Mortality of Neonatal Sepsis with Abnormal Blood Glucose Level

Made Laksmi Dewi Adnyana,Ida Bagus Subanada,I Gusti Ngurah Sanjaya,Ni Putu Siadi Purniti,I Wayan Gustawan,Made Sukmawati

doi:10.11648/j.ajp.20210701.13

Abstract

Sepsis is the third leading cause of death in neonates after asphyxia and low birth weight babies (LBW). Abnormal blood glucose, both hypoglycemia and hyperglycemia, were common metabolic changes in neonatal sepsis. This condition can higher the risk of morbidity and mortality in neonatal sepsis. The aim of this study is to prove the difference in mortality of neonatal sepsis with abnormal blood glucose compared to normal blood glucose. This was a cohort retrospective study with subjects were neonate with 28-42 weeks of gestational age with neonatal sepsis confirmed from clinical sign or blood culture at neonatal ward Sanglah hospital in the period January-August 2020. Subjects were classified as abnormal and normal blood glucose level. Chi-square test was used to assess the difference of mortality in blood glucose level. Multivariate analysis was performed with logistic regression. A total of 64 subjects with abnormal blood glucose and 64 subjects with normal blood glucose were included in this study. Mortality in subject with abnormal blood glucose was 50% and 17.2% with normal blood glucose (P<0,005). Multivariate analysis found abnormal blood glucose increases the risk of mortality 3,04 times compare with normal blood glucose (95% CI 1.09 to 8,45, P<0.033). Mechanical ventilation and asphyxia can also increase the risk of mortality in neonatal sepsis by 12,33 times (95% CI 3,99 to 38,07, P<0,001) and 8.17 times (95% CI 2,35 to 28,37, P<0,001) respectively. Subanalysis found hypoglycemia increases the risk of mortality 3.75 times compare to normoglycemia (95% CI 2.06 to 6.82, P<0.005), and hyperglycemia increases the risk of mortality 2.12 times compare to normoglycemia (95% CI 1.04 to 4.26, P=0.035). Conclusion there are significant difference of mortality in neonatal sepsis with abnormal blood glucose which is higher than normal blood glucose level. This research also found mechanical ventilation and asphyxia can effect the mortality in neonatal sepsis.

Highlights

Abnormal sugar level was common metabolic changes in neonatal sepsis and indirectly increase the mortality
Inclusion criteria were neonate with 28-42 weeks of gestational age diagnosed with neonatal sepsis confirmed from clinical sign or blood culture at neonatal ward Sanglah hospital
The most abnormal sugar levels found in neonatal sepsis were hyperglycemia (51.6%), but mortality occurred more in hypoglycemia

Summary

Introduction

Abnormal sugar level was common metabolic changes in neonatal sepsis and indirectly increase the mortality. The brain cannot produce glucose or other metabolic reserves, it depends on the supply of glucose, with insulin and glucagon as the role hormone in glucose control. [1, 10] In sepsis, hypoglycemia occurs due to the inability to break down glycogen reserves and hyperinsulinemia, on the other hand, metabolic changes in sepsis cause glucagon as a counter regulatory hormone failed to meet alternative glucose needs from other sources such as fatty acids and amino acids. Septicemia increased hormonal changes, pro-inflammatory cytokines, interleukins (IL-1, IL-6), and tumor necrosis factor (TNF)-alpha that cause hyperglycemia. Made Laksmi Dewi Adnyana et al.: Mortality of Neonatal Sepsis with Abnormal Blood Glucose Level glucosuria and osmotic diuresis, leading to dehydration, ketosis, and metabolic acidosis. Researcher conducted a study by considering the mechanism of blood sugar homeostasis in newborns and analyzing confounding variables that had not been carried out in previous studies

Objectives

Methods

Findings

Discussion

Conclusion