Neonatal dysglycemia: a review of dysglycemia in relation to brain health and neurodevelopmental outcomes

Micheline Lagacé; Emily W Y Tam

doi:10.1038/s41390-024-03411-0

Neonatal dysglycemia: a review of dysglycemia in relation to brain health and neurodevelopmental outcomes

Pediatr Res. 2024 Jul 7. doi: 10.1038/s41390-024-03411-0. Online ahead of print.

Authors

Micheline Lagacé^{1

2}, Emily W Y Tam^{3

4}

Affiliations

¹ Faculty of Medicine, Clinician Investigator Program, University of British Columbia, Vancouver, BC, Canada.
² Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
³ Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. emily.tam@utoronto.ca.
⁴ Neurosciences and Mental Health, SickKids Research Institute, Toronto, ON, Canada. emily.tam@utoronto.ca.

PMID: 38972961
DOI: 10.1038/s41390-024-03411-0

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.

Publication types

Review