UAMS, Baylor Study Finds Neonatal Hypoglycemia May Affect School-Age Academic Outcomes

By Ben Boulden

Transient low blood sugar is a type of hypoglycemia in which an initial low blood sugar reading is followed by a second test showing a normal blood sugar level.

The UAMS and Baylor researchers were able to make the association of early transient hypoglycemia with decreased proficiency on literacy and mathematics tests, after controlling for gestational age, race, gender, socioeconomic status and maternal education.

Babies with normal glucose levels were about 20 percent more proficient on achievement tests than those with initially low glucose levels. This finding is important since lower fourth-grade achievement test scores can be associated with lower high school graduation rates, less college attendance, and ultimately less long-term economic success.

“With the findings of this study, we have shown some evidence of the impact of early transient newborn hypoglycemia,” said Nahed O. ElHassan, M.D., M.P.H., associate professor in the neonatology section of the UAMS Department of Pediatrics.

ElHassan emphasized that the study was preliminary and the findings will have to be validated by other researchers before any changes to screening or management of newborn hypoglycemia are considered.

Co-authors of the study include ElHassan and Shasha Bai, Ph.D., assistant professor in the Biostatistics Division of the UAMS College of Medicine’s Department of Pediatrics. Jeffrey R. Kaiser, M.D., a former UAMS College of Medicine faculty member, is the study’s principal investigator. He is now a professor of pediatrics and obstetrics and gynecology at the Baylor College of Medicine and Texas Children’s Hospital.

Using data from infants born at UAMS in 1998, where all newborns have their sugar levels screened during the first three hours after birth, the team sought to determine the effect of hypoglycemia on academic achievement in fourth grade.

With the availability of the universal glucose screening data from more than 30,000 Arkansas infants, the research team was able to team with the Arkansas Department of Education and Arkansas Department of Health to match data from 1,395 infants born in 1998 with their 2008 achievement test scores when the children were 10 years old.

Hypoglycemia is important because the newborn’s brain principally uses glucose for energy. Persistent and very low glucose levels in newborns are associated with brain damage and poor long-term development. The research team wanted to look further into the impact of transient hypoglycemia using the data available at UAMS.

The data collection portion of the study was conducted while Kaiser was on the UAMS faculty. The analysis portion was conducted by the Pediatric Biostatistics Program at UAMS and the Arkansas Children’s Hospital Research Institute. The analysis was initiated while Kaiser was on the UAMS faculty and completed following his move in 2012 to Baylor College of Medicine and Texas Children’s Hospital.

“The No. 1 thing I learned while doing this study was how important collaboration is between clinicians, medical students and biostatisticians,” Bai said. “We matched our database at the hospital to data from the Arkansas Department of Education for outcomes and information from the Arkansas Department of Health. Previous studies on hypoglycemia didn’t combine data similarly. It took a lot of effort between UAMS, Baylor and the state agencies here.”

In addition to ElHassan and Bai, Christopher J. Swearingen, Ph.D., former UAMS faculty, also is a co-author along with Neal Gibson and Greg Holland of the University of Central Arkansas; Tsai Mei Lin of the Arkansas Department of Health, and Jennifer K. Mehl who was a medical student at UAMS and is now a pediatric resident at Baylor.  Swearingen is now at Samumed, LLC.