Abstract
Higher and unstable glucose concentrations in the first 48 hours in neonates at risk of hypoglycaemia have been associated with neurosensory impairment. It is unclear what defines and contributes to instability. This was a prospective study of term and late preterm babies (N = 139) born at risk of neonatal hypoglycaemia who had interstitial glucose (IG) monitoring and ≥1 hypoglycaemic episode <48 hours after birth (blood glucose concentration <2.6 mmol/l [<47 mg/dl]). For 6-hour epochs after each hypoglycaemic episode, masked IG parameters (time to reach maximum IG concentration [hours]; range, average, maximum and minimum IG concentrations; proportion of IG measurements outside the central band of 3–4 mmol/l [54–72 md/dl]; and total duration [hours] of IG concentrations <2.6 mmol/l) were analysed in tertiles and related to: (i) glycaemic instability in the first 48 hours (defined as the proportion of blood glucose concentrations outside the central band in the first 48 hours); (ii) risk factors and treatment for each episode; and (iii) risk of neurosensory impairment at 4.5 years, or at 2 years if a child was not seen at 4.5 years. Glycaemic instability in the first 48 hours was related to IG instability after hypoglycaemia. Risk factors for hypoglycaemia were not related to IG parameters. Treatment with intravenous dextrose was associated with higher IG maximum and range, and lower minimum compared to treatment with dextrose gel plus breast milk, breast milk alone or formula alone. The risk of neurosensory impairment was increased with both shorter and longer time to reach maximum epoch IG (P = 0.04; lower tertile [0.4–2.2 hours] vs middle [2.3–4.2 hours] OR 3.10 [95% CI 1.03; 9.38]; higher tertile [4.3–6.0 hours] vs middle OR 3.07; [95% CI 1.01; 9.24]). Glycaemic response to hypoglycaemia contributes to overall glycaemic instability in newborns and is influenced by treatment. Slow or rapid recovery of hypoglycaemia appears to be associated with neurosensory impairment.
Highlights
Neonatal hypoglycaemia is a common condition described as a failure of metabolic adaptation to the postnatal environment[1,2,3]
In this study we found that parameters reflecting glucose stability in 6-hour epochs following hypoglycaemia in the first 48 hours were not related to neonatal risk factors but were related to treatment
In our previous study, while babies who experienced hypoglycaemia had a greater proportion of blood glucose concentrations outside the central band, the extent to which instability was temporally related to hypoglycaemia and to the subsequent higher glucose concentrations after hypoglycaemia was unclear[8]
Summary
Neonatal hypoglycaemia is a common condition described as a failure of metabolic adaptation to the postnatal environment[1,2,3]. Babies with higher or less stable blood glucose concentrations in the first 48 hours had higher risk of neurosensory impairment[8]. These associations were strongest in babies who had experienced hypoglycaemia and were treated with dextrose, raising concern that glycaemic responses to treatment may influence long-term neurodevelopmental outcome after hypoglycaemia. It was not clear if the instability and adverse www.nature.com/scientificreports/. The aim of this study was to investigate [1] the association between stability of blood glucose in the first 48 hours and interstitial glucose parameters following hypoglycaemia; [2] the effects of neonatal risk factors, gestational age at birth, feeding and dextrose treatment on changes in glucose parameters following hypoglycaemia; [3] the association between interstitial glucose parameters following hypoglycaemia and neurosensory impairment at 2 or 4.5 years
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
