose level <45 mg/dL, with 10.3% registering <35 mg/dL and 6.4% at <35 mg/dL.
A smaller portion of hypoglycemic newborns (<30 mg/dL) were proficient in both fourth-grade literacy and math testing compared to normoglycemic newborns (≥35 mg/dL). The literacy test proficiency rate was 57% for normoglycemic newborns and 32% for hypoglycemic newborns, and 64% and 46% for math, respectively.
The researchers matched data from 1,395 newborns, with a mean gestational age of 36.8 weeks. Demographic characteristics of the sample were 94.7% black or white race and 50.3% male and a large majority (81.5%) with Medicaid or no insurance. There were 4.9% of mothers with diabetes mellitus. Infants with prolonged hypoglycemia, congenital anomalies, or chromosomal abnormalities were excluded.
Limitations to the study included its retrospective observational nature, and that glucose concentrations were collected at the discretion of bedside nurses. The authors also noted that information about signs of hypoglycemia was inconsistently available from medical records and that they could not account for potential confounders, such as 10 years of environmental influences, that may have contributed to test scores.
In an accompanying editorial, Christopher J.D. McKinlay, MBchB, PhD, and Jane E. Harding, MBchB, DPhil, both of the University of Auckland in New Zealand, pointed out there were no data on breastfeeding and that the duration of transitional hypoglycemia was brief. They also warned of the potential adverse effects for universal screening, such as pain-induced stress from repeated heal lancing.
"In the absence of evidence from randomized controlled trials (RCTs), clinicians should follow published guidelines [...] which recommend glucose screening only in at-risk infants," they wrote. "However, the data presented by Kaiser and colleagues emphasize that neonatal hypoglycemia is not a trivial matter."
Kaiser agreed, saying that the next steps would be to do an RCT assessing treatment outcomes for infants with low sugar levels. He also hoped that another hospital would replicate this study to see if the results were similar.
"We need another study or two to say 'We found the same thing,' and then perhaps, we'll start screening all newborns for low sugars," Kaiser stated.
Kaiser and co-authors disclosed no relevant relationships with industry.
Harding disclosed being an investigator on the Children with Hypoglycaemia and Their Later Development (CHYLD) Study.
McKinlay and Harding disclosed no relevant relationships with industry.
Harding disclosed being an investigator on the Children with Hypoglycaemia and Their Later Development (CHYLD) Study.
McKinlay and Harding disclosed no relevant relationships with industry.
last updated
Primary Source
JAMA Pediatrics
Source Reference: Kaiser JR, et al "Association between transient newborn hypoglycemia and fourth-grade achievement test proficiency: A population-based study" JAMA Pediatrics 2015; DOI: 10.1001/jamapediatrics.2015.1631.Secondary Source
JAMA Pediatrics
Source Reference: McKinlay CJD, Harding JE "Revisiting transitional hypoglycemia: Only time will tell" JAMA Pediatrics 2015; DOI: 10.1001/jamapediatrics.2015.1766.
Không có nhận xét nào:
Đăng nhận xét