Diagnosis Of Neonatal Hypoglycemia Research Articles

Prematuridad, peso al nacer del neonato, y obesidad de la gestante como factor de riesgo de hipoglicemia neonatal

Se elaboró un estudio restrospectivo de casos y controles, con recién nacidos de ambos sexos, con y sin diagnóstico de hipoglicemia neonatal, atendidos en el Hospital Víctor Lazarte Echegaray del 2016 al 2017. A través de las historias clínicas se obtuvieron 43 casos y 43 controles, se hizo uso del análisis bivariado y multivariado para determinar asociación y factores de riesgo. Se halló significancia estadística con el sexo del neonato, prematuridad y muy bajo peso al nacer (p<0.05). El normopeso resultó ser un factor protector de hipoglicemia neonatal (p:0). En el análisis multivariado permanece sólo con significancia estadística el sexo masculino como factor de riesgo de hipoglicemia neonatal.

A Concept Map of Neonatal Hypoglycemia

Objectives: To analyze current management of neonatal hypoglycemia and establish a concept map based on testimonials from physicians who use capillary blood glucose tests to guide management. Methods: This was an observational, descriptive, mixed qualitative and quantitative study. A questionnaire was administered to physicians, seeking to characterize their responses to neonatal hypoglycemia in pregnancy, labor and delivery, and the immediate neonatal period. Data collection was performed with two groups of Brazilian physicians: neonatologists (group GN) and pediatricians (group GP). A Likert-type scale was used to collect responses. The Mann-Whitney test and Fisher’s exact test were used for statistical analysis of continuous and categorical variables respectively. Statistical significance was accepted at 5%. Principal components analysis with varimax rotation and Kaiser normalization was used to verify the structure of question/answer factors in the two groups of professionals. A concept map was constructed using the Cmap Tools Knowledge Kit, version 5.05.01. Results: Of the 98 questionnaires analyzed, 34.7% were completed by neonatologists (n=34/98) and 65.3% by pediatricians (n=64/98). Mean age in the two groups (GN and GP) was 42.4 years (SD: 11.78; 95% CI: 40.10, 44.88; p=0.597), with a significant difference in age in men (mean=50 years; SD: 10.35; 95% CI: 45.20, 54.90; p<0.001); 79.2% of respondents (n=78/98) were women. Overall, 32.7% of respondents (n=32/98) claimed they did not currently work with neonates. Respondents in GN had completed more postgraduate courses (p=0.38). The two groups responded similarly to all questions. The responses highlighted the importance of values lower than 40 mg/dL in the diagnosis of neonatal hypoglycemia, as well as the indication of intravenous infusion when glucose was below 40 mg/dL in symptomatic neonates. Immediate institution of periodic capillary blood glucose measurement was recommended for the following groups of neonates: those born to diabetic mothers, those with intrauterine growth restriction, small for gestational age, large for gestational age, preterm neonates, septic neonates, and those with birth asphyxia. Conclusions: Capillary blood glucose is part of routine neonatal management, especially preventive, in light of the possibility of neonatal hypoglycemia. Our findings highlight that, in high-risk gestational groups, the entire neonatal team should be focused on the risk of hypoglycemia. The development of management algorithms based on the use of peripheral blood glucose test strips has contributed to streamlining the management of neonatal hypoglycemia.

Improving the Diagnosis of Neonatal Hypoglycemia in a Well-Baby Nursery.

Point of care glucose (POCG) measurements, used for detecting neonatal hypoglycemia, can have variable accuracy. The appropriate diagnosis of neonatal hypoglycemia in babies with low POCG measurements involves confirmatory serum glucose (CSG) testing. At our institution, no babies with low POCG measurements had CSG testing in their evaluation of neonatal hypoglycemia over a three year period. Our aim was to increase the percentage of CSG testing in babies with a low POCG. A secondary aim was to decrease the percentage of low-risk, asymptomatic babies who received POCG testing. Interventions included the design and implementation of an evidence-based protocol for the diagnosis and management of neonatal hypoglycemia (cycle 1), along with supportive education for multi-disciplinary providers on best practices related to neonatal hypoglycemia (cycle 2). Data were analyzed using statistical process control. During Cycle 1, the percentage of CSG testing in babies with POCG ≤40 mg/dL significantly increased from 0 to 33%, and increased further to 63% during Cycle 2. The initial gain was sustained over 2 years. The percentage of POCG testing among low-risk asymptomatic babies was 40% at baseline and did not change during the project period. 18 babies with low POCG results were spared from a diagnosis of neonatal hypoglycemia based on CSG testing. Implementation of a neonatal hypoglycemia protocol, along with supportive education, significantly improved rates of CSG testing, but not POCG overutilization, in our newborn population. Factors related to POCG overutilization should be further explored.

Neonatal hypoglycemic brain injury is a cause of infantile spasms.

Neonatal hypoglycemic brain injury is one of the causes of infantile spasms. In the present study, the clinical history and auxiliary examination results of 18 patients who developed infantile spasms several months after neonatal hypoglycemia were retrospectively analyzed. Among the 666 patients with infantile spasms admitted to two pediatric centers between January 2008 and October 2012, 18 patients developed infantile spasms after being diagnosed with neonatal hypoglycemia, defined as a whole blood glucose concentration of <2.6 mmol/l. These patients developed infantile spasms from between 2 and 10 months (mean, 4.9 months) following the diagnosis of neonatal hypoglycemia. All 18 patients had abnormal electroencephalographic findings with either classical or modified hypsarrhythmia. Upon examination using brain magnetic resonance imaging (MRI), 10 patients (55.6%) exhibited abnormalities. The MRI results principally showed a disproportional involvement of parietal and occipital cortices and sub-cortical white matter lesions. In conclusion, the results of this study indicate that neonatal hypoglycemic brain injury is associated with the subsequent development of infantile spasms.

Hematocrit correction does not improve glucose monitor accuracy in the assessment of neonatal hypoglycemia

The lack of accuracy of point of care (POC) glucose monitors has limited their use in the diagnosis of neonatal hypoglycemia. Hematocrit plays an important role in explaining discordant results. The objective of this study was to to assess the effect of hematocrit on the diagnostic performance of Abbott Precision Xceed Pro (PXP) and Nova StatStrip (StatStrip) monitors in neonates. All blood samples ordered for laboratory glucose measurement were analyzed using the PXP and StatStrip and compared with the laboratory analyzer (ABL 800 Blood Gas analyzer [ABL]). Acceptable error targets were ±15% for glucose monitoring and ±5% for diagnosis. A total of 307 samples from 176 neonates were analyzed. Overall, 90% of StatStrip and 75% of PXP values met the 15% error limit and 45% of StatStrip and 32% of PXP values met the 5% error limit. At glucose concentrations ≤4 mmol/L, 83% of StatStrip and 79% of PXP values met the 15% error limit, while 37% of StatStrip and 38% of PXP values met the 5% error limit. Hematocrit explained 7.4% of the difference between the PXP and ABL whereas it accounted for only 0.09% of the difference between the StatStrip and ABL. The ROC analysis showed the screening cut point with the best performance for identifying neonatal hypoglycemia was 3.2 mmol/L for StatStrip and 3.3 mmol/L for PXP. Despite a negligible hematocrit effect for the StatStrip, it did not achieve recommended error limits. The StatStrip and PXP glucose monitors remain suitable only for neonatal hypoglycemia screening with confirmation required from a laboratory analyzer.

Diagnosis of Neonatal Hypoglycemia at the Cotside. A Comparison of Precision Q.I.D., Hemocue and Hexokinase Methods

Diagnosis of Neonatal Hypoglycemia at the Cotside. A Comparison of Precision Q.I.D., Hemocue and Hexokinase Methods

Body size and neonatal hypoglycemia in intrauterine growth retardation

The relationship between blood glucose and body physique of 233 (42 hypo and 191 normoglycemic) intrauterine growth-retarded neonates was analyzed using different body measurements and indices of body proportions. Classification by combination of weight and length deficit for fetal age revealed that the disproportionately retarded infants (deficit in weight for age >30%; deficit in length for age <15%) were particularly prone to hypoglycemia. The lowest incidence of hypoglycemia was observed in the group with severe proportionate retardation (weight deficit for age >30%; length deficit for age >15%). Among the indices of body proportions ponderal index (W/L 3), and percentage deviation from the expected weight for length turned out to be a sensitive predictor of the risk of hypoglycemia. The majority of hypoglycemia neonates were underweight for length and a considerable number of normoglycemic infants were overweight for length. These findings point to the significance of soft tissue wasting rather than low birth weight for gestational age itself, in the development and diagnosis of neonatal hypoglycemia. The significance of anthropometry in the classification of different types of intrauterine growth impairment, as well as in predicting specific hazards after birth is discussed.

The use of dextrostix and dextrostix reflectance meters in the diagnosis of neonatal hypoglycemia

Dextrostix is now widely used as a method of screening for hypoglycemia of the newborn. There has always been some anxiety about its accuracy for estimating very low blood sugars; this is important, since symptomatic hypoglycemia of the newborn does not usually occur until the blood glucose falls below 20 mg/dl. In 1970 a reflectance meter was introduced which would measure the colour of the strip electronically. The aim of this study was to assess the accuracy of the meter and its reliability in estimating hypoglycemia. The study was continued to investigate a new model of the reflectance meter which superseded the original one. In the pilot study using the original model, blood samples were taken from 46 babies. Readings of the Dextrostix were made by two independent observers and compared with a reading taken on the reflectance meter. These estimations were later compared with blood glucose measured by the glucose oxidase method. the meter showed a marked tendency to overestimate the blood glucose: 44 out of 46 samples were overestimated (Fig. 1, 2). In the second series 180 cord blood samples were collected. Because the intention was to study very low levels of blood glucose, the samples were allowed to stand at room temperature for several hours to allow glycolysis to occur. Again, readings were taken by two independent observers and compared with the readings taken on the new Dextrostix-Eyetone meter. The blood glucose was measured on each of the samples. There was a strong correlation (r = 0.8877, p less than 0.00005) between the blood glucose values and the readings taken from the meter, with no tendency towards overestimation (Fig. 3). A similar correlation (r = 0.8533, p less than 0.00005) was seen for the observers' readings and the chemical method, although there was a tendency to underestimate blood glucose (Fig. 4). When the meter gave an estimate of more than 20 ml/dl, in no case was the actual blood glucose in the profoundly hypoglycemic group of less than 10 mg/dl. When estimated by eye there was one case in which the blood glucose was only 7 mg/dl but the observer had estimated the result of 30 mg/dl. In order to avoid any possibility that a blood glucose was less than 20 mg/dl, it is necessary to take action on any estimate below 40 mg/dl on a Dextrostix. Despite this, Dextrostix remains a very useful method of screening for neonatal hypoglycemia, whether assessed by eye or with the new Dextrostix-Eyetone meter. the meter does give better results than estimating Dextrostix by eye, but the difference was never statistically significant.