Neonatal Blood Glucose Levels Research Articles

406 A CTS Team Approach to Identifying Risk of Neonatal Hypoglycemia and its Relationship with Endothelial Dysfunction

OBJECTIVES/GOALS: Neonatal hypoglycemia is seen in 65% of maternally diabetic pregnancies, and can lead to severe neurological damage. Neonatal glycemia may also be an indicator of placental function in these pregnancies. The purpose of this study is to identify patterns of neonatal glycemia, and associated endothelial dysfunction, by maternal diabetes subtype. METHODS/STUDY POPULATION: Pregnancies with maternal Type 1 (T1DM), Type 2 (T2DM), and gestational diabetes mellitus (GDM) are being enrolled. Maternal hemoglobin A1c (HbA1c) and umbilical cord insulin/glucose are being collected from 20 pregnancies in each group, 10 of which also undergo placental/umbilical cord tissue collection. Following delivery, neonatal blood glucose levels are also collected every 3-4 hours (4+ measurements) to determine rate of glycemic change. Linear regression modeling will be used to determine associations with placental and umbilical endothelial RNA expression, umbilical cord insulin levels, and maternal HbA1c within each diabetic subtype and between normoglycemic and hypoglycemic neonates. Endothelial gene expression will be compared using paired t-tests with Benjamini-Hochberg correction. RESULTS/ANTICIPATED RESULTS: Thus far, 5 T1DM, 10 T2DM, and 13 GDM samples have been collected. Gestational age at delivery and birth weight were similar between groups (38.1 ± 1.05 weeks; 3.6 ± 0.59 kilograms) and delivery method is evenly distributed (Cesarean section or vaginal delivery). Currently, with limited cohort size, no association is evident between maternal HbA1c and umbilical cord glucose/insulin (p=0.114) or neonatal hypoglycemia diagnosis (p=0.674) when controlled for gestational age and infant birthweight. We hypothesize that, with pending analyses, maternal HbA1c and umbilical cord insulin levels will correlate negatively with the rate of neonatal glycemic change, and positively with the level of inflammatory and angiogenic transcription identified in placental and umbilical endothelium. DISCUSSION/SIGNIFICANCE: Characterization of postnatal glucose control is key to prognosis and risk stratification of infants of diabetic mothers. Understanding placental response to glucose, as well as sequela in the fetal endothelium, is also critical to understanding the pathogenesis of neonatal hypoglycemia and other adverse outcomes of diabetic pregnancy.

Impacts of Tocolytics on Maternal and Neonatal Glucose Levels in Women With Gestational Diabetes Mellitus.

We investigated the impacts of tocolytic agents on maternal and neonatal blood glucose levels in women with gestational diabetes mellitus (GDM) who used tocolytics for preterm labor. This multi-center, retrospective cohort study included women with GDM who were admitted for preterm labor from twelve hospitals in South Korea. We excluded women with multiple pregnancies, anomalies, overt DM diagnosed before pregnancy or 23 weeks of gestation, and women who received multiple tocolytics. The patients were divided according to the types of tocolytics; atosiban, ritodrine, and nifedipine group. We collected baseline maternal characteristics, pregnancy outcomes, maternal glucose levels during hospitalization, and neonatal glucose levels. We compared the frequency of maternal hyperglycemia and neonatal hypoglycemia among three groups. A multivariate logistic regression analysis was performed to evaluate the contributing factors to the occurrence of maternal hyperglycemia and neonatal hypoglycemia. A total of 128 women were included: 44 (34.4%), 51 (39.8%), and 33 (25.8%) women received atosiban, ritodrine, and nifedipine, respectively. Mean fasting blood glucose (FBG) (112.3, 109.6, and 89.5 mg/dL, P < 0.001) and 2-hour postprandial glucose (PPG2) levels (145.4, 148.3, and 116.5 mg/dL, P = 0.004) were significantly higher in atosiban and ritodrine group than those in nifedipine group. Even after adjusting for covariates including antenatal steroid use, gestational age at admission, and pre-pregnancy body mass index, there was an increased risk of high maternal mean FBG (≥ 95 mg/dL) and PPG2 (≥ 120 mg/dL) levels in the atosiban and ritodrine group than in nifedipine group. The atosiban and ritodrine groups are also at increased risk of neonatal hypoglycemia (< 47 mg/dL) compared to the nifedipine group with the odds ratio of 4.58 and 4.67, respectively (P < 0.05). There is an increased risk of maternal hyperglycemia and neonatal hypoglycemia in women with GDM using atosiban and ritodrine tocolytics for preterm labor compared to those using nifedipine.

PDX1 Methylation, NGN3 and Pax6 Expression Levels in Pregnant Women with Gestational Diabetes Mellitus and their association with neonatal blood sugars and birth weight.

To investigate the correlation of maternal PDX1 methylation, NGN3 and Pax6 expression levels with neonatal blood sugars and birth weight in pregnant women with GDM and non GDM. This was a prospective cohort study. Total 80 pregnant women who were examined and delivered in the Department of Obstetrics of Affiliated Hospital of Hebei University from January 2019 to June 2022 were recruited and divided into two groups according to the results of oral glucose tolerance test (OGTT): the control group and the observation group, with 40 cases in each group. PDXl methylation rate was measured by the methylation-specific PCR method, whereas gene expression levels of PDX1, NGN3 and Pax6 were measured by RT-PCR meanwhile, neonatal blood glucose and hemoglobin A1c (HbA1c) levels were also measured. In comparison with the control group, the observation group had higher levels of FBG, 2-hour postprandial blood glucose (2hPBG) and HbA1c (P<0.05). Neonatal birth weight and insulin levels in the observation group were significantly higher than those in the control group, while Apgar scores and blood glucose were lower than those in the control group(P<0.05). Moreover, the observation group had significantly lower gene expression levels of PDX1, NGN3 and Pax6, and a higher PDX1 methylation rate than the control group (P<0.05). Correlation analysis revealed a negative correlation between neonatal blood glucose levels and PDX1, NGN3 and Pax6 levels in the observation group, with statistical significance (P<0.05). Changes in maternal PDX1 methylation, NGN3 and Pax6 expression levels may lead to abnormal glucose metabolism in neonates, which has a close bearing on neonatal hypoglycemia and blood glucose levels caused by GDM.

Effects of women with gestational diabetes mellitus related weight gain on pregnancy outcomes and its experiences in weight management programs: a mixed-methods systematic review.

Proper controlling gestational diabetes mellitus (GDM)-related gestational weight gain (GWG) during pregnancy can optimize pregnancy outcomes and improve postpartum glucose homeostasis. This study aimed to explore the existing intervention programs, the effects on pregnancy outcomes, and the experiences of weight management for GDM-related GWG in women with GDM. This mixed-methods systematic review was retrieved from nine databases. The retrieval time was from the database construction to September 20, 2023, and all studies were published in English and Chinese. The included records used quantitative, qualitative, or mixed methods and reported original studies of weight-related intervention regimens, effects on pregnancy outcomes, and women's experiences and perceptions. This review used a convergent segregated approach to synthesize and integrate research findings from Joanna Briggs Institute (JBI) mixed-methods systematic reviews. There were 16 articles that met the inclusion criteria, and the articles came from seven different countries and included 23,997 women with GDM. The meta-analysis pooled outcomes for the incidence of weight gain exceeding the Institute of Medicine (IOM) recommendations after GDM diagnosis to delivery was 0.31% (95% CI 0.21-0.42). The effectiveness of GDM-related weight interventions in reducing weight gain after GDM diagnosis was supported by quantitative evidence. The GDM-related GWG below the IOM recommendations is a protective factor (OR=0.68, 95%CI 0.48-0.97) for large for gestational Age (LGA), and above the IOM recommendations is a risk factor (OR=1.62, 95%CI 1.15-2.27) for LGA. In addition, no significant statistical significance was found in the pooled outcomes of small for gestational age (SGA). Avoiding excessive weight gain helps to optimize neonatal birth weight, pregnancy outcomes, and maternal blood glucose levels. According to qualitative survey results, some women with GDM experienced weight stigma, and a positive relationship between healthcare providers and GDM women helped in weight management. Following a diagnosis of GDM, weight management interventions positively affected GWG and pregnancy outcomes. In order to improve compliance and safety of weight management in women with GDM, criteria and interventions for weight gain associated with GDM need to be further explored and improved. https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=404492, identifier CRD42023404492.

Characteristics of pregnancy complicated with type 1 and type 2 diabetes.

Diabetes in pregnancy is a major risk factor for adverse perinatal outcomes such as congenital anomalies, hypertensive disorders of pregnancy (HDP), and macrosomia. For the mechanism of onset of type 1 and type 2 diabetes are different, we focused on the difference in perinatal outcomes between the type 1 and type 2 diabetes groups. We retrospectively reviewed 22 pregnancies with type 1 diabetes and 15 pregnancies with type 2 diabetes, who were managed in our single center, with regard to maternal diabetes conditions during pregnancy and neonatal birthweight and blood glucose level. Furthermore, we checked the effect of continuous glucose monitoring and continuous subcutaneous insulin injection in pregnancies with type 1 diabetes. Type 1 diabetes in pregnancy was less controllable and increased neonatal birth weight and neonatal hypoglycemia within 2h after birth after neonatal care unit admission. Continuous glucose monitoring and continuous subcutaneous insulin injection that are convenient to use, had a similar effect in the management of type 1 diabetes during pregnancy, compared with conventional diabetes treatment. In contrast, maternal BMI and HDP were increased in women with type 2 diabetes. In the management of pregnancy with diabetes, we should pay attention to the difference in pregnancy prognosis between type 1 and type 2 diabetes.

Oral Carbohydrate Administration was Suitable for Cesarean Section–A Systematic Review and Meta-Analysis of Randomized Trials

The use of carbohydrate (CHO) drinks prior to elective cesarean section has gained momentum, but its effect on maternal and neonatal outcomes remains controversial. The aim of this meta-analysis was to assess the effect of an oral CHO load prior to cesarean delivery on insulin sensitivity, insulin resistance, maternal glycemia, neonatal glycemia, and breastfeeding. As of May 21, 2023, we searched through five databases for English-language experimental studies on pre-cesarean oral CHO. A total of 3,940 citations were received, of which seven were selected. The concentrations of CHO used in these studies ranged from 5.9% to 14.2%, and the amounts used were 300-400 ml. We found that pre-cesarean CHO loading reduced maternal insulin resistance and increased maternal glucose levels. CHO loading activates the insulin pathway of critical en-zymes to some extent, increasing glucose utilization by peripheral tissues and ultimately reducing postop-erative insulin resistance. Of course, this is also beneficial in improving maternal blood sugar. We did not find that CHO increased maternal insulin sensitivity or neonatal blood glucose levels. Future prospective randomized controlled trials can use nutritional load to increase colostrum production after Caesarean sec-tion to enhance the confidence of these mothers in breastfeeding. In addition, our preoperative beverage could be more individualized to accommodate diabetic women.

Intrapartum continuous subcutaneous insulin infusion vs intravenous insulin infusion among pregnant individuals with type 1 diabetes mellitus: a randomized controlled trial

Intrapartum glucose management is critical to reducing neonatal hypoglycemia shortly after birth. Although it is known that insulin is required for all pregnant individuals with type 1 diabetes mellitus, the optimal mode of intrapartum glycemic control is not known. This study aimed to compare the effect of intrapartum use of continuous subcutaneous insulin infusion with that of intravenous insulin infusion for glucose management among pregnant individuals with type 1 diabetes mellitus on neonatal blood glucose levels. This was a randomized controlled trial of pregnant participants with type 1 diabetes mellitus. After written informed consent, participants were randomly allocated to 1 of 2 intrapartum insulin administration strategies: continuation of their continuous subcutaneous insulin infusion or intravenous insulin infusion. The primary outcome was the first neonatal blood glucose level. Between March 2021 and April 2023, 76 participants were approached, and 70 participants were randomized (35 participants in the intravenous insulin infusion group and 35 participants in the continuous subcutaneous insulin infusion group). The groups were similar in terms of age, race/ethnicity, pregravid body mass index, nulliparity, and gestational age at delivery. There was no statistically significant difference in the first neonatal glucose measurement between the 2 groups (50.1±23.4 vs 49.2±22.6; P=.86). In addition, there were no statistically significant differences in any secondary neonatal outcomes. Approximately 57.1% of neonates in the continuous subcutaneous insulin infusion group required either oral, intravenous, or both treatments for hypoglycemia, whereas 51.4% of neonates in the intravenous infusion group required treatment. In both groups, 28.6% of neonates required intravenous treatment for hypoglycemia. Pregnant individuals with type 1 diabetes mellitus using either intravenous insulin infusion or continuation of their continuous subcutaneous insulin infusion for intrapartum insulin administration had no difference in the primary outcome of neonatal hypoglycemia. Patients should be given the option of both glycemic management strategies intrapartum.

Effect of epidural labor analgesia on maternal and infant outcomes in parturients with gestational diabetes mellitus-A prospective cohort study.

The occurrence of gestational diabetes mellitus (GDM) is caused by a variety of factors and associated with increased risks of several adverse outcomes for both mothers and infants. However, the effects of epidural labor analgesia in parturients with GDM on maternal and infant outcomes have not been characterized. According to parturients' choice, they were divided into the epidural group (n = 133) and no epidural (control) group (n = 135). Data for relative variables in the perinatal period were collected, and the potential associations of epidural labor analgesia with infant outcomes were analyzed by univariate analysis and multivariate logistic regression analyses. The rate of neonatal admission to the neonatal intensive care unit (NICU) for hypoglycemia was higher in the epidural group (7.52%) than in the control group (1.48%; P < 0.05). Epidural labor analgesia and drug-based diabetes control were independent predictors of the rate of neonate transfer to the NICU for hypoglycemia. Epidural labor analgesia was associated with an increased risk of neonatal transfer to the NICU for hypoglycemia. Thus, monitoring of neonatal blood glucose levels after administration of epidural labor analgesia in parturients with GDM may be beneficial.Trial registration: The study was registered in the China Clinical Registration Center (Registration No. ChiCTR-OOC-17013164, Registered on 30 October 2017).

Effects of antenatal corticosteroids on neonatal blood glucose fluctuation in late-preterm infants.

To evaluate the effects of antenatal corticosteroids (ACS) on blood glucose fluctuations in late-preterm neonates. A retrospective study was performed on 236 neonates with gestational age of 34+0 to 36+6 weeks who were admitted to the neonatology department of a tertiary general hospital in China's Zhejiang Province between April 2020 and February 2022. The neonates were divided into three groups: complete course, partial course, and control. Primary outcome was the neonatal blood glucose levels within the first 48 h of life. 134 (56.8%) newborns were exposed to a complete course of ACS, 56 (23.7%) had a to a partial course of ACS, and 46 (19.5%) had no exposure to ACS. The patients in the complete course group had the highest proportion of neonatal hypoglycemia (16.4% vs. 3.6% and 6.5%).The patients exposed to a complete course of dexamethasone had significantly lower blood glucose levels within 12 h of birth than the control group, although no significant differences were observed after 24 h. Differences in blood glucose levels were more significant among male infants, although blood glucose curves of the male and female infants remained close to the overall trend. Blood glucose levels in late-preterm neonates may decrease after ACS administration, especially after exposure to a complete course. The effects are more pronounced in the first 12 h of life, with males being more severely affected; however, the effects on blood glucose levels were not significant 24 h after birth. This can provide a reference for future clinical studies.

Blood Glucose Levels and Characteristics of Hypoglycemia in Low Birth Weight Neonates

Introduction: Low birth weight (LBW) neonates comprising of preterm and small for gestational age (SGA) are at risk of hypoglycemia. Hypoglycemia as such in LBW neonates is not well characterized. We aimed to study the blood glucose levels of these neonates and characterise the hypoglycemia. Methods: Blood glucose levels in singleton neonates with birth weight between 1500 gm and 2499 gm were studied prospectively. Glucose levels were assessed at six hour intervals in the first 48 hours of life and extended if indicated. Glucose level ≤ 45 mg/dL in the first 24 hours and &lt; 50 mg/dL thereafter was considered hypoglycaemia. Results: A total of 320 among 3822 neonates satisfied inclusion criteria; 104 had at least one low glucose reading with an incidence of hypoglycaemia of 32.5%. Preterm neonates constituted 158 (49.4%) and SGA 76 (23.8%). Mean blood glucose values were lowest in the first hour of life (60.1 ± 17.2 mg/dL). Incidence of hypoglycemia was highest within one hour of life followed by day two of life (16.3% and 11.6% respectively). About 86 (82.6%) neonates were asymptomatic. Overall, 75% of neonates had a single episode of hypoglycemia and 25% had a recurrence. Hypoglycaemia was noted in 31.8% of neonates born to diabetic mothers, mostly in the first hour (57.1%). Other risk factors for hypoglycemia included intrapartum fluids, birth weight &lt; 2000 g and polycythemia. Conclusions: About a third of LBW neonates had hypoglycemia; mostly on the first hour and day one of life. Asymptomatic nature of hypoglycaemia in the large majority and recurrent hypoglycemia in 25% cases warrants glucose monitoring in this subgroup.

The role of maternal diet on offspring hyperinsulinaemia and adiposity after birth: a systematic review of randomised controlled trials.

In utero diet may be directly related to the risk of fetal hyperinsulinaemia and offspring metabolic health. This review examines the relationship between maternal dietary exposures and sub-clinical fetal hyperinsulinaemia and neonatal adiposity. Articles were identified in MEDLINE, Web of Science, Cochrane Controlled Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, SCOPUS, and SPORTDiscus (September 2019-March 2021) using the preferred reporting items for systematic reviews and meta-analyses guidelines. PROSPERO registration ID CRD42020146453. Studies were selected by two independent reviewers. Randomised controlled trials (RCT) involving a dietary intervention with pregnant women (healthy pregnancy, gestational diabetes mellitus and obesity) and reporting fetal cord-blood insulin, c-peptide, glucose or adiposity estimates were included. One author extracted all information on main study characteristics and outcomes. Risk of bias was assessed using the Cochrane Collaboration's bias risk assessment tool. A total of 733 articles were identified. Fourteen articles from 11 RCTs (3614 participants) were included. Studies reviewed showed no specific effect of maternal diet on neonatal cord blood insulin, c-peptide or glucose levels. Infants born to mothers who followed a low glycaemic load (GL) had lower skin fold thickness compared to controls. Interventions that provided individualised nutrition counselling to women with obesity or previous infant born > 4 kg were also associated with lower adiposity. The studies reviewed suggest that lifestyle-based dietary interventions to improve glycaemia (low GL) have a protective effect against excess adiposity. Future studies should incorporate multi-modal interventions with dietary counselling to support lifestyle changes throughout gestation and include assessments of maternal insulin resistance at recruitment.

Effect of Donor Breastmilk vs Formula Supplementation on Blood Glucose Levels in Neonates at Risk for Hypoglycemia

Effect of Donor Breastmilk vs Formula Supplementation on Blood Glucose Levels in Neonates at Risk for Hypoglycemia

Safety and feasibility of oral carbohydrate consumption before cesarean delivery on patients with gestational diabetes mellitus: A parallel, randomized controlled trial.

To investigate the safety and feasibility of taking low-concentration carbohydrate solution at 2 h before induction of anesthesia for gestational diabetes mellitus (GDM) patients. GDM patients undergoing cesarean section were randomly assigned to experimental group (n = 43) and control group (n = 42). Two hours before induction of anesthesia, participants in experimental group orally received 300 mL low-concentration carbohydrate solution, while those in control group received equivalent warm water. Blood glucose and serum insulin were measured at 2 h before induction of anesthesia, right before induction of anesthesia, and the morning of postoperative day 1. Neonatal blood glucose level was monitored at birth. Maternal gastrointestinal function and well-being were assessed perioperatively. The levels of blood glucose and serum insulin right before induction of anesthesia in the experimental group were significantly higher than those in the control group. There were four cases with hypoglycemia in the experimental group and 19 cases in the control group right before induction of anesthesia (9.3% vs 45.2%, p < 0.001). The incidence of neonatal hypoglycemia was 2.3% in the experimental group and 7.1% in the control group with no significance. Hunger score of the participants between the two groups right before induction of anesthesia was significantly different. No aspiration, nausea, and vomiting occurred in both groups before, during, and after surgery. No significant difference was found in the time to the first flatus and abdominal distension between the two groups. Taking low-concentration carbohydrate solution is safe and feasible for patients with GDM undergoing elective cesarean section.

The danger of diazoxide in the neonatal intensive care unit.

Background:The most common cause of persistent hypoglycemia in infancy is hyperinsulinemic hypoglycemia. When conservative measures fail, providers often use medications to treat persistent hypoglycemia. Diazoxide is first-line therapy for neonatal hypoglycemia and works by inhibiting insulin secretion. Diazoxide is associated with fluid retention, and less commonly with respiratory decompensation and pulmonary hypertension. Case reports documenting these severe adverse events exist in the literature, although the overall incidence, risk factors, and timing for these effects in a newborn are not clearly defined.Methods:We performed a retrospective chart review of all infants admitted to the neonatal intensive care unit (NICU) at Regional One Health from 1 January 2013 until 15 August 2019, who received diazoxide as a treatment for persistent hypoglycemia secondary to hyperinsulinism. Patients were stratified as either having no adverse event or having an adverse outcome to the medication. A severe adverse outcome was defined as any known major side effect of the medication, which a patient developed within 2 weeks of medication initiation that led to medication discontinuation.Results:From our pharmacy database, we identified a total of 15 babies who received diazoxide for persistent hypoglycemia. Of these patients, eight (53%) were classified as having a complication requiring discontinuation of the medication. Six out of eight patients required intubation with mechanical ventilation and five out of eight patients developed pulmonary hypertension. All patients returned to their baseline respiratory support after drug discontinuation.Conclusions:A total of 53% of our study population had an adverse outcome to diazoxide. Previous studies suggest 5% of patients may have respiratory decompensation and require ventilatory support while on diazoxide; however, 40% of our patients deteriorated and then required mechanical ventilation. Based on our data, respiratory deterioration may be more likely to occur when diazoxide is used in preterm infants, those with lower birth weight and intrauterine growth restriction.Plain language summary The dangers in diazoxide Newborns could experience a transient period of low blood glucose levels soon after birth. However, some may progress to persistent low blood glucose levels that cannot be controlled with adequate glucose infusion and may require other ways of treatment. Diazoxide is the first-line drug approved by the US Food and Drug Administration (FDA) for this condition. However, certain cases have reported the development of respiratory deterioration, including increased blood pressure in lung circulation after its use. This prompted a black box warning in 2015 by the FDA. The incidence of neonatal low blood glucose levels seems to have increased and so has the use of this drug. Our study identifies 15 newborns who received diazoxide at Regional One Health neonatal intensive care unit in the past 6 years and reports a significantly higher rate of adverse events in our population leading to drug discontinuation in almost 53% of our cases.

The Effects of Cord Clamping Time and Early Skin-to-Skin Contact on Maternal Birth Satisfaction in Term Infants

Objective: Meeting the expectations of mothers during labor is defined as birth satisfaction. Evaluation of women’s perception of satisfaction at birth is an important quality criterion in the evaluation of services. This study aims to determine the effect of cord clamping time and early skin contact on maternal birth satisfaction.Methods: Randomized controlled experimental study. The study data were collected between June and December 2018, from a total of 80 participants.Results: Case group was applied late cord clamping and skin contact, control group was applied routine care. The first breastfeeding time was 11.20 ± 5.16 min. for the case group and 44.55 ± 18.03 min. for the control group (p&amp;lt;0.001). Neonatal blood glucose levels within the first 15 minutes were 91.23 ± 20.61 mg/dL for the case group and 83.13 ± 14.17 mg/dL for the control group (p=0.044). Hemoglobin levels of the newborn 24 hours after birth were 18.90 ± 1.58 g/dL for the case group and 18.13 ± 1.78 g/dL for the control group (p=0.042). The difference between the before and after birth hemoglobin-hematocrit values of the mothers was not statistically significant (p=0.327 for Hgb; p=0.238 fot Htc). Postpartum satisfaction levels of the mothers were found to be 106.28 ± 9.52 for the case group and 99.93 ± 13.17 for the control group; mothers at the case group had higher postpartum satisfaction levels (p=0.016).Conclusion: Late cord clamping and early skin contact in newborn positively affect the first breastfeeding time, hemoglobin, hematocrit and blood sugar levels of newborns and can be considered as an important factor that increases mothers’ satisfaction independent of many variables.

Prevalence and factors associated with neonatal hypoglycemia in Northern Uganda: a community-based cross-sectional study

BackgroundNeonatal hypoglycemia is the most common endocrine abnormality in children, which is associated with increased morbidity and mortality. The burden and risk factors of neonatal hypoglycemia in rural communities in sub-Saharan Africa are unknown.ObjectiveTo determine the prevalence and risk factors for neonatal hypoglycemia in Lira District, Northern Uganda.MethodsThis was a community-based cross-sectional study, nested in a cluster randomized controlled trial designed to promote health facility births and newborn care practices in Lira District, Northern Uganda. This study recruited neonates born to mothers in the parent study. Random blood glucose was measured using an On Call® Plus glucometer (ACON Laboratories, Inc., 10125 Mesa Road, San Diego, CA, USA). We defined hypoglycemia as a blood glucose of < 47 mg/dl. To determine the factors associated with neonatal hypoglycemia, a multivariable linear regression mixed-effects model was used.ResultsWe examined 1416 participants of mean age 3.1 days (standard deviation (SD) 2.1) and mean weight of 3.2 kg (SD 0.5). The mean neonatal blood glucose level was 81.6 mg/dl (SD 16.8). The prevalence of a blood glucose concentration of < 47 mg/dl was 2.2% (31/1416): 95% CI 1.2%, 3.9%. The risk factors for neonatal hypoglycemia were delayed breastfeeding initiation [adjusted mean difference, − 2.6; 95% CI, − 4.4, − 0.79] and child age of 3 days or less [adjusted mean, − 12.2; 95% CI, − 14.0, − 10.4].ConclusionThe incidence of neonatal hypoglycemia was low in this community and was predicted by delay in initiating breastfeeding and a child age of 3 days or less. We therefore suggest targeted screening and management of neonatal hypoglycemia among neonates before 3 days of age and those who are delayed in the onset of breastfeeding.

Study of glucose levels in newborn with reference to hypoglycemia

Background: Hypoglycemia is one of the common metabolic problems in neonatal medicine. Early diagnosis and treatment of neonatal hypoglycemia is important as many studies found that, hypoglycaemic episodes in neonates lead to neurodevelopmental and physical growth deficits. In this study, blood glucose levels at different time points were assessed and the influence of maternal blood glucose, mode of delivery, gestational age on neonatal blood glucose levels were studied.Methods: Blood glucose levels were low at 0 and 6th hour and maximum at 24th hour. The blood glucose levels ranged from 27 mg/dl to 140 mg/dl. Neonates with high maternal blood glucose were hypoglycaemic, showing a negative correlation.Results: The mean blood glucose levels were low in pre-term and post term babies compared to term and the range was wide in pre-term and term babies compared to post-term. The mean blood glucose levels were high and range was wide in babies delivered vaginally at all the time points compared to the babies delivered by LSCS. 17% babies were hypoglycaemic at birth but none of them had signs. The major signs noted were jitteriness (88%), high cry (88%), lethargy (55%), tremors (55%), limpness (22%), apathy (22%), weak cry (11%) and poor feeding (11%).Conclusions: 0 and 6th hour are the vulnerable time points for hypoglycaemia. Neonates with high maternal blood glucose, pre-term, post-term and babies delivered by LSCS were more prone for hypoglycaemia requiring blood glucose monitoring. There is a wide variation in signs of hypoglycaemia and babies showing signs require monitoring.

Comparative study of glucometer and laboratory glucose oxidase method for the estimation of blood glucose levels in neonates

Introduction: Hypoglycemia is one of the most common metabolic problems encountered in neonates. The glucose oxidase method used in the laboratory for determining the blood glucose concentration is precise and specific for glucose. The glucometers are often used for blood glucose estimation in NICU. Objectives: This is a prospective study done to determine the efficacy of glucometer in estimation of blood glucose levels in neonates in comparison with the laboratory values. Methods: 170 neonates admitted in NICU in Jay Kay Lon Hospital, Kota associated with Government Medical College Kota with varied symptomatology were enrolled in this study. Blood glucose estimation was done by glucometer and laboratory method using the same venous sample at the time of admission. Statistical analysis was done by using Pearson correlation. Hypoglycemia was defined as blood glucose level <45mg%. Laboratory value was taken as gold standard. Results: Hypoglycemia was common in neonates with risk factors like prematurity, meconium aspiration, septicemia, birth asphyxia etc. In our study Glucometer had a specificity of 98.20%, sensitivity of 64.48 %, positive predictive value of 95%, negative predictive value of 83.84% and accuracy of 86.47%. There was good correlation and no significant difference between two methods in the range between 45 mg/dl and 145 mg/dl but not at very high or very low glucose concentrations Conclusion: The ‘Point of care “device - glucometer as a sole measuring device to screen neonatal hypoglycemia is not satisfactory and confirmation with the laboratory measurements of plasma glucose is still of up most importance.

Study of Association between Mode of Delivery and Blood Glucose Levels in Neonates

Study of Association between Mode of Delivery and Blood Glucose Levels in Neonates

410: Neonatal hypoglycemia after corticosteroid exposure: what is the effect of plurality?

Antenatal corticosteroid (ACS) administration before anticipated preterm birth is one of the most important therapies available to improve neonatal outcomes. Nevertheless, this treatment is associated with increased risk of neonatal hypoglycemia. While the association between ACS and neonatal hypoglycemia has been investigated in singleton pregnancies, there is paucity of data regarding twin gestation. Thus, the aim of our study was to determine whether preterm twins who receive ACS are at increased risk for developing hypoglycemia. A retrospective cohort study of all preterm births of twins at a single tertiary center from 2011 to 2018. The primary outcome was neonatal hypoglycemia (<40 mg/dL) within the first 48 h of life. The study population included 3 groups: 1. twin neonates who received a course of ACS 1-7 days before birth (n=264); 2. preterm twins who did not receive ACS at that time interval (n=80) and 3. singletons receiving ACS 1-7 days before birth (n=277). The groups were matched for gestational age (GA) at delivery and birth weight. Non-parametric statistical methods as well as regression analysis were employed. Neonatal hypoglycemia was less common in the twin newborns who received a course of ACS close to delivery than in the singletons who received ACS (29.1% vs. 37.7%, p=0.01). The prevalence of neonatal hypoglycemia within 48 h of life did not differ significantly between twin pregnancies who received ACS and twin pregnancies who did not (29.1% vs. 26.6%, p=0.55). The three groups did not differ in the lowest neonatal blood glucose levels measured in the first or second day of life (p=0.08 and p=0.12, respectively), or through the entire hospitalization (p=0.06). Compared to singleton pregnancy, exposure to ACS in twin gestation was significantly associated with lower rate of neonatal hypoglycemia after adjustment for maternal age and BMI, gestational diabetes, GA at delivery, mode of delivery and birth weight (OR 0.67, 95% CI 0.46 - 0.98, p=0.04). To the best of our knowledge, this is the first study to examine the association between ACS exposure in preterm twins and neonatal hypoglycemia. Our findings suggest ACS administration in preterm twins is not associated with neonatal hypoglycemia. This is in contrast to the finding of neonatal hypoglycemia in late preterm singletons, and may be due to higher volume of distribution and a shorter half-life of betamethasone in twin pregnancies compared to singleton pregnancies.