Neurodevelopmental outcome of neonates with hypoglycemia in Erbil, Iraq
Keywords:
Bayley Scales, Developmental Disabilities, Gestational Age, Hypoglycemia, InfantAbstract
Background and Objectives: Neonatal hypoglycemia is a frequent metabolic disturbance that may result in long‑term neurodevelopmental impairment. This study evaluated the neurodevelopmental outcomes of neonates with hypoglycemia in Erbil, Iraq, and identified associated risk factors.
Methods: A prospective observational study was conducted from January 2023 to June 2024 involving 140 neonates with hypoglycemia (blood glucose < 40 mg/dL) admitted to two tertiary hospitals. Neurodevelopmental status was assessed at 6, 12, and 18 months using the Denver II and Bayley III scales.
Results: Among 140 infants (47.9% males; mean gestational age 37.75 ± 1.16 weeks; mean birth weight (BW) 2.73 ± 0.31 kg), 46 (32.9%) had normal development, 48 (34.2%) mild delay, 32 (22.9%) moderate delay, and 14 (10.0%) severe delay. Developmental delay significantly correlated with severity of hypoglycemia (p < 0.001), duration > 6 hours (95.4% of delays), low BW (<2.5 kg, p < 0.001), prematurity (<37 weeks, p = 0.006), and maternal diabetes (p < 0.001). Infants without delay had higher mean blood glucose (34.15 ± 2.22 mg/dL) and BW (2.94 ± 0.19 kg) (p < 0.001). Motor (38.3%) and language (34.0%) deficits were most common.
Conclusion: Neonatal hypoglycemia, especially when severe, prolonged, or associated with maternal diabetes and low BW, significantly increases the risk of neurodevelopmental delay. Early diagnosis and vigilant glucose management are essential for neuroprotection
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References
Kebede SD, Kassaw A, Aytenew TM, Agmas K, Kefale D. Prevalence of prolonged transitional neonatal hypoglycemia and associated factors in Ethiopia: A systematic review and meta-analysis. PLOS ONE. 2025;20(2):e0316464. https://doi.org/10.1371/journal.pone.0316464
Diggikar S, Trif P, Mudura D, Prasath A, Mazela J, Ognean ML, et al. Neonatal Hypoglycemia and Neurodevelopmental Outcomes-An Updated Systematic Review and Meta-Analysis. Life (Basel, Switzerland). 2024;14(12):1618. https://doi.org/10.3390/life14121618
Sharma A, Davis A, Shekhawat PS. Hypoglycemia in the preterm neonate: etiopathogenesis, diagnosis, management and long-term outcomes. Translational pediatrics. 2017;6(4):335-48. https://doi.org/10.21037/tp.2017.10.06
De Angelis LC, Brigati G, Polleri G, Malova M, Parodi A, Minghetti D, et al. Neonatal Hypoglycemia and Brain Vulnerability. Frontiers in endocrinology. 2021;12:634305. https://doi.org/10.3389/fendo.2021.634305
Paulsen ME, Rao RB. Cerebral Effects of Neonatal Dysglycemia. Clinics in perinatology. 2022;49(2):405-26. https://doi.org/10.1016/j.clp.2022.02.008
Roeper M, Hoermann H, Körner LM, Sobottka M, Mayatepek E, Kummer S, et al. Transitional Neonatal Hypoglycemia and Adverse Neurodevelopment in Midchildhood. JAMA network open. 2024;7(3):e243683. https://doi.org/10.1001/jamanetworkopen.2024.3683
Ghazala N, Bala A, Ansari MA. Neurodevelopmental Outcomes in Children with Neonatal Hypoglycemia. International Journal of Current Pharmaceutical Review and Research. 2025;17(8):577-81.
Mahrous RFA, Hassanin SHA, Elbashir REE, Elseed HG, Elnour SEA, Elsayid NN, et al. Neonatal Hypoglycemia and Long-Term Pediatric Neurodevelopmental Outcomes: A Systematic Review. Cureus. 2025;17(6):1-11. https://doi.org/10.7759/cureus.86183
Rasmussen AH, Wehberg S, Pørtner F, Larsen AM, Filipsen K, Christesen HT. Neurodevelopmental outcomes after moderate to severe neonatal hypoglycemia. European journal of pediatrics. 2020;179(12):1981-91. https://doi.org/10.1007/s00431-020-03729-x
Garg M, Devaskar SU. Exploring the long-term impacts of neonatal hypoglycemia to determine a safe threshold for glucose concentrations. European journal of pediatrics. 2025;184(4):263. https://doi.org/10.1007/s00431-025-06082-z
De Rose DU, Perri A, Maggio L, Salvatori G, Dotta A, Vento G, et al. Neonatal hypoglycemia and neurodevelopmental outcomes: Yesterday, today, tomorrow. European journal of pediatrics. 2024;183(3):1113-9. https://doi.org/10.1007/s00431-023-05405-2
Rodolaki K, Pergialiotis V, Iakovidou N, Boutsikou T, Iliodromiti Z, Kanaka-Gantenbein C. The impact of maternal diabetes on the future health and neurodevelopment of the offspring: a review of the evidence. Frontiers in endocrinology. 2023;14:1125628. https://doi.org/10.3389/fendo.2023.1125628.
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