Early hypoglycemia is not an independent risk factor for 2-year neurodevelopmental impairment in appropriate-for-gestational age preterm infants < 32 weeks

Objective: To evaluate whether hypoglycemia within the first 6 h of life (HOL) is an independent risk factor for 2-year neurodevelopmental impairment in appropriate-for-gestational age (AGA) preterm infants with a gestational age (GA) <32+0/7 weeks/days. Methods: We retrospectively analyzed data of 598 AGA preterm infants (GA: 24+0/7–31+6/7 weeks/days). Infants with at least one episode of hypoglycemia within the first 6 HOL (blood glucose concentration below 40 mg/dL; Glyc<40[Birth-6HOL]) were compared with infants without any hypoglycemia (Glyc≥40[Birth-6HOL]). Propensity score matching analysis was conducted for comparisons. Logistic regression analyses were used to evaluate the association of Glyc<40[Birth-6HOL] with 2-year cognitive (COG) and motor (MOT) impairments defined as a Bayley-III score < 85. Results: Of the 598 AGA preterm infants, 129 (21.6 %) were classified as Glyc<40[Birth-6HOL], and 469 (78.4 %) as Glyc≥40[Birth-6HOL]. Time from birth to intravenous glucose infusion did not significantly differ between Glyc<40[Birth-6HOL] and Glyc≥40[Birth-6HOL]. After multiple adjustments, Glyc<40[Birth-6HOL] infants did not have a significantly higher risk of both 2-year COG (ExpB: 1.150, p = 0.656) and MOT (ExpB: 0.982, p = 0.834) impairment compared to Glyc≥40[Birth-6HOL]. No differences in 2-year neurodevelopmental scores were found between the 79 matched infant pairs. Conclusion: In a clinical setting with strict glycemic monitoring and standardized glucose management, early hypoglycemia (≤6 HOL) was not identified as an independent risk factor for 2-year COG and MOT impairment in AGA preterm infants with a GA between 24+0/7 and 31+6/7 weeks/days.