Incidence of hypoglycemia during the first 48 hours of life in small-for-gestational-age neonates in a tertiary care hospital

Chaitra Reddy Molugu; Molugu Hemanth Reddy; Ramisetti Manikanta

doi:10.18203/2349-3291.ijcp20263284

Authors

Chaitra Reddy Molugu Kamineni Academy of Medical Sciences and Research Centre, L. B. Nagar, Hyderabad, Telangana, India
Molugu Hemanth Reddy Apollo Institute of Medical Sciences and Research, Jubilee Hills, Film Nagar, Hyderabad, Telangana, India
Ramisetti Manikanta Konaseema Institute of Medical Sciences (KIMS), Chaitanya Health City, Amalapuram, Andhra Pradesh, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20263284

Keywords:

Neonatal hypoglycemia, Small-for-gestational-age neonates, Preterm neonates, Term neonates, Blood glucose, Early feeding, Birth weight, Apgar score, NICU

Abstract

Background: To determine the incidence of hypoglycemia during the first 48 hours of life among small-for-gestational-age (SGA) neonates and compare its occurrence between term and preterm SGA neonates.

Methods: A prospective observational study was conducted among 100 SGA neonates admitted to a tertiary care neonatal intensive care unit. Blood glucose was measured at 1, 2, 4, 6, 12, 24, and 48 hours of life. Maternal and neonatal characteristics, risk factors, feeding practices, clinical manifestations, and outcomes were recorded. Associations with hypoglycemia were assessed using univariate and multivariable logistic regression.

Results: Of 625 newborns enrolled, 100 (16.0%) were SGA; 66 (66.0%) were term and 34 (34.0%) preterm. Hypoglycemia occurred in 26 (26.0%) neonates and was significantly more frequent in preterm than term SGA neonates (47.1% vs. 15.2%, p<0.001). Among hypoglycemic neonates, 16 (61.5%) were symptomatic. The highest frequency of hypoglycemia occurred at 2 hours of life. Delayed initiation of enteral feeding was significantly associated with hypoglycemia. Blood glucose levels differed significantly between neonates weighing <1.8 kg and those weighing ≥1.8 kg at 2 and 4 hours. Univariate analysis identified low birth weight, prematurity, anthropometric measures, caesarean delivery, and 1-minute Apgar score as significant factors. On multivariable analysis, head circumference, chest circumference, 1-minute Apgar score, and caesarean delivery remained significantly associated with hypoglycemia. Two neonates with concomitant sepsis died.

Conclusion: Hypoglycemia was common among SGA neonates, particularly those born preterm. Early glucose monitoring, especially during the first 4 hours, together with timely enteral feeding, may facilitate early detection and prevention of neonatal hypoglycemia.

References

Lucas A, Morley R, Cole T. Adverse neurodevelopmental outcome of moderate neonatal hypoglycaemia. British Med J. 1988;297(6659):1304-8.

Rozance PJ, Hay WW Jr. Describing hypoglycemia—definition or operational threshold. Early Hum Dev. 2010;86(5):275-80.

Hawdon JM, Ward Platt MP, Aynsley-Green A. Patterns of metabolic adaptation for preterm and term infants in the first neonatal week. Arch Dis Child. 1992;67(4):357-65.

Bromiker R, Perry A, Kasirer Y, Einav S, Klinger G, Levy-Khademi F. Early neonatal hypoglycemia: incidence of and risk factors. A cohort study using universal point of care screening. J Maternal-Fetal Neon Med. 2019;32(5):786-92.

Adamkin DH; Committee on Fetus and Newborn. Postnatal glucose homeostasis in late-preterm and term infants. Pediatrics. 2011;127(3):575-9.

McKinlay CJD, Alsweiler JM, Ansell JM, Anstice NS, Chase JG, Gamble GD, et al. Association of neonatal glycemia with neurodevelopmental outcomes at 4.5 years. JAMA Pediatr. 2017;171(10):972-83.

Diggikar S, Trif P, Mudura D, Prasath A, Mazela J, Ognean ML, et al. Neonatal hypoglycemia and neurodevelopmental outcomes—an updated systematic review and meta-analysis. Life (Basel). 2024;14(12):1618.

Rozance PJ, Hay WW. Hypoglycemia in newborn infants: features associated with adverse outcomes. Biol Neonate. 2006;90(2):74-86.

Narang A, Chaudhuri MK, Kumar P. Small for gestational age babies: Indian scene. Indian J Pediatrics. 1997;64:221-4.

Behera B, Modi M, Thakur A, Garg P, Kler N, Chopra A, et al. Hypoglycemia in small for gestational age infants in a level III NICU: An observational study. Current Med Res Practice. 2015;5(1):10-3.

Lubchenco LO, Bard H. Incidence of hypoglycemia in newborn infants classified by birth weight and gestational age. Pediatrics. 1971;47(5):831-8.

Holtrop PC. The frequency of hypoglycemia in full-term large and small for gestational age newborns. Am J Perinatol. 1993;10(2):150-4.

Shirley AS, Jerry ALT, Shiji R. Incidence and risk factors associated with hypoglycemia in the first 48 hours of life in Small for Gestational Age Neonates. Int J Contemp Pediatr. 2018;5:2300-3.

Wang LY, Wang LY, Wang YL, Ho CH. Early neonatal hypoglycemia in term and late preterm small for gestational age newborns. Pediatr Neonatol. 2023;64(5):538-46.