Lower versus Traditional Treatment Threshold for Neonatal Hy
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Worldwide, many newborns who are preterm, small or large for gestational age, or born to mothers with diabetes are screened for hypoglycemia, with a goal of preventing brain injury. However, there is no consensus on a treatment threshold that is safe but also avoids overtreatment.

In a multicenter, randomized, noninferiority trial involving 689 otherwise healthy newborns born at 35 weeks of gestation or later and identified as being at risk for hypoglycemia, the Author compared two threshold values for treatment of asymptomatic moderate hypoglycemia. The author sought to determine whether a management strategy that used a lower threshold (treatment administered at a glucose concentration of <36 mg per deciliter) would be noninferior to a traditional threshold (treatment at a glucose concentration of <47 mg per deciliter ) with respect to psychomotor development at 18 months, assessed with the Bayley Scales of Infant and Toddler

Development, third edition, Dutch version (Bayley-III-NL; scores range from 50 to 150, with higher scores indicating more advanced development and 7.5 points (one half the SD) representing a clinically important difference). The lower threshold would be considered noninferior if scores were less than 7.5 points lower than scores in the traditional-threshold group.

Bayley-III-NL scores were assessed in 287 of the 348 children (82.5%) in the lower-threshold group and in 295 of the 341 children (86.5%) in the traditional-threshold group. Cognitive and motor outcome scores were similar in the two groups and in the lower-threshold group and in the traditional-threshold group). The prespecified inferiority limit was not crossed. The mean glucose concentration was in the lower-threshold group and in the traditional-threshold group. Fewer and less severe hypoglycemic episodes occurred in the traditional-threshold group, but that group had more invasive diagnostic and treatment interventions. Serious adverse events in the lower-threshold group included convulsions (during normoglycemia) in one newborn and one death.

In otherwise healthy newborns with asymptomatic moderate hypoglycemia, a lower glucose treatment threshold (36 mg per deciliter) was noninferior to a traditional threshold (47 mg per deciliter) with regard to psychomotor development at 18 months.

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa1905593
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