IMPORTANCE Prolonged neonatal hypoglycemia is associated with poor long-term neurocognitive function. However, little is known about an association between early transient newborn hypoglycemia and academic achievement.OBJECTIVE To determine if early (within the first 3 hours of life) transient hypoglycemia (a single initial low glucose concentration, followed by a second value above a cutoff) is associated with subsequent poor academic performance. DESIGN, SETTING, AND PARTICIPANTSA retrospective population-based cohort study of all infants born between January 1, 1998, and December 31, 1998, at the University of Arkansas for Medical Sciences who had at least 1 recorded glucose concentration (a universal newborn glucose screening policy was in effect) was conducted. Medical record data from newborns with normoglycemia or transient hypoglycemia were matched with their student achievement test scores in 2008 from the Arkansas Department of Education and anonymized. Logistic regression models were developed to evaluate the association between transient hypoglycemia and school-age achievement test proficiency based on perinatal factors. Common hypoglycemia cutoffs of a glucose level less than 35 mg/dL (primary) and less than 40 and 45 mg/dL (secondary) were investigated. All 1943 normoglycemic and transiently hypoglycemic infants (23-42 weeks' gestation) were eligible for inclusion in the study. Infants with prolonged hypoglycemia, congenital anomalies, or chromosomal abnormalities were excluded from the study. EXPOSURE Hypoglycemia as a newborn. MAIN OUTCOMES AND MEASURESThe primary outcome was proficiency on fourth-grade literacy and mathematics achievement tests at age 10 years. We hypothesized a priori that newborns with early transient hypoglycemia would be less proficient on fourth-grade achievement tests compared with normoglycemic newborns.RESULTS Perinatal data were matched with fourth-grade achievement test scores in 1395 newborn-student pairs (71.8%). Transient hypoglycemia (glucose level <35, <40, and <45 mg/dL) was observed in 6.4% (89 of 1395), 10.3% (143 of 1395), and 19.3% (269 of 1395) of newborns, respectively. After controlling for gestational age group, race, sex, multifetal gestation, insurance status, maternal educational level and socioeconomic status, and gravidity, transient hypoglycemia was associated with decreased probability of proficiency on literacy and mathematics fourth-grade achievement tests. For the 3 hypoglycemia cutoffs, the adjusted odds ratios (95% CIs) for literacy were 0.49 (0.28-0.83), 0.43 (0.28-0.67), and 0.62 (0.45-0.85), respectively, and the adjusted odds ratios (95% CIs) for mathematics were 0.49 (0.29-0.82), 0.51 (0.34-0.78), and 0.78 (0.57-1.08), respectively.CONCLUSIONS AND RELEVANCE Early transient newborn hypoglycemia was associated with lower achievement test scores at age 10 years. Given that our findings are serious and contrary to expert opinion, the results need to be validated in other populations before universal newborn glucose screening should be adopted.

Objective: To examine whether hypercapnia in very low birth weight (VLBW) infants during the first 3 days of life is associated with severe intraventricular hemorrhage (IVH).Study design: Retrospective cohort study of inborn VLBW infants between January 1999 and May 2004 with arterial access during the first 3 days of life. A multiple logistic regression analysis was used where IVH was dichotomized ((grades 0/1/2) ¼ non-severe; (grades 3/4) ¼ severe). Measures of hypercapnia were entered into the model to ascertain their association with severe IVH.Results: In total, 574 VLBW infants met entry criteria. Worst IVH grade was 0 in 400; 1: 54; 2: 42; 3: 47; and 4: 31 infants. The logistic regression model consisted of the following predictors of severe IVH: gestational age, gender, 1 min Apgar score (dichotomized into two groups: >3 vs p3), multifetal gestation, vasopressor use, and maximum PaCO 2 .Conclusion: In addition to traditional risk factors, it appears maximum PaCO 2 is a dose-dependent predictor of severe IVH during the permissive hypercapnia era.

Permissive hypercapnia, a strategy allowing high PaCO 2 , is widely used by neonatologists to minimize lung damage in ventilated very low birth weight (VLBW) infants. While hypercapnia increases cerebral blood flow (CBF), its effects on cerebral autoregulation of VLBW infants are unknown. Monitoring of mean CBF velocity (mCBFv), PaCO 2 , and mean arterial blood pressure (MABP) from 43 ventilated VLBW infants during the first week of life was performed during and after 117 tracheal suctioning procedures. Autoregulation status was determined during tracheal suctioning because it perturbs cerebral and systemic hemodynamics. The slope of the relationship between mCBFv and MABP was estimated when PaCO 2 was fixed at 30, 35, 40, 45, 50, 55, and Neonatologists frequently use permissive hypercapnia, a strategy that allows high PaCO 2 (45-55 mm Hg), to avoid ventilator-induced lung injury during mechanical ventilation of premature infants (1). The theoretical benefit of permissive hypercapnia is that lower tidal volumes and mean airway pressures may prevent alveolar overdistension and lung injury (1). Randomized controlled trials of permissive hypercapnia, however, failed to demonstrate significant improvements in survival without chronic lung disease over routine ventilation strategies (1,2). Despite its widespread use, the effects of permissive hypercapnia on cerebral autoregulation of premature infants are not known.Cerebral autoregulation is an essential physiologic mechanism that maintains constant blood flow to the brain despite variations in cerebral perfusion pressure (3). The BP range over which CBF remains constant is known as the autoregulatory plateau. In this portion of the curve, CBF is independent of BP and the slope is 0. Below the autoregulatory plateau, CBF declines; above it, CBF rises in a pressure-passive manner (Fig. 1 A) (4,5). In contrast, in impaired autoregulation, CBF linearly follows changes in BP (over all BPs), where the slope is significantly Ͼ0 (Fig. 1B) (6). Despite the widespread belief that cerebral autoregulation is impaired in sick, ventilated premature infants (6), recent evidence using continuous monitoring systems suggests that many premature infants do have intact autoregulation (7,8

Preemptive morphine infusions, additional morphine, and lower gestational age were associated with hypotension among preterm neonates. Severe IVH, any IVH, and death were associated with preexisting hypotension, but morphine therapy did not contribute to these outcomes. Morphine infusions, although they cause hypotension, can be used safely for most preterm neonates but should be used cautiously for 23- to 26-week neonates and those with preexisting hypotension.

Objective To investigate the association of neonatal hypoglycaemia and hyperglycaemia with outcomes in infants with hypoxic ischaemic encephalopathy (HIE). Design Post hoc analysis of the CoolCap Study.