Executive function and behaviour problems in school-age children born at risk of neonatal hypoglycaemia.
Darren W T Dai, Nike Franke, Christopher J D McKinlay and 5 others
PMID 36722028WHAT IT FOUND
Children exposed to neonatal hypoglycaemia had similar results on computerised executive function tasks but parents reported more difficulty initiating, planning, organising and self-monitoring, plus peer problems, especially after severe or recurrent low glucose.
Teacher reports did not show the same pattern.
Key findings
01At 9–10 years, children exposed to neonatal hypoglycaemia had similar risks of difficulties in performance-based executive function as non-exposed children.
02Neonatal hypoglycaemia was associated with a two-fold increased risk of parent-reported metacognition difficulties and a 1.5-fold increased risk of parent-reported peer problems, but not teacher-reported executive function or behaviour problems.
03Children exposed to ≥3 hypoglycaemic events had a nearly 3-fold increased risk of parent-reported metacognition difficulties and a nearly 2-fold increased risk of parent-reported peer problems; children exposed to ≥1 severe hypoglycaemic event had an approximately 2.5 to 3.5-fold increased risk of parent-reported metacognition and overall executive function difficulties and a 2-fold increased risk of parent-reported peer problems and teacher-reported conduct problems.
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What it does not show
This was an observational cohort, so it cannot show that neonatal hypoglycaemia caused the later executive function or behaviour problems. Many outcomes were examined, which increases the chance that some findings are false positives. IQ was not measured at the same time as the school-age assessments; the analyses used earlier IQ, and IQ can change during childhood. Parent and teacher reports were the main sources for the positive findings, and the parent questionnaire has low to moderate agreement between raters and can be influenced by responder bias. Children who were not assessed were more likely to be of other ethnicity, so the follow-up sample may not represent all children born at risk.
Declared interests
The supplied metadata lists NIH extramural and non-U.S. government research support. No author conflict-of-interest declaration is included.
The easy way to misread this
Do not conclude that neonatal hypoglycaemia causes later behaviour problems. The study was observational, many outcomes were tested, and the main differences were parent-reported rather than seen on computerised executive function tasks.