Failure to detect preterm infants at risk of hypoglycemia before discharge☆,☆☆,★
Section snippets
EXPERIMENTAL SUBJECTS
Consecutive preterm infants who were 25 to 36 weeks’ gestation (n = 79), admitted to a level III nursery, and survived to discharge home were recruited. At the time of discharge home all infants were receiving regular feeds every 4 hours. Blood glucose and lactate concentrations were measured 4 hours from the start of the last feed. The scheduled feed was omitted, and blood glucose and lactate concentrations were measured 2 and 4 hours later. Insulin, glucagon, corticotropin, cortisol, human
METHODS
All blood glucose and lactate measurements were determined immediately on site with a Yellow Springs Instruments analyzer. Hypoglycemia was defined as a blood glucose measurement of <2.6 mmol/L (47 mg/dL). Severe hypoglycemia was defined as a blood glucose <2.2 mmol/L (40 mg/dL) and persistent if 2 such results were recorded. Hormonal and metabolite assays were done in the Department of Biochemical Medicine of Ninewells Hospital. Acetoacetate and β-hydroxybutyrate concentrations were measured
RESULTS
The infants were subdivided into groups: (1) infants who remained normoglycemic (n = 65, 82.3%), (2) infants who were transiently hypoglycemic (n = 9, 11.4%), lowest blood glucose values 2.42 ± 0.06 mmol/L, n = 9, and (3) infants who had severe and persistent hypoglycemia (n = 5, 6.3%) (Table).
Empty Cell Normoglycemia (n = 65) Transient hypoglycemia (n = 9) Severe persistent hypoglycemia (n = 5) At birth M/F 40:25 2:7 4:1 Gestational age (wk) 32.3 ± 0.3 32.3 ± 0.9 32.0 ±
DISCUSSION
Hypoglycemia is common in newborn preterm infants. For the first few days blood glucose concentrations are routinely measured, and glucose is given to achieve normoglycemia.9, 13, 14 Subsequently, many infants are given parenteral feeding or continuous or frequent bolus nasogastric milk feeds (usually hourly). Thereafter, it is not normal practice to routinely measure blood glucose concentrations, and most infants will advance to an increased reliance on enteral nutrition and a progression from
Acknowledgements
We thank Mrs Pamela Houston for excellent technical assistance and Ian Hanning and Callum Fraser, Department of Biochemical Medicine, for advice.
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Cited by (42)
Glucose
2018, Volpe's Neurology of the NewbornRetrospective evaluation of a national guideline to prevent neonatal hypoglycemia
2017, Pediatrics and NeonatologyCitation Excerpt :No evidence of an increase in hypoglycemia was observed after the guideline introduction, suggesting that the uniform incidence decrease was not due to methodological bias. The overall population incidence of neonatal hypoglycemia, according to discharge diagnosis, was 8.4%, which was within previously reported incidences of 5–15%.2,7,8,16,17,25,26 Our estimate had the advantage of being based on a large population birth cohort, but the disadvantage of being based predominantly on discharge diagnoses and glucose measurements obtained with different methods.
Recommendations from the Pediatric Endocrine Society for Evaluation and Management of Persistent Hypoglycemia in Neonates, Infants, and Children
2015, Journal of PediatricsCitation Excerpt :Because of the difficulty in distinguishing a suspected persistent hypoglycemia disorder from transitional neonatal glucose concentrations during the first 48 hours of life, we suggest delaying diagnostic evaluations until 2-3 days after birth. Some neonates can be identified by various clinical features as being at high risk for severe hypoglycemia during the first 48 hours after delivery,16,26 and a subset of those neonates are also at increased risk for persistent hypoglycemia beyond 48 hours of life (Table).27-30 These include not only the rare infants with genetic hypoglycemia disorders, such as congenital hyperinsulinism or hypopituitarism,31 but also those with relatively more common prolonged neonatal hyperinsulinism (also referred to as perinatal stress hyperinsulinism) associated with birth asphyxia, intrauterine growth restriction, or toxemia.27,28,30
Instability of glucose values in very preterm babies at term postmenstrual age
2014, Journal of PediatricsCitation Excerpt :Previous studies have shown a high prevalence (up to 36%) of hypoglycemia in very premature babies during their first days of life, whether using intermittent capillary24 or continuous interstitial glucose monitoring.12 Some reports also find low glucose values whether by intermittent or continuous methods in about one-third of VPT babies about 5 weeks old, just after transitioning to full enteral feedings,13,25 if challenged by a fasting period at the time of discharge.14 Our data suggests that hypoglycemia is not restricted to the first weeks after birth, but persists in time, at least up until term-equivalent age, when these patients are usually discharged.
Incidence of neonatal hypoglycemia in babies identified as at risk
2012, Journal of PediatricsCitation Excerpt :Nevertheless, in those whom we did continue to monitor, over one-third of hypoglycemic babies had their first episode after 3 normal blood glucose measurements, and 6% had a first hypoglycemic episode after 24 hours of age. Previous authors have also shown that hypoglycemic episodes can occur long after the first 48 hours in preterm babies,2,10 suggesting that there may have been others whose first hypoglycemic episode occurred after monitoring was discontinued. Once again, the significance of any such episodes for long-term neurologic outcome remains uncertain.
Neonatal hypoglycemia - Answers, but more questions
2012, Journal of Pediatrics
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Supported by grants from the Scottish Home and Health Department (A.B., R.H.), Wellcome Trust (R.H.), Tenovus (Scotland) (R.H., A.B.), Research Trust for Metabolic Diseases in Children (A.B.), Paediatric Metabolic Research Trust (R.H.), and the Northwood Charitable Trust (A.B.). Dr Burchell was a Lister Institute Research Fellow.
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Reprint requests: Robert Hume, FRCPEdin, Department of Obstetrics and Gynaecology, University of Dundee, Ninewells Hospital & Medical School, Dundee, DD1 9SY, Scotland.
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0022-3476/99/$8.00 + 0 9/22/97127