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

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

doi:10.18203/2349-3291.ijcp20173766

Authors

Pradeep Alur Division of Neonatology, University of Mississippi Medical Center, Jackson, MS, USA
Sriharsha Talluri Division of Neonatology, York Hospital, PA, USA
Vishwarath Bollampalli Division of Neonatology, York Hospital, PA, USA
Theodore Bell Division of Neonatology, York Hospital, PA, USA
Jonathan Liss Division of Neonatology, York Hospital, PA, USA
Prabhu Parimi Department of Neonatology, All Childrens Hospital Johns Hopkins Medicine, St. Petersburg, FL, USA

DOI:

https://doi.org/10.18203/2349-3291.ijcp20173766

Keywords:

Cholestasis, Hypoglycemia, Infants, Premature, VLBW

Abstract

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.

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