Neonatal Hypoglycemia Research Articles

Glycemic Control Trajectories and Risk of Perinatal Complications Among Individuals With Gestational Diabetes

ABSTRACT Approximately 8% of pregnancies in the United States are affected by gestational diabetes mellitus (GDM) per year. The condition is associated with higher risk of adverse perinatal outcomes, including hypertensive disorders of pregnancy, cesarean delivery (CD), macrosomia, shoulder dystocia, neonatal hypoglycemia, and adverse long-term outcomes, including diabetes and cardiovascular disease. Randomized clinical trials have suggested that glycemic control of GDM with medical nutritional and insulin therapies may improve perinatal outcomes. The American Diabetes Association recommends using self-monitoring of blood glucose (BG) to manage glycemic control during pregnancy. However, large-scale, population-based studies evaluating self-monitoring of BG are limited. In addition, the conventional model for glycemic control status using optimal versus suboptimal is insufficient to capture progressive changes during pregnancy. The aim of this study was to review whether glycemic control trajectories (GCTs) from GDM diagnosis to delivery are associated with the risk of perinatal complications. This was a population-based, cohort study of individuals with GDM who received prenatal care in an integrated health care delivery system between 2007 and 2017. Included were those diagnosed with GDM at 24 to 28 weeks of gestation. Excluded were those who had diabetes before pregnancy. Individuals were asked to self-monitor BG measurements to assess glycemic control 4 times per day at mealtimes. The measurements were collected by nurses or dietitians during weekly counseling calls. Optimal glycemic control was defined as <95 mg/dL for fasting and <140 mg/dL for 1 hour after lunch or dinner. Perinatal complications were the outcomes measured, including CD, preterm birth, shoulder dystocia, neonatal intensive care unit (NICU) admission, NICU stays ≥7 days, stillbirth, large-for-gestational age (LGA), and small-for-gestational age (SGA). To estimate associations between GCTs with the perinatal complications, multivariate Poisson regression models were used. A total of 26,774 individuals were included in the analysis. Four distinct GCTs were identified: trajectory 1 (T1) for stably optimal GCTs (39.3% of individuals), trajectory 2 (T2) for rapidly improving GCTs (34.9%), trajectory 3 (T3) for slowly improving to near-optimal GCTs (15.4%), and trajectory 4 (T4) for slowly improving to suboptimal GCTs (11%). For the T1 group, there were lower risks of CD (adjusted relative risk [aRR], 0.93; 95% confidence internal [CI], 0.89–0.96), shoulder dystocia (aRR, 0.75; 95% CI, 0.61–0.92), and NICU admission (aRR, 0.90; 95% CI, 0.83–0.97) compared with the T2 or reference group (P for trend <0.001), whereas for the T4 group there were higher risks of CD (aRR, 1.18; 95% CI, 1.12–1.24; P for trend <0.001), shoulder dystocia (aRR, 1.41; 95% CI, 1.12–1.78; P for trend <0.001), and NICU admission (aRR, 1.33; 95% CI, 1.20–1.47; P for trend <0.001). There was an increased risk of LGA across GCTs (from T1 [aRR, 0.74; 95% CI, 0.69–0.80] to T4 [aRR, 1.42; 95% CI, 1.31–1.53]; P for trend <0.001; vs T2), but there was a decreased trend of SGA (from T1 [aRR, 1.10; 95% CI, 1.02–1.20] to T4 [aRR, 0.63; 95% CI, 0.53–0.75]; P for trend <0.001). There was not a significant trend across GCTs for the risk of preterm birth and NICU stays ≥7 days. Overall, there was increasing risk of perinatal complications from T1 to T4 GCT, except for SGA. This study highlights the need for early GDM management to prevent perinatal complications.

Diabetes Mellitus in Pregnancy.

Diabetes mellitus (DM) in pregnancy imposes increased risks for the pregnant person, fetus, and infant, which includes miscarriage, congenital anomalies, accelerated fetal growth, iatrogenic prematurity, preeclampsia, delivery-related trauma, cesarean section, neonatal hypoglycemia, and respiratory distress syndrome. Preconceptual counseling for people with type 1 or type 2 DM who are contemplating pregnancy includes education about these risks, and optimization of glucose control. Fetal screening early in pregnancy in persons with type 1 or type 2 DM allows for early diagnosis and therapy optimization. In addition, screening for gestational DM in the late second trimester is routine given that such pregnancies are also affected. The overall perinatal morbidity and mortality of pregnancies complicated by DM is substantially higher than in the general obstetric population, proportionate to the level of glucose control.

IDF2022-0448 Insulin degludec cord blood level and neonatal hypoglycaemia in pregnant women with type 1 diabetes in the EXPECT study

IDF2022-0448 Insulin degludec cord blood level and neonatal hypoglycaemia in pregnant women with type 1 diabetes in the EXPECT study

Pattern of weight gain in pregnant women and effect on maternal and neonatal outcome in Abuja, Nigeria: A longitudinal multicentre study

Background: Normal pregnancy is usually associated with weight gain. Abnormal weight gain in pregnancy could result in adverse neonatal and maternal outcome. Studies related to this in Nigeria are limited.Objective: The aim was to evaluate the pattern of weight gain in pregnancy and the feto-maternal outcome among women with different body mass indices attending antenatal clinic in the Federal capital territory (FCT).Study design: This was a longitudinal, multicentre study.Materials and Methods: Two hundred and twenty participants were recruited from 6 general hospitals in the FCT. Their body mass indices were calculated and they were categorized as underweight, normal weight, overweight and obese accordingly. They were followed up till 2 weeks postpartum. Maternal outcome sought included gestational hypertension, gestational diabetes and mode of delivery, postpartum haemorrhage, retained placenta and perineal injury. Neonatal outcomes included macrosomia, low birth weight, neonatal hypoglycaemia, shoulder dystocia, stillbirth and admission into special care baby unit (SCBU).Result: The mean age of participants was 28.8 years ±4.7 with parities ranging from 0-8. The majority of them (39%) were overweight. While most of the women (118, 56.2%) had normal weight gain (NWG) in pregnancy, 15(7.1%) had low weight gain (LWG) and 77(36.6%) had high weight gain (HWG). Most (95%) of the HWG was among the overweight and obese women. There was a higher induction rate and postpartum haemorrhage among HWG women and postdate among the obese group. There was no difference in neonatal outcome among the groups.Conclusion: This study demonstrated that HWG and LWG have more adverse pregnancy outcomes than NWG. Younger women (20-24years) with normal BMI at booking tend to gain suboptimal weight in pregnancy. HWG in pregnancy was commoner among overweight and obese women with increased induction of labour and postpartum haemorrhage among them. Post-date pregnancy was higher among the obese group. There was no difference in neonatal outcomes among the groups.

Association between newborn hypoglycemia screening and breastfeeding success in an Ottawa, Ontario, hospital: a retrospective cohort study.

There has been limited investigation of the unintended effects of routine screening for asymptomatic hypoglycemia in at-risk newborns. This study aimed to explore whether rates of exclusive breastfeeding were lower in screened babies than in unscreened babies. This retrospective cohort study conducted in Ottawa, Canada, used data from Hôpital Montfort's electronic health information system. Healthy singleton newborns discharged between Feb. 1, 2014, and June 30, 2018, were included. We excluded babies and mothers with conditions expected to interfere with breastfeeding (e.g., twins). We investigated the association between postnatal screening for hypoglycemia and initial exclusive breastfeeding (in the first 24 hours of life). We included 10 965 newborns; of these, 1952 (17.8%) were fully screened for hypoglycemia. Of screened newborns, 30.6% exclusively breastfed and 64.6% took both formula and breastmilk in the first 24 hours of life. Of unscreened newborns, 45.4% exclusively breastfed and 49.8% received both formula and breastmilk. The adjusted odds ratio for exclusive breastfeeding in the first 24 hours of life among newborns screened for hypoglycemia was 0.57 (95% confidence interval 0.51-0.64). The association of routine newborn hypoglycemia screening with a lower initial rate of exclusive breastfeeding suggests a potential effect of screening on early breastfeeding success. Confirmation of these findings might warrant a re-evaluation of the net benefit of asymptomatic postnatal hypoglycemia screening for different newborn populations at risk of hypoglycemia.

Using Machine Learning to Develop a Predictive Model of Infant Hypoglycemia Based on Maternal and Infant Variables in an Electronic Health Record

All newborns experience low blood glucose levels when they first initiate carbohydrate metabolism. Some levels remain low, with potential seizures and severe brain injury. Predicting newborns at higher risk is clinically useful because newborns can have their blood sugar raised with breastfeeding, donor milk, formula, or oral dextrose gels. Additionally, informing parents of this higher risk can enhance shared decision-making in the first 48 hours after birth. To address this, we propose three predictive models using binary logistic regression for newborns receiving treatment with oral dextrose gels for hypoglycemia. The first is a parsimonious model, where a high-risk newborn's first blood glucose value is highly predictive of requiring an oral dextrose gel treatment. The second model can be used earlier in the clinical workflow. It is based on the most predictive variables that are also electronically available for all newborns and do not change much in the electronic health record. The third model explores the most predictive variables based on a conceptual model of factors associated with health disparities. These three models are informed from insights gleaned by an exploratory analysis of alternative outcome measures, variables, and threshold cutoffs using a standard heuristic of greedily finding the highest average difference for records on both sides of partitions. We discuss how the dynamics of when data are available during a hospital stay in the postnatal care unit for all patients impact the selection of useful variables for electronically-based decision support. We plan to modify handouts for postnatal care nurses that detail treatment guidance and support shared decision-making. We plan to embed stratified guidance, recommended scripts for high and low-risk cohorts, orientation materials for float and junior nurses, and patient-facing educational materials.

Using flash glucose monitoring in pregnancies in routine care of patients with gestational diabetes mellitus: a pilot study

AimFlash glucose monitoring (FGM) has been approved for the care of pregnant women with preexisting diabetes since 2017. However, its use in gestational diabetes (GDM) has been critically discussed. Inaccuracy and missing recommendations for target values are the main arguments against the use of FGM in GDM. To date, there is a lack of data to justify routine use of FGM in GDM pregnancies. Consequently, this new technology has been withheld from GDM-patients. Aim of our pilot study was to analyze the impact of FGM use on pregnancy outcomes, patient’s satisfaction and to confirm the safe use in GDM pregnancies.MethodsCohort study of 37 FGM-managed GDM pregnancies compared with 74 matched women using self-monitoring of blood glucose (SMBG). Group comparison using nonparametric testing concerning patients characteristic and perinatal outcome focusing on adverse outcomes (preeclampsia, preterm delivery, large for gestational age, C-sections, neonatal intensive care unit admission, hyperbilirubinemia and hypoglycemia). Evaluation of patient’s treatment satisfaction using the “Diabetes Treatment Satisfaction Questionnaire change” (DTSQc) and patient interviews.ResultsNo significant differences in patient’s characteristics despite gestational age at diagnosis (FGM with 20 vs. SMBG with 25 weeks). No difference in gestational weight gain, HbA1c progression and perinatal outcome. Treatment satisfaction obtained by the DTSQc revealed a high level of satisfaction with FGM use.ConclusionFGM use was well accepted and did not affect perinatal outcome. Use of FGM during pregnancy is safe and non-inferior to the management with SBGM. FGM should be considered as an option in the management of GDM patients.

Remote patient monitoring for management of diabetes mellitus in pregnancy is associated with improved maternal and neonatal outcomes

Diabetes is a common medical complication of pregnancy and its treatment is complex. Recent years have seen an increase in the application of mobile health tools and advanced technologies, such as remote patient monitoring (RPM), to try to improve care of diabetes in pregnancy. Previous studies of these technologies for the treatment of diabetes in pregnancy have been small and have not clearly shown clinical benefit from implementing their use. RPM allows clinicians to monitor patients' health data (such as glucose values) in near real-time, in between clinic visits, to make timely adjustments to care. Our objective was to determine if using RPM for management of diabetes in pregnancy leads to improvement in maternal and neonatal outcomes. This was a retrospective cohort study of pregnant patients with diabetes managed by the Maternal Fetal Medicine practice at one academic institution between October 2019 - April 2021. The practice transitioned from paper blood glucose logs to RPM in February 2020. RPM options included: 1) Device integration with Bluetooth glucometers that automatically upload measured glucose values to the patient's Epic MyChart application or 2) Manual entry where patients manually log glucose readings into their MyChart application. Values in the MyChart application directly transfer to the patient's Electronic Health Record for review and changes in management by clinicians. In total, 533 patients were studied. We compared 173 patients managed with paper logs to 360 patients managed with RPM (176 device integration and 184 manual entry). Our primary outcomes were composite maternal morbidity (which included third/fourth-degree laceration, chorioamnionitis, postpartum hemorrhage requiring transfusion, postpartum hysterectomy, wound infection or separation, venous thromboembolism, and maternal admission to ICU) and composite neonatal morbidity (which included umbilical cord pH <7.00, 5 min APGAR <7, respiratory morbidity, hyperbilirubinemia, meconium aspiration, intraventricular hemorrhage, necrotizing enterocolitis, sepsis, pneumonia, seizures, hypoxic ischemic encephalopathy, shoulder dystocia, trauma, brain or body cooling, and NICU admission). Secondary outcomes were measures of glycemic control, as well as the individual components of the primary composite outcomes. We also performed a secondary analysis comparing patients utilizing the two aforementioned RPM options. Chi square, Fisher's exact, 2-sample t, and Mann-Whitney tests were used to compare the groups. A result was considered statistically significant at p<0.05. Maternal baseline characteristics were not significantly different between the RPM and paper groups, aside from a slightly higher baseline rate of chronic hypertension in the RPM group (6.1 vs 1.2%). The primary outcome of composite maternal and composite neonatal morbidity was not significantly different between the groups. However, RPM patients submitted more values, were more likely to achieve glycemic control in target range (79.2% vs 52.0%, p<0.0001), and achieved target range sooner (median 3.3 vs 4.1 weeks, p 0.025) than patients managed with paper logs. This was achieved without increasing in-person visits. RPM patients had lower rates of preeclampsia (5.8% vs 15.0%, p 0.0006) and their infants had lower rates of neonatal hypoglycemia in the first 24 hours of life (29.8% vs 51.7%, p<0.0001). Remote patient monitoring for management of diabetes in pregnancy is superior to a traditional paper-based approach in achieving glycemic control and is associated with improved maternal and neonatal outcomes.

Antenatal dietary supplementation with myo-inositol for preventing gestational diabetes.

Gestational diabetes with onset or first recognition during pregnancy is an increasing problem worldwide. Myo-inositol, an isomer of inositol, is a naturally occurring sugar commonly found in cereals, corn, legumes and meat. Myo-inositol is one of the intracellular mediators of the insulin signal and correlates with insulin sensitivity in type 2 diabetes. The potential beneficial effect of improving insulin sensitivity suggests that myo-inositol may be useful for women in preventing gestational diabetes. This is an update of a review first published in 2015. To assess if antenatal dietary supplementation with myo-inositol is safe and effective, for the mother and fetus, in preventing gestational diabetes. We searched the Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, WHO ICTRP (17 March 2022) and the reference lists of retrieved studies. We included published and unpublished randomised controlled trials (RCTs) including cluster-RCTs and conference abstracts, assessing the effects of myo-inositol for the prevention of gestational diabetes in pregnant women. We included studies that compared any dose of myo-inositol, alone or in a combination preparation, with no treatment, placebo or another intervention. Quasi-randomised and cross-over trials were not eligible. We excluded women with pre-existing type 1 or type 2 diabetes. Two review authors independently assessed studies for inclusion, assessed risk of bias and extracted the data. We checked the data for accuracy. We assessed the certainty of the evidence using the GRADE approach. We included seven RCTs (one conducted in Ireland, six conducted in Italy) reporting on 1319 women who were 10 weeks to 24 weeks pregnant at the start of the studies. The studies had relatively small sample sizes and the overall risk of bias was low. For the primary maternal outcomes, meta-analysis showed that myo-inositol may reduce the incidence of gestational diabetes (risk ratio (RR) 0.53, 95% confidence interval (CI) 0.31 to 0.90; 6 studies, 1140 women) and hypertensive disorders of pregnancy (RR 0.34, 95% CI 0.19 to 0.61; 5 studies, 1052 women). However, the certainty of the evidence was low to very low. For the primary neonatal outcomes, only one study measured the risk of a large-for-gestational-age infant and found myo-inositol was associated with both appreciable benefit and harm (RR 1.40, 95% CI 0.65 to 3.02; 1 study, 234 infants; low-certainty evidence). None of the included studies reported on the other primary neonatal outcomes (perinatal mortality, mortality or morbidity composite). For the secondary maternal outcomes, we are unclear about the effect of myo-inositol on weight gain during pregnancy (mean difference (MD) -0.25 kilogram (kg), 95% CI -1.26 to 0.75 kg; 4 studies, 831 women) and perineal trauma (RR 4.0, 95% CI 0.45 to 35.25; 1 study, 234 women) because the evidence was assessed as being very low-certainty. Further, myo-inositol may result in little to no difference in caesarean section (RR 0.91, 95% CI 0.77 to 1.07; 4 studies, 829 women; low-certainty evidence). None of the included studies reported on the other secondary maternal outcomes (postnatal depression and the development of subsequent type 2 diabetes mellitus). For the secondary neonatal outcomes, meta-analysis showed no neonatal hypoglycaemia (RR 3.07, 95% CI 0.90 to 10.52; 4 studies; 671 infants; very low-certainty evidence). However, myo-inositol may be associated with a reduction in the incidence of preterm birth (RR 0.35, 95% CI 0.17 to 0.70; 4 studies; 829 infants). There were insufficient data for a number of maternal and neonatal secondary outcomes, and no data were reported for any of the long-term childhood or adulthood outcomes, or for health service utilisation outcomes. Evidence from seven studies shows that antenatal dietary supplementation with myo-inositol during pregnancy may reduce the incidence of gestational diabetes, hypertensive disorders of pregnancy and preterm birth. Limited data suggest that supplementation with myo-inositol may not reduce the risk of a large-for-gestational-age infant. The current evidence is based on small studies that were not powered to detect differences in outcomes such as perinatal mortality and serious infant morbidity. Six of the included studies were conducted in Italy and one in Ireland, which raises concerns about the lack of generalisability to other settings. There is evidence of inconsistency among doses of myo-inositol, the timing of administration and study population. As a result, we downgraded the certainty of the evidence for many outcomes to low or very low certainty. Further studies for this promising antenatal intervention for preventing gestational diabetes are encouraged and should include pregnant women of different ethnicities and varying risk factors. Myo-inositol at different doses, frequency and timing of administration, should be compared with placebo, diet and exercise, and pharmacological interventions. Long-term follow-up should be considered and outcomes should include potential harms, including adverse effects.

Fetal growth restriction in diabetic pregnancy: a retrospective single-center study

BACKGROUND: The high risk of adverse maternal and perinatal complications in patients with fetal growth restriction and diabetes mellitus requires a detailed assessment of the major risk factors and outcomes.&#x0D; AIM: The aim of this study was to determine the main risk factors for fetal growth retardation in pregnant women with pregestational and gestational diabetes mellitus, and to assess obstetric and perinatal outcomes in these patients.&#x0D; MATERIALS AND METHODS: We conducted a retrospective single-center cohort study at the premises of the Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott, Saint Petersburg, Russia. The study included 103 patients with type 1 diabetes mellitus, type 2 diabetes mellitus, or gestational diabetes mellitus with fetal growth retardation who delivered a singleton neonate from January 2017 to December 2021. Based on the antenatal diagnosis, the patients were divided into the following comparison groups: group I early fetal growth retardation (n = 29), group II late fetal growth retardation (n = 27), group III small for gestational age (n = 47). Relative risk calculations were used to assess the contribution of risk factors and the risk of developing secondary outcomes.&#x0D; RESULTS: Pregestational diabetes mellitus was the major risk factor for early fetal growth retardation development (relative risk 1.91; 95% confidence interval 1.043.50); especially type 1 diabetes mellitus (relative risk 1.64; 95% confidence interval 1.022.74) and more than 10 years of pregestational diabetes mellitus duration (relative risk 2.62; 95% confidence interval 1.126.17). Chronic hypertension increases the risk of early fetal growth retardation (relative risk 2.11; 95% confidence interval 2.213.68), while gestational hypertension was a significant risk factor for late fetal growth retardation development (relative risk 1.81; 95% confidence interval 1.013.70). Preeclampsia is associated with both early and late forms of fetal growth retardation. Maternal characteristics, such as age over 35 years, obesity, and in vitro fertilization pregnancy, increased the risk of early fetal growth retardation development. In turn, the presence of fetal growth retardation in patients with diabetes mellitus is associated with increased risk of cesarean section, prolonged stay of the newborn in the neonatal intensive care unit (5 days), low Apgar scores (7 at the 5th minute), and neonatal hypoglycemia. Early fetal growth retardation is a significant risk factor for preterm birth (relative risk 6.23; 95% confidence interval 2.8713.42) and fetal distress (relative risk 5.51; 95% confidence interval 2.2813.33).&#x0D; CONCLUSIONS: Being associated with a highly increased risk of adverse obstetric and perinatal outcomes, early fetal growth retardation in diabetic pregnancy is related to pregestational diabetes mellitus, especially type 1 diabetes mellitus, with a long history, as well as with hypertension in pregnancy.

Neonatal hypoglycemia: pre-emptive monitoring and treatment may result in normal neurodevelopmental outcome.

Neonatal hypoglycemia: pre-emptive monitoring and treatment may result in normal neurodevelopmental outcome.

Rate of Spontaneous Preterm Delivery Between Pregnant Women With and Without Gestational Diabetes.

Objective The aim of this study is to compare the rate of spontaneous preterm delivery between gestational diabetes mellitus (GDM) and normal pregnancy. Pregnancy outcomes and associated risk factors for spontaneous preterm delivery were evaluated. Methods A retrospective cohort study was conducted on 120 GDM and 480 normal pregnant women. All women received GDM screening with 50-g glucose challenge test and 100-g oral glucose tolerance test at the first visit and repeated at 24-28 weeks. Data were retrieved from medical records and included baseline and obstetric characteristics, preterm risks, GDM risks, and pregnancy outcomes. Spontaneous preterm birth was defined as delivery before 37 completed weeks of gestation that had been preceded by spontaneous labor. Results GDM women were more likely to be ≥30 years (p=0.032) and have previous GDM (p=0.013). Incidence of overall preterm delivery was significantly higher in GDM women (17.5% vs. 8.5%, p=0.004), as well as the incidence of spontaneous preterm delivery (15.8% vs. 7.1%, p=0.004). GDM women had less gestational weight gain (p<0.001) and were less likely to have excessive weight gain (p=0.002). GDM women were more likely to deliver large for gestational age (LGA) (p=0.02) and macrosomic infants (p=0.027). Neonatal hypoglycemia was significantly more common among GDM women (p=0.013). Multivariate analysis showed that previous preterm birth and GDM independently increased the risk of spontaneous preterm delivery (adjusted OR: 2.56, 95% CI: 1.13-5.79, p=0.024, and adjusted OR: 2.15, 95% CI: 1.2-3.84, p = 0.010, respectively). Conclusion GDM and previous preterm birth significantly increased the risk of spontaneous preterm delivery. GDM also increased the risk of LGA, macrosomia, and neonatal hypoglycemia.

HYPOGLYCEMIA IN EXCLUSIVELY BREASTFED LOW BIRTH WEIGHT NEONATES

Background and Aim: Hypoglycemia is an important problem encountered in Low Birth Weight (LBW) neonates. Incidence and risk factors associated with hypoglycemia in low birth weight neonates on exclusive breast milk were studied. Material and Methods: A Prospective observational study was done between Jan-June 2022. Low birth weight neonates (≥1.8 kg &lt;2.5 kg) who were fed exclusively with breast milk were screened for hypoglycemia by measuring capillary blood glucose by glucometer strips at 1 , 2 , 6 , 12 , 24 , 48 and 72 hours of age. Results: 180 Low Birth Weight neonates were included in the study, of which 41 developed hypoglycemia with incidence of 22.7%. Majority of them (85.3%) were asymptomatic . 70.7 % of hypoglycemia episodes occurred in rst 24 hours of life. 58.5% neonates with hypoglycemia had only one episode while 31.7% and 9.8% had 2 and 3 or more episodes of hypoglycemia respectively. Incidence was more in Pre term (PT) (27.3%) compared to Full Term(FT) neonates (16.2%). Also Small for Gestational Age (SGA) neonates were more prone to hypoglycemia compared to Appropriate for Gestational Age (AGA) neonates (48.2 % against 18.4%) Incidence in PT SGA, FT SGA and PT AGA neonates was 27.9%,20.3 &amp; 18.4% respectively. Incidence was also more in neonates born to primigravida mothers and those delivered by cesarean section. Conclusion: Low birth weight Neonates especially late preterms and SGAneonates on exclusive breast milk should be monitored for hypoglycemia in rst 72 hours of life. Early initiation of breast feeding should be ensured to prevent hypoglycemia in them.

Executive function and behaviour problems in school-age children born at risk of neonatal hypoglycaemia.

To examine the relationship between neonatal hypoglycaemia and specific areas of executive function and behaviour in mid-childhood. Participants in a prospective cohort study of infants born late preterm or at term at risk of neonatal hypoglycaemia were assessed at 9 to 10 years. We assessed executive function using performance-based (Cambridge Neuropsychological Tests Automated Battery) and questionnaire-based (Behavior Rating Inventory of Executive Function) measures and behaviour problems with the Strengths and Difficulties Questionnaire. Data are reported as adjusted odds ratio (aOR) with 95% confidence intervals, and standardized regression coefficients. We assessed 480 (230 females, 250 males; mean age 9 years 5 months [SD 4 months, range 8 years 8 months-11 years 0 months]) of 587 eligible children (82%). There were no differences in performance-based executive function between children who did and did not experience neonatal hypoglycaemia (blood glucose <2.6 mmoL/L). However, children who experienced hypoglycaemia, especially if severe or recurrent, were at greater risk of parent-reported metacognition difficulties (aOR 2.37-3.71), parent-reported peer (aOR 1.62-1.89) and teacher-reported conduct (aOR 2.14 for severe hypoglycaemia) problems. Both performance- and questionnaire-based executive functions were associated with behaviour problems. Neonatal hypoglycaemia may be associated with difficulties in specific aspects of parent-reported executive functions and behaviour problems in mid-childhood.

Effectiveness of multidisciplinary intervention for gestational diabetes mellitus.

To explore the effectiveness of multidisciplinary intervention for patients with gestational diabetes mellitus (GDM). A total of 126 patients diagnosed with GDM from January 2020 to December 2021 in our hospital were enrolled in this retrospective study. Patients were divided into the control group (conventional treatment) and the study group (adding multidisciplinary intervention). Glucose index, self-management ability, psychological status, and delivery outcomes were evaluated. Fasting plasma glucose (4.32 ± 0.81 mmol/L), glycosylated hemoglobin (5.47 ± 1.09%), and postprandial blood glucose (6.02 ± 1.47 mmol/L) after intervention in study group were significantly lower than those in control group (p < 0.05), as well as those before intervention (p < 0.05). The score of GDM knowledge (38.03 ± 2.76), self-management (38.93 ± 2.32), social support (17.84 ± 1.23), and belief (17.93 ± 1.09) were all significantly higher than those of control group (p < 0.05), as well as those before intervention (p < 0.05). Besides, anxiety (7.83 ± 1.59) and depression (10.29 ± 1.82) evaluation scores showed that emotional relief were significantly achieved after intervention in study group compared with control group (p < 0.05). Moreover, the incidence of postpartum hemorrhage, cesarean delivery, premature delivery, macrosomia, and neonatal hypoglycemia was also significantly improved after intervention in study group compared with control group (p < 0.05). Multidisciplinary intervention can effectively control blood glucose levels, adjust self-management behavior, relieve psychological disorder, reduce complications, and improve delivery outcomes of GDM patients.

Maternal and fetal benefits of fetal reduction in triplet pregnancies

IntroductionTriplet pregnancy is a type of high-risk pregnancy that often results in premature delivery. Although fetal reduction is recommended, a number of factors can lead to triplet pregnancies without reduction. As there is no consensus on reduction, it is necessary to carry out a specific evaluation of the benefits of reduction in triplet pregnancy. This study was performed to evaluate and discuss the prognosis of triplet pregnancy with or without fetal reduction.Material and methodsClinical data from 24 women with triplet pregnancies were retrospectively collected and analyzed. Twelve women underwent fetal reduction (fetal reduction group) and 12 women continued triplet pregnancy (non-fetal reduction group). In the fetal reduction group, four dichorionic triamniotic triplets were reduced to dichorionic diamniotic twins (with a reduction of one of the monochorionic diamniotic fetuses); six trichorionic triamniotic triplets were reduced to dichorionic diamniotic twins (with a reduction of one monochorionic monoamniotic fetus).ResultsThere were significant differences in the incidence of premature rupture of membranes and neonatal hypoglycemia between the reduction and non-reduction groups. The average birth weight was significantly different between the reduction group and non-reduction group. The Apgar score was significantly different between the monochorionic monoamniotic reduction group and monochorionic diamniotic reduction group.ConclusionsTriplet pregnancy should be closely monitored throughout pregnancy and the perinatal period, regardless of fetal reduction. The chorionicity should be considered with fetal reduction. Compared with the mother, the remaining fetuses may benefit more from fetal reduction, especially in terms of neonatal weight.

Occurrence of neonatal hypothermia and associated risk factors among low birth weight (LBW) infants in Accra, Ghana

Background Neonatal hypothermia is a prominent issue in low-resource settings. Preterm and low birth weight (LBW) infants are at increased risk for developing hypothermia. If left untreated, hypothermia can lead to hypoxia, sepsis, hypoglycemia, apnea, and poor weight gain in neonates, contributing to neonatal morbidity and mortality. Identifying risk factors for neonatal hypothermia is important, especially in low-resource settings, where the burden of neonatal mortality is highest. The study sought to describe the distribution of neonatal hypothermia and examine risk factors associated with neonatal hypothermia among LBW infants admitted to Korle-Bu Teaching Hospital in Accra, Ghana. Methods Infants in the neonatal intensive care unit (NICU) at Korle-Bu Teaching Hospital, who were less than 28 days old, weighing less than &lt;2,500 grams, and clinically stable, were enrolled. Infants of mothers under 18 years old and those expected to be discharged within 24 hours were excluded from the study. A standardized questionnaire was administered to collect information on the mother, infant, pregnancy, and birth characteristics. Axillary temperature readings were taken every 4 hours over a 24-hour monitoring period and during hypothermic events detected by the continuous temperature monitoring bracelet. Univariate and multivariate linear regression analyses with generalized estimating equations were used to examine risk factors associated with temperature. Results Of the 254 infants included in the analysis, 42.1% were male, 49.6% were very LBW (&lt;1,500 grams), and 94.1% were preterm (&lt;37 weeks). Of the 1,948 temperature readings, 44.5% were hypothermic (&lt;36.5oC). Hypothermia occurred in 85.8% of infants during the 24-hour monitoring period. Multivariate linear regression demonstrated that being very LBW, having no skin-to-skin contact immediately after birth, not being wrapped or treated in an incubator at the time of temperature, and mixed feeding (compared to exclusive breastfeeding) were associated with lower neonatal temperatures. Conclusions Neonatal hypothermia was common among infants admitted to the NICU. The findings highlight the importance of thermal practices such as wrapping, exclusive breastfeeding and skin-to-skin contact. Increased education to promote thermal care is needed.

Quality and credibility of clinical practice guidelines recommendations for the management of neonatal hypoglycemia. A protocol for a systematic review and recommendations' synthesis.

Hypoglycemia is one of the most frequent metabolic conditions in neonates. Clinical practice guidelines (CPGs) influence clinical practice as high-quality CPGs facilitate the use of evidence in practice. This proposed study aims to systematically identify and appraise CPGs and CPG recommendations (CPGRs) for treating neonatal hypoglycemia (NH). We will conduct searches in MEDLINE, EMBASE, CINAHL, Cochrane Library, LILACS (Latin American & Caribbean Health Sciences Literature), and Epistemonikos. Authors will search CPGs-specific databases and grey literature. Two reviewers will independently perform the titles and abstract screening, full-text review, and data extraction. Two appraisers will assess the quality of the CPGs and their recommendations using AGREE II (Appraisal of Guidelines Research and Evaluation) and AGREE-REX (Appraisal of Guidelines Research and Evaluation-Recommendations Excellence) instruments. Scores of ≥ 60% in the rigour of development domain will be considered for defining high-quality with AGREE II tool. CPGRs with scores >60% in the three domains will be used to determine high quality with the AGREE REX tool. We will perform a synthesis of the CPGRs to identify the consistency among the CPGRs and the methodological quality of primary studies that support them. The results will help us to identify the methodological and quality gaps in the existing CPGs for the treatment of NH. Our findings will be submitted to peer-review journals and presented at academic conferences. Based on the study design, approval from the institutional ethics board is not required for this project. Systematic Review Registration Number (PROSPERO): CRD 42021239921.

Role of maternal variables on the development of neonatal hypoglycaemia and influence of neonatal hypoglycaemia on performance of goat kids

The study evaluated the influence of maternal variables (age, body weight and body mass index; BMI) during mating on the development of hypoglycaemia and investigated whether hypoglycaemia at birth impairs thermoregulation, metabolism, body weight gain and immunoglobulin concentration in neonatal goat kids. Post-kidding, the kids born with hypoglycaemia (n = 19) and normoglycaemia (n = 19) were immediately identified and postnatal blood samples, body weight and cardinal physiological variables were determined. Results revealed no significant (P < 0.05) difference in pre-mating maternal variables between dams that kidded hypoglycaemic and normoglycaemic kids. Kids born with hypoglycaemia had lower (P <0.05) blood glucose concentration from birth, until Day 2, when values became comparable between the two groups. Afternoon respiratory and pulse rates were markedly (P < 0.05) unstable in kids born with hypoglycaemia and the early postnatal rise (P < 0.05) in morning rectal temperature in both groups was accompanied by a decrease (P < 0.05) on day 20 in kids born with hypoglycaemia. Blood cholesterol and triglyceride concentrations were lower (P < 0.05) in hypoglycaemic kids and the normoglycaemic kids showed marked increase (P < 0.05) in circulating immunoglobulin concentration 24 h after birth, while age had no (P > 0.05) effect in hypoglycaemic kids. A more pronounced decrease (P < 0.05) in weekly weight gain was observed in hypoglycaemic kids. It was concluded that neonatal goat kids born with hypoglycaemia may have compromised thermoregulation, metabolism and body weight gain, and the cause of hypoglycaemia in kids may not be related to pre-mating maternal variables.

Glucose and Calcium Profile in Infants of Diabetic and Nondiabetic mothers- A Comparative Study

Background: Diabetes is one of the commonest and most important metabolic disorders that affect the health of pregnant women and infants. Diabetic mellitus is one of the most common metabolic disorders complicating pregnancy. The neonatal mortality rate is over five times that of nondiabetic mothers and is higher irrespective of birth weight and gestational age. There has been significant improvement in the outcome of diabetic pregnancies largely due to better metabolic control before and during pregnancy and vigorous neonatal care in developed countries. The management in our country still poses a major challenge.&#x0D; Methods: This case-control study was designed to find out the association between an infant's hypoglycemia and hypocalcemia with maternal diabetes. For the research, a total of 300 neonates were selected, where cases were selected from infants of diabetic mothers, and the control group was selected from infants of nondiabetic mothers. The mothers were interviewed by specific questionnaire, selected neonates were examined, and some biochemical tests were done to find out the outcome.&#x0D; Results: The study included 300 neonates of diabetic and nondiabetic mothers. The mean age of the Mothers of these neonates was 25.36 (SD±5.50) years. Among diabetic mothers 115(76%) had GDM and 36(23.8%) had PGDM. It is revealed that 83 (55%) of 150 mothers took insulin as the treatment. Hypoglycemia in neonates of diabetic and nondiabetic mothers right after birth at their first ½ hour of age 111 (37%). Hypoglycemia was found in 94 (62.3%) of infants of the diabetic mother than only 17(11.4%) in infants of the nondiabetic mother. Where the p-value is &lt;0.001, which explains developing hypoglycemia in the infant of a diabetic mother is higher than nondiabetic mother. The number of hypocalcemic infants of the diabetic mother was 34 (22.5%), while hypocalcemic infants of the nondiabetic mother were only 8 (5.4%), which is significantly (p-value &lt;0.001) lower.&#x0D; Conclusions: Hypoglycemia and hypocalcemia in infants were directly associated with the presence of diabetes during pregnancy. In spite of intensive management of maternal diabetes, the infants of diabetic mothers continue to be a high-risk population. Among the pregnancies complicated by diabetes, GDM continues to have a major contribution. Hypoglycemia remains the most common biochemical abnormality, followed by hypocalcemia. Therefore, this pregnancy complication will require increased re- sources to manage appropriate glycemic control during pregnancy and reduce adverse perinatal outcomes.&#x0D; TAJ 2022; 35: No-2: 93-102