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ma=86400 Neonatal dysglycemia: a review of dysglycemia in relation to brain health and neurodevelopmental outcomes | Pediatric Research
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Neonatal dysglycemia: a review of dysglycemia in relation to brain health and neurodevelopmental outcomes

Pediatric Research volume 96, pages 1429–1437 (2024)Cite this article

Abstract

Neonatal dysglycemia has been a longstanding interest of research in neonatology. Adverse outcomes from hypoglycemia were recognized early but are still being characterized. Premature infants additionally introduced and led the reflection on the importance of neonatal hyperglycemia. Cohorts of infants following neonatal encephalopathy provided further information about the impacts of hypoglycemia and, more recently, highlighted hyperglycemia as a central concern for this population. Innovative studies exposed the challenges of management of neonatal glycemic levels with a “u-shape” relationship between dysglycemia and adverse neurological outcomes. Lately, glycemic lability has been recognized as a key factor in adverse neurodevelopmental outcomes. Research and new technologies, such as MRI and continuous glucose monitoring, offered novel insight into neonatal dysglycemia. Combining clinical, physiological, and epidemiological data allowed the foundation of safe operational definitions, including initiation of treatment, to delineate neonatal hypoglycemia as ≤47 mg/dL, and >150–180 mg/dL for neonatal hyperglycemia. However, questions remain about the appropriate management of neonatal dysglycemia to optimize neurodevelopmental outcomes. Research collaborations and clinical trials with long-term follow-up and advanced use of evolving technologies will be necessary to continue to progress the fascinating world of neonatal dysglycemia and neurodevelopment outcomes.

Impact statement

  • Safe operational definitions guide the initiation of treatment of neonatal hypoglycemia and hyperglycemia. Innovative studies exposed the challenges of neonatal glycemia management with a “u-shaped” relationship between dysglycemia and adverse neurological outcomes. The importance of glycemic lability is also being recognized. However, questions remain about the optimal management of neonatal dysglycemia to optimize neurodevelopmental outcomes. Research collaborations and clinical trials with long-term follow-up and advanced use of evolving technologies will be necessary to progress the fascinating world of neonatal dysglycemia and neurodevelopment outcomes.

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Fig. 1: Illustrative example of acquired brain injury following neonatal hypoglycemia.

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Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

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Acknowledgements

M.L. is supported by the University of British Columbia Clinician Investigator Program. This article includes work supported by the SickKids Foundation awarded to EWYT.

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Authors and Affiliations

  1. Faculty of Medicine, Clinician Investigator Program, University of British Columbia, Vancouver, BC, Canada

    Micheline Lagacé

  2. Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

    Micheline Lagacé & Emily W. Y. Tam

  3. Neurosciences and Mental Health, SickKids Research Institute, Toronto, ON, Canada

    Emily W. Y. Tam

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M.L. drafted the article and reviewed it critically for important intellectual content. E.T. guided the drafting of the article and reviewed it critically for important intellectual content. M.L. and E.T. approved the final version to be published.

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Correspondence to Emily W. Y. Tam.

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EWYT reports research funding from SickKids Foundation and UCB Biopharma outside the submitted work, expert testimony fees from Carbert Waite LLP, and leadership roles in the Pediatric Academic Societies Meeting, Society for Pediatric Research, and the Newborn Brain Society. All other authors declare no competing interests.

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Lagacé, M., Tam, E.W.Y. Neonatal dysglycemia: a review of dysglycemia in relation to brain health and neurodevelopmental outcomes. Pediatr Res 96, 1429–1437 (2024). https://doi.org/10.1038/s41390-024-03411-0

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