Asymptomatic moderate hypoglycemia in newborns: can the threshold be lowered?

  • van Kempen AAMW & al.
  • N Engl J Med
  • 6 Feb 2020

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • Compared with normal newborn hypoglycemia cutoffs, a lower glucose treatment threshold in asymptomatic moderate cases yields noninferior outcomes at age 18 months.

Why this matters

  • Consensus is lacking on the right balance between treatment threshold and the threshold to avoid overtreatment.

Key results

  • Developmental scores (Bayley-III-NL) at age 18 months were similar for children in the low-threshold (
  • Cognitive mean scores: 102.9±0.7 for low vs 102.2±0.7 for traditional threshold.
  • Motor outcome scores: 104.6±0.7 for low vs 104.9±0.7 for traditional threshold.
  • The traditional threshold group did have fewer hypoglycemic episodes and less severe events.
  • However, they also had more invasive diagnostics and treatments.
  • Study design

    • Multicenter, randomized, noninferiority trial, 689 healthy newborns (35+ weeks of gestation) at risk for hypoglycemia.
    • Funding: Netherlands Organization for Health Research and Development.

    Limitations

    • 15.5% loss to follow-up.