Abstract
Hypoglycemia is a serious risk factor in neonates. The signs and symptoms are non-specific. Early diagnosis is essential to reduce the associated morbidity and mortality. Objective: To determine the efficacy and correlation of capillary and venous bedside glucose estimation using a glucometer in comparison with laboratory blood glucose analysis by glucose oxidase method in sick hypoglycemic neonates. Methods: Blood glucose estimation was done in 200 sick neonates admitted to NICU by glucometer and by glucose oxidase method in the laboratory using the same venous sample at the time of admission. In addition, glucose estimation of capillary blood was also done using the same glucometer. Statistical analysis was done by Pearson correlation. Results: The incidence of hypoglycemia in sick neonates by laboratory analysis was 15.5%. When laboratory values were used as gold standard, capillary blood glucose estimates had a sensitivity of 74.19%, specificity of 98.2%, PPV of 88.4% and NPV of 95.4%,whereas venous blood glucose estimates had a sensitivity of 93.55%, specificity of 98.23%, PPV of 90.62% and NPV of 98.8% in identifying hypoglycemia by glucometer in sick neonates. Conclusion: Venous and capillary blood glucose estimation by glucometer has a good sensitivity and negative predictive value in detecting hypoglycemia in sick neonates. Further, the sensitivity of glucometer using venous blood is superior to capillary sample estimates. Laboratory blood glucose estimation should still be performed if bedside venous or capillary blood glucometer values are in the hypoglycemic range.
Highlights
Glucose is the major energy source for the fetus and neonate
There were 204 sick neonates admitted to Level 3 NICU during the study period, who were included in the study
A bedside glucometer analysis was performed on one sample and the other two samples were sent to the clinical laboratory where PCV and blood glucose by glucose oxidase method were estimated within 30 minutes
Summary
Glucose is the major energy source for the fetus and neonate. The newborn brain depends on glucose almost exclusively. Up to 90% of glucose used is consumed by the brain. Alternate fuels (e.g. ketones and lactate) are produced in very low quantities. Glucose regulating mechanisms is sluggish at birth. The neonate is susceptible to hypoglycemia when glucose demands are increased or when exogenous or endogenous glucose supply is limited. Both preterm and term neonates are at risk of adverse neuro developmental outcome with prolonged hypoglycemia. The clinical features of neonatal hypoglycemia are non-specific and it is not possible to diagnose hypoglycemia clinically
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