The risk of hypoglycemia-associated seizures in large-for-gestational-age (LGA) full-term neonates was assessed by analysis of data from the Netherlands Perinatal Registry at Wilhelmina Children’s Hospital, Utrecht. Hypoglycemia, defined as a plasma glucose below 2.5 mmol/1, was recorded from 1997-2002 in 1513 of 9318 (16.2%) of LGA full-term neonates without maternal diabetes; 20 (1.3%) of these had seizures, and hypoglycemia was the single cause of seizures in 6. Perinatal asphyxia, birth trauma and infections may have contributed to the hypoglycemia and seizures in the remaining 14. Hyperinsulinism was demonstrated in one LGA neonate with seizures and maternal diabetes, and in none without diabetes. The number with abnormal neurodevelopment was not recorded. The safe lower level of plasma glucose in healthy LGA neonates needs to be established. [1]
COMMENT. Hypoglycemic seizures may occur in LGA full-term neonates even in the absence of risk factors, such as maternal diabetes, perinatal asphyxia, trauma or infections, but the incidence is low. A wide variation in definition of hypoglycemia is quoted in textbooks, ranging from a glucose level of <1 to <2.5 mmol/1 for term babies of appropriate weight. An even greater range is used by practicing pediatricians [2]. The safe blood glucose concentration varies with many factors, including rate of fall of blood glucose. [3]