Hypoglycemia occurs frequently in very low birth weight premature infants with cholestasis

Pradeep Alur, Sriharsha Talluri, Vishwarath Bollampalli, Theodore Bell, Jonathan Liss, Prabhu Parimi


Background: The study purpose was to examine the incidence of hypoglycemia in very low birth weight (VLBW) infants with cholestasis while on complete enteral nutrition.

Methods: A retrospective study of 270 VLBW (<1500 grams) infants born between 2008 and 2012 at York Hospital with cholestasis was performed. A blood glucose concentration ≤50 mg/dl was used to define hypoglycemia, and hypoglycemic events were recorded while infants were on full enteral feeds. Characteristics of infants with cholestasis were compared with those without cholestasis.

Results: Cholestasis was noted in 9.6% (26/270) of VLBW infants, four babies were excluded. Twenty-two infants with cholestasis were analyzed and compared. Among those with cholestasis, hypoglycemic episodes occurred in 12 (54.5%) infants at 17±13 days (mean ±SD) after being on exclusive enteral nutrition and at a post-conception age between 31-42 weeks. Three infants (25%) needed transient reintroduction of parenteral glucose and/or alteration of feeding regimen to correct hypoglycemia. In contrast, the incidence of hypoglycemia in the control group (VLBW infants without cholestasis on full enteral feeds) was 4.5% (3/67) (P= <0.001). Receiver operating characteristic curve analysis showed a peak direct bilirubin of >4.1mg/dl (before full enteral feeds) predicts hypoglycemia while on full enteral feeds, with a sensitivity of 100%, specificity of 50%, and negative predictive value of 100%.

Conclusions: Hypoglycemia is an unrecognized complication occurring in a high percentage of VLBW infant with history of cholestatic jaundice while receiving full enteral feeds. We propose that care-givers in the neonatal ICU monitor glucose levels in this select group of VLBW infants to avoid recurrent asymptomatic hypoglycemia.


Cholestasis, Hypoglycemia, Infants, Premature, VLBW

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