Muristek
Hypoglycemia is a common condition in newborns, and its management is a frequently debated topic in pediatrics and neonatology. Some newborns with hypoglycemia have permanent brain injury, especially infants with persistent genetic hypoglycemia disorders such as congenital hyperinsulinism. Brain injury also can occur in newborns without identified genetic hypoglycemia disorders, particularly if the hypoglycemia persists for many hours to days and is associated with signs of acute brain dysfunction, such as lethargy, coma, and seizures. In addition, the inability to predict which newborns will have brain injury based on the glucose concentration, the duration of hypoglycemia, and associated signs complicates management. Even the question of whether asymptomatic or mildly symptomatic hypoglycemia in genetically normal newborns can cause brain injury is unanswered. Often, the same features that increase the risk of hypoglycemia in newborns also increase the risk for poor outcomes independent of hypoglycemia. Two studies in this issue of JAMA provide new findings that inform how neonatal hypoglycemia can be understood and managed.
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