Risk Factors Of Neonatal Hypoglycemia Research Articles

Early blood glucose screening in asymptomatic high-risk neonates.

Detecting and treating severe hypoglycemia promptly after birth is crucial due to its association with adverse long-term neurodevelopmental outcomes. However, limited data are available on the optimal timing of glucose screening in asymptomatic high-risk neonates prone to hypoglycemia. Risk factors associated with asymptomatic high-risk neonates include late prematurity≥35 and <37weeks gestation (LPT), small-for-gestational-age (SGA), large-for-gestational-age (LGA), and infant-of-a-diabetic mother (IDM). This study aims to determine the incidence and the impact of individual risk factors on early hypoglycemia (defined as blood glucose≤25 mg/dL in the initial hour after birth) in asymptomatic high-risk neonates. All asymptomatic high-risk neonates ≥35weeks gestation underwent early blood glucose screening within thefirst hour after birth (n=1,690). A 2-year retrospective analysis was conducted to assess the incidence of early neonatal hypoglycemia in this cohort and its association withhypoglycemia risk factors. Out of the 9,919 births, 1,690 neonates (17 %) had risk factors for neonatal hypoglycemia, prompting screening within the first hour after birth. Incidence rates for blood glucose≤25 mg/dL and≤15 mg/dL were 3.1 and 0.89 %, respectively. Of concern, approximately 0.5 % of all asymptomatic at-risk neonates had a blood glucose value of≤10 mg/dL. LPT and LGA were the risk factors significantly associated with early neonatal hypoglycemia. Asymptomatic high-risk neonates, particularly LPT and LGA neonates, may develop early severe neonatal hypoglycemia identified by blood glucose screening in the first hour of life. Additional investigation is necessary to establish protocols for screening and managing asymptomatic high-risk neonates.

Early blood glucose screening in asymptomatic high-risk neonates.

Detecting and treating severe hypoglycemia promptly after birth is crucial due to its association with adverse long-term neurodevelopmental outcomes. However, limited data are available on the optimal timing of glucose screening in asymptomatic high-risk neonates prone to hypoglycemia. Risk factors associated with asymptomatic high-risk neonates include late prematurity≥35 and <37weeks gestation (LPT), small-for-gestational-age (SGA), large-for-gestational-age (LGA), and infant-of-a-diabetic mother (IDM). This study aims to determine the incidence and the impact of individual risk factors on early hypoglycemia (defined as blood glucose≤25 mg/dL in the initial hour after birth) in asymptomatic high-risk neonates. All asymptomatic high-risk neonates ≥35weeks gestation underwent early blood glucose screening within thefirst hour after birth (n=1,690). A 2-year retrospective analysis was conducted to assess the incidence of early neonatal hypoglycemia in this cohort and its association withhypoglycemia risk factors. Out of the 9,919 births, 1,690 neonates (17 %) had risk factors for neonatal hypoglycemia, prompting screening within the first hour after birth. Incidence rates for blood glucose≤25 mg/dL and≤15 mg/dL were 3.1 and 0.89 %, respectively. Of concern, approximately 0.5 % of all asymptomatic at-risk neonates had a blood glucose value of≤10 mg/dL. LPT and LGA were the risk factors significantly associated with early neonatal hypoglycemia. Asymptomatic high-risk neonates, particularly LPT and LGA neonates, may develop early severe neonatal hypoglycemia identified by blood glucose screening in the first hour of life. Additional investigation is necessary to establish protocols for screening and managing asymptomatic high-risk neonates.

Meta-analysis of Clinical High-risk Factors for the Development of Neonatal Hypoglycemia

GDM is a common clinical complication of pregnancy, the incidence rate has been increasing in recent years and the risk of neonatal development of neonatal hypoglycemia (NH) has significantly increased. Studies have shown that the incidence of NH in GDM-delivered newborns is up to 27%. Severe hypoglycemia can cause irreversible brain injury and neurological sequelae in newborns, NH is one of the most common metabolic diseases in neonatal intensive care units. However, many scholars have discussed the related risk factors of neonatal hypoglycemia, but the risk factors and research results are different among the studies and there are some controversies. Therefore, this study aims to conduct a Meta-analysis through the domestic and foreign published studies on the risk factors for neonatal hypoglycemia, to identify the main risk factors for neonatal hypoglycemia, and to provide a basis for early clinical prevention and timely development of scientific and effective interventions. Through health and interest Engineering, the computer conducted a literature search in the medical databases of Wanfang Medical, PubMed database, domestic medical research journals, and biomedical medical literature, and conducted a Meta-analysis using Rev Man 5.2 software based on the clinical risk factors of neonatal hypoglycemia. The retrieved literature was screened according to the criteria of study subjects, methods, disease type, and so on, and a total of 9 documents meeting the criteria were finally included, with low bias. The results of the Meta-analysis showed statistical differences in the incidence of pregnant and maternal gestational diabetes, neonatal asphyxia and low birth weight infants in the hypoglycaemic and non-hypoglycaemic neonatal groups, Moreover, the incidence of pregnant and maternal gestational diabetes, neonatal asphyxia, and low birth weight infants was significantly lower in the hypoglycemic neonatal group(P&lt;0.05); Studies evaluated maternal gestational diabetes, neonatal asphyxia and low birth weight infants with neonatal hypoglycemia, The results showed that maternal gestational diabetes, neonatal asphyxia, and low birth weight infants all increase the risk of neonatal hypoglycemia(P&lt;0.001). Therefore, for children with neonatal hypoglycemia, pregnant mothers and gestational diabetes, neonatal asphyxia, and low-weight children are all high-risk factors for hypoglycemia, clinicians should do a good job in prevention and control, and intervention to reduce the incidence of neonatal hypoglycemia.

Neonatal Hypoglycemia and Neurocognitive Function at School Age: A Prospective Cohort Study

To determine the relationship between transient neonatal hypoglycemia in at-risk infants and neurocognitive function at 6-7 years of corrected age. The pre-hPOD Study involved children born with at least one risk factor for neonatal hypoglycemia. Hypoglycemia was defined as ≥1 consecutive blood glucose concentrations <47 mg/dl (2.6 mmol/L), severe as <36 mg/dl (2.0 mmol/L), mild as 36 to <47 mg/dL (2.0 to <2.6 mmol/L), brief as 1 to 2 episodes, and recurrent as ≥3 episodes. At 6-7 y children were assessed for cognitive and motor function (NIH-Toolbox), learning, visual perception and behavior. The primary outcome was neurocognitive impairment, defined as >1 SD below the normative mean in ≥1 Toolbox tests. The eight secondary outcomes covered children's cognitive, motor, language, emotional-behavioral, and visual perceptual development. Primary and secondary outcomes were compared between children who did and did not experience neonatal hypoglycemia, adjusting for potential confounding by gestation, birthweight, sex and receipt of prophylactic dextrose gel (pre-hPOD intervention). Secondary analysis included assessment by severity and frequency of hypoglycemia. Of 392 eligible children, 315 (80%) were assessed at school age (primary outcome, n=308); 47% experienced hypoglycemia. Neurocognitive impairment was similar between exposure groups (hypoglycemia 51% vs. 50% no hypoglycemia; aRD -4%, 95%CI -15%, 7%). Children with severe or recurrent hypoglycemia had worse visual motion perception and increased risk of emotional-behavioral difficulty. Exposure to neonatal hypoglycemia was not associated with risk of neurocognitive impairment at school-age in at-risk infants, but severe and recurrent episodes may have adverse impacts.

Association of Fetal Catecholamines With Neonatal Hypoglycemia

Perinatal stress and fetal growth restriction increase the risk of neonatal hypoglycemia. The underlying pathomechanism is poorly understood. In a sheep model, elevated catecholamine concentrations were found to suppress intrauterine insulin secretion, followed by hyperresponsive insulin secretion once the adrenergic stimulus subsided. To determine whether neonates with risk factors for hypoglycemia have higher catecholamine concentrations in umbilical cord blood (UCB) and/or amniotic fluid (AF) and whether catecholamines are correlated with postnatal glycemia. In a prospective cohort study of 328 neonates at a tertiary perinatal center from September 2020 through May 2022 in which AF and UCB were collected immediately during and after delivery, catecholamines and metanephrines were analyzed using liquid chromatography with tandem mass spectrometry. Participants received postnatal blood glucose (BG) screenings. Risk factor for neonatal hypoglycemia. Comparison of catecholamine and metanephrine concentrations between at-risk neonates and control participants, and correlation of concentrations of catecholamines and metanephrines with the number and severity of postnatal hypoglycemic episodes. In this study of 328 neonates (234 in the risk group: median [IQR] gestational age, 270 [261-277] days; and 94 in the control group: median [IQR] gestational age, 273 [270-278] days), growth-restricted neonates showed increased UCB median (IQR) concentrations of norepinephrine (21.10 [9.15-42.33] vs 10.88 [5.78-18.03] nmol/L; P < .001), metanephrine (0.37 [0.13-1.36] vs 0.12 [0.08-0.28] nmol/L; P < .001), and 3-methoxytyramine (0.149 [0.098-0.208] vs 0.091 [0.063-0.149] nmol/L; P = .001). Neonates with perinatal stress had increased UCB median (IQR) concentrations of norepinephrine (22.55 [8.99-131.66] vs 10.88 [5.78-18.03] nmol/L; P = .001), normetanephrine (1.75 [1.16-4.93] vs 1.25 [0.86-2.56] nmol/L; P = .004), and 3-methoxytyramine (0.120 [0.085-0.228] vs 0.091 [0.063-0.149] nmol/L; P = .008) (P < .0083 was considered statistically significant). Concentrations of UCB norepinephrine, metanephrine, and 3-methoxytyramine were negatively correlated with AF C-peptide concentration (rs = -0.212, P = .005; rs = -0.182, P = .016; and rs = -0.183, P = .016, respectively [P < .017 was considered statistically significant]). Concentrations of UCB norepinephrine, metanephrine, and 3-methoxytyramine were positively correlated with the number of hypoglycemic episodes (BG concentration of 30-45 mg/dL) (rs = 0.146, P = .01; rs = 0.151, P = .009; and rs = 0.180, P = .002, respectively). Concentrations of UCB metanephrine and 3-methoxytyramine were negatively correlated with the lowest measured BG concentration (rs = -0.149, P = .01; and rs = -0.153, P = .008, respectively). Neonates at risk for hypoglycemia displayed increased catecholamine and metanephrine concentrations that were correlated with postnatal hypoglycemic episodes and lower BG levels; these results are consistent with findings in a sheep model that fetal catecholamines are associated with neonatal β-cell physiology and that perinatal stress or growth restriction is associated with subsequent neonatal hyperinsulinemic hypoglycemia. Improving the pathomechanistic understanding of neonatal hypoglycemia may help to guide management of newborns at risk for hypoglycemia.

Transitional Neonatal Hypoglycemia and Adverse Neurodevelopment in Midchildhood

The circumstances under which neonatal hypoglycemia leads to brain damage remain unclear due to a lack of long-term data on the neurodevelopment of affected children. As a result, diagnostic strategies and treatment recommendations are inconsistent. To evaluate whether the occurrence of severe transitional neonatal hypoglycemia (defined as having at least 1 blood glucose measurement of 30 mg/dL or below) is associated with adverse neurodevelopment in midchildhood. This cohort study using neurodevelopmental testing of a retrospectively recruited cohort was conducted at a single-center tertiary hospital in Germany between March 2022 and February 2023. Children with neonatal blood glucose screening data were randomly selected from all births between 2010 and 2015. Frequency matching for sex, birth weight, gestational age, socioeconomic status, and primary risk factors for neonatal hypoglycemia was performed. Children with persistent hypoglycemia diseases or any risk factor for adverse neurodevelopment except hypoglycemia were excluded. Data were analyzed between February 2023 and March 2023. At least 1 neonatal hypoglycemia measurement with blood glucose measuring 30 mg/dL or below vs all measured blood glucose levels above 30 mg/dL during postnatal blood glucose screening starting on the first day of life. Cognitive function measured by full-scale IQ test. Secondary outcomes included standardized scales of motor, visual, and executive functions, and child behavior, each measured at ages 7 to 11 years. A total of 140 children (mean [SD] age 9.1 [1.3] years; 77 male [55.0%]) participated in the study. Children with severe neonatal hypoglycemia had a 4.8 points lower mean full-scale IQ than controls (107.0 [95% CI, 104.0-109.9] vs 111.8 [95% CI, 108.8-114.8]). They showed a 4.9-fold (95% CI, 1.5-15.5) increased odds of abnormal fine motor function and a 5.3-fold (95% CI, 2.1-13.3) increased odds of abnormal visual-motor integration. Significantly higher T scores for attention problems (58.2 [95% CI, 56.1-60.2] vs 54.6 [95% CI, 52.6-56.6]) and attention-deficit/hyperactivity disorder symptoms (58.2 [95% CI, 56.2-60.2] vs 54.7 [95% CI, 52.8-56.7]) were reported by parents. Neonatal hypoglycemia with blood glucose levels of 30 mg/dL or below was associated with an increased risk for suboptimal neurodevelopmental outcomes in midchildhood. These findings imply that treatment strategies should aim to prevent episodes of hypoglycemia at these severely low levels.

Determinants of Hypoglycemia in Premature Vietnamese Infants: A Case-Control Study.

Background Premature infants are more likely to experience hypoglycemia. Early recognition and prompt therapy are essential to avoiding neurological sequelae in the future. This study aimed to identify the determinants of hypoglycemia in premature Vietnamese infants. Methodology This was a case-control study conducted at the Neonatal Intensive Care Unit, The Women and Children Hospital of An Giang, Vietnam. Hypoglycemia was defined as a plasma glucose value of less than 2.6 mmol/L (47 mg/dL) after two hours postpartum. Maternal and neonatal information was collected and analyzed. Both bivariate and multiple logistic regression models were used to identify the risk factors of neonatal hypoglycemia (NH) Results A total of 65 cases and 195 controls were included in the study. Gestational diabetes mellitus (GDM) (adjusted odds ratio [AOR] 3.78, 95% confidence interval [CI] 1.69-8.52; P< 0.001) and excessive gestational weight gain (GWG) (AOR 2.80, 95% CI1.12-6.98; P < 0.026) were associated with NH in the multiple logistic regression model. An observed positive interaction between gestational hypertension and GDM on NH yielded an odds ratio (OR) of 6.29 (95% CI2.46-16.64). Conclusions GDM, excessive GWG, andthe interaction between gestational hypertension and GDM were the determinants of hypoglycemia in premature infants.

Infants Eligible for Neonatal Hypoglycemia Screening

Neonatal hypoglycemia is common, occurring in up to 50% of infants at risk for hypoglycemia (infant of diabetic mother [IDM], small for gestational age [SGA], large for gestational age [LGA], and preterm) and is associated with long-term neurodevelopmental impairment. Guidelines recommend screening infants at risk of hypoglycemia. The proportion of infants who require screening for neonatal hypoglycemia is unknown. To determine the proportion of infants eligible for neonatal hypoglycemia screening using criteria from the highest-scoring critically appraised clinical guideline. This systematic review of the literature was conducted to identify clinical practice guidelines for neonatal hypoglycemia and took place at a tertiary maternity hospital in Auckland, New Zealand. Eligible guidelines were critically appraised using the Appraisal of Guidelines for Research and Evaluation II tool. Using screening criteria extracted from the highest-scoring guideline, the proportion of infants eligible for neonatal hypoglycemia screening was determined in a retrospective observational cohort study of infants born January 1, 2004, to December 31, 2018. Data were analyzed by logistic regression. Infant participants were included if gestational age was 35 weeks or more, birth weight was 2000 g or more, and they were not admitted to a neonatal intensive care unit less than 1 hour after birth. The data were analyzed from November 2022 through February 2023. A total of 101 372 infants met the inclusion criteria. Risk factors for neonatal hypoglycemia. Proportion of infants eligible for neonatal hypoglycemia screening. The study team screened 2366 abstracts and 18 guidelines met inclusion criteria for appraisal. There was variability in the assessed quality of guidelines and a lack of consensus between screening criteria. The highest-scoring guideline defined screening criteria as: IDM, preterm (less than 37 weeks' gestation), SGA (less than 10th percentile), birth weight of less than 2500 g or more than 4500 g, LGA (more than 90th percentile), or gestational age more than 42 weeks. A total of 101 372 infants met criteria for inclusion in the cohort study; median (IQR) gestational age was 39 (38-40) weeks and 51% were male. The overall proportion of infants eligible for screening was 26.3%. There was an increase in the proportion of eligible infants from 25.6% to 28.5% over 15 years, which was not statistically significant after adjustment for maternal age, body mass index, ethnicity, and multiple pregnancy (odds ratio, 0.99; 95% CI, 0.93-1.03; change in proportion per year). A systematic review found that practice guidelines providing recommendations for clinical care of neonatal hypoglycemia were of variable quality with is a lack of consensus regarding definitions for infants at risk for hypoglycemia. In the cohort study, one-quarter of infants were eligible for hypoglycemia screening. Further research is required to identify which infants may benefit from neonatal hypoglycemia screening.

Analysis of risk factors of neonatal hypoglycemia and its correlation with blood glucose control of gestational diabetes mellitus: A retrospective study.

This study aimed to investigate the risk factors associated with neonatal hypoglycemia and its correlation with blood glucose control in patients with gestational diabetes mellitus (GDM). This study was a retrospective study. 880 pregnant women with GDM and their newborns were hospitalized from January 2018 to December 2022 in our hospital. The clinical information of GDM pregnant women and their newborns were reviewed and the hemoglobin A1c (HbA1c) values measured within 1 week before delivery were collected. According to the occurrence of neonatal hypoglycemia, which was divided into the control and observation groups. Logistic regression model was used to estimate the potential factors associated with neonatal hypoglycemia. The association between HbA1c of pregnant women before delivery and abnormal glucose metabolism in newborns was examined using spearman correlation analysis. A total of 104 cases of hypoglycemia occurred in neonates delivered by 880 GDM women and the incidence of neonatal hypoglycemia was 11.82%. There were significant differences in pre-pregnancy overweight or obesity, delivery mode, maternal blood sugar control effect and neonatal feeding standard between the 2 groups of GDM women (P < .05). Pre-pregnancy overweight or obesity, poor blood sugar control in GDM women, and improper neonatal feeding were risk factors for neonatal hypoglycemia. The results of logistic regression analysis showed that abnormal glucose metabolism in newborn (odds ratio [OR]: 2.43, 95% confidence interval [CI]: 1.12-4.73) and neonatal hypoglycemia (OR: 3.04, 95% CI: 1.33-5.79) were a risk factor. We also conducted the logistic analysis to evaluate the correlation between HbA1c before delivery and abnormal glucose metabolism in newborns of pregnant women with GDM through adjusting some potential factors. The results were still significant in the abnormal glucose metabolism in newborn (OR: 2.84, 95% CI: 1.23-6.63) and neonatal hypoglycemia (OR: 3.64, 95% CI: 1.46-8.18). Overweight or obesity of GDM parturient before pregnancy, poor blood glucose control of GDM parturient and improper feeding of newborns are all risk factors for neonatal hypoglycemia. HbA1c before delivery has a certain predictive value for abnormal glucose metabolism in newborns.

Clinical Profile and Risk Factors of Neonatal Hypoglycemia in Tertiary Care Teaching Hospital

Introduction: Hypoglycemia is a frequent metabolic problemin the nursery and neonatal intensive care unit.1 The majority ofincidents of neonatal hypoglycemia are transient and representtypical glucose metabolism. Also, hypoglycemia signs maymatch those of various newborn illnesses. The aim of the studywas to evaluate the clinical profile and risk factors of neonatalhypoglycemia in neonatal admitted to a tertiary care teachinghospital.Materials and Methods: It was a prospective hospital-basedstudy conducted in the Pediatric unit of Shri Ram Murti SmarakInstitute of Medical Sciences, Bareilly, which is a tertiary careteaching hospital of the Rohilkhand region. All neonates wereadmitted to the Pediatric Department and bedside glucoselevels &lt;40 mg/dl were included. Initial blood glucose levelswere checked by glucometer in all neonates within 2 hoursof admission and once daily thereafter. Repeat testing wasdone whenever it was clinically indicated (lethargy, refusal tofeed or new onset seizures) and in neonates with documentedhypoglycemia at 2nd, 6th, 12th, 24th, 48th and 72nd hours of initialepisode and management.Results: The development of hypoglycemia was seen in babiesborn to mothers who had diabetes mellitus or gestationaldiabetes at a rate of 42.27%, eclampsia at a rate of 10.31%,and mode of delivery at a rate of 21.65% in the category ofmaternal risk factors. The prevalence of SGA (49.48%) was thefactor that was related with hypoglycemia the most frequently.Lethargy (49.49%), jitteriness (47.42%), and seizures (42.27%)were the most prevalent manifestations found in infants whohad the clinical presentation of hypoglycemia. Cyanosis wasnot observed in any neonate with hypoglycemia.Conclusion: Hypoglycemia is the most preventable metaboliccondition in neonates. The result showed that LBW, SGA,LGA, IDM/IGDM, newborns with respiratory distress, sepsis,hypothermia, and neonates with delayed and infrequent feedinghad an increased risk of hypoglycemia. The most commonpresentation was lethargy, jitteriness and seizures amongthese neonates.

Prevalence and Associated Risk Factors of Neonatal Hypoglycemia in Iran: A Systematic Review and Meta-Analysis

Background: Neonatal hypoglycemia is the most common metabolic abnormality affecting newborns and contributes to increased morbidity and mortality. Objectives: The present systematic review and meta-analysis aim to explore the prevalence and risk factors associated with neonatal hypoglycemia in Iran. Methods: A systematic search was performed in Iranian and international databases, including SID, MagIran, Barakat Knowledge Network System, PubMed, Scopus, Web of Science, and the Google Scholar search engine searched for relevant articles using valid keywords. The search process was updated until September 28, 2021. Data were analyzed using STATA 14 software, and the significance level for all tests was considered P&lt;0.05. Results: In 14 reviewed articles with a sample size of 18217, the prevalence of hypoglycemia in Iranian newborns was 29% [95%CI: 21%, 37%, P=0.0001] (64% in boys and 37% in girls). The hypoglycemia prevalence was 67% in infants born via cesarean section compared to 24% in vaginally delivered infants. The lowest and highest prevalence of neonatal hypoglycemia was observed in Mashhad (12%) and Arak (53%), respectively. The most common risk factors for neonatal hypoglycemia in Iran were infant prematurity (61%), septicemia (45%), respiratory distress syndrome (RDS) (26%), small for gestational age (SGA) (26%), maternal diabetes (21%), hypocalcemia (19%), intrauterine growth restriction (IUGR) (9%) and perinatal asphyxia (8%). Conclusions: Neonatal hypoglycemia is very common in Iran, affecting nearly one-third of Iranian newborns. The prevalence of hypoglycemia in boys was almost twice as high as that in girls and 2.5 times higher in infants born by cesarean section than in infants delivered vaginally. Furthermore, prematurity was reportedly the most common risk factor for neonatal hypoglycemia in Iran.

Risk factors of neonatal hypoglycemia in neonates born to mothers with gestational diabetes.

Hypoglycemia is one of the most significant problems in neonates born to mothers with gestational diabetes (GDM). This study aimed to identify novel predictors of hypoglycemia in neonates born to mothers with GDM. A total of 443 term singleton infants from mothers diagnosed with GDM and cared for at Keio University Hospital between January 2013 and December 2019 were included in this study. Neonatal hypoglycemia was defined as hypoglycemia of less than 47 mg/dL at 1 or 2 or 4 h after birth, according to previous studies. Among 443 full-term singleton neonates born to mothers with GDM, 200 developed hypoglycemia (45%). Gestational weight gain (GWG), HbA1c at 1st trimester, HbA1c at GDM diagnosis, and the incidence of insulin therapy in the neonatal hypoglycemia group were significantly higher than those in the non-neonatal hypoglycemia group (p = 0.016, p = 0.032, p = 0.011, and p = 0.017, respectively). Regarding the multiple regression analysis adjusted for nulliparity, GWG, and gestational weeks at delivery, the odds ratio for maternal HbA1c ≥5.2% at 1st trimester was 1.63 (p = 0.034), and maternal insulin therapy during pregnancy was 1.72 (p = 0.015). In conclusion, HbA1c in the 1st trimester and insulin therapy during pregnancy were good predictors of hypoglycemia in neonates born to GDM mothers, especially when their HbA1c was 5.2% or more. Further research will be necessary to improve the perinatal management of hypoglycemia.

Risk of hypoglycemia by anthropometric measurements in neonates of mothers with diabetes

Macrosomia in neonates of diabetic women is a risk factor for neonatal hypoglycemia, with an over-risk for asymmetric macrosomia. This study aimed to study the association between anthropometric measurements and hypoglycemia in neonates of mothers treated for gestational diabetes. This is a secondary analysis of the INDAO trial study conducted between May 2012 and November 2016 in 13 French tertiary care university hospitals in 890 pregnant women with gestational diabetes treated with either insulin or glyburide. Neonatal anthropometric measurements were birthweight and weight-length ratio (WLR, defined as birth weight/length). Neonatal hypoglycemia was defined as capillary blood glucose below 36mg/dL (2mmol/L) or below 45mg/dL (2.5mmol/L) associated with clinical signs after 2h of life. Their relationships were modeled with logistic regressions using fractional polynomials. Extreme categories of birthweight or WLR adjusted for gestational age at birth and sex were defined as Z-score < -1.28 or > 1.28. These categories were compared to Z-score between -1.28 and 1.28 by estimating odds ratios and confidence intervals for neonatal hypoglycemia. Neonatal hypoglycemia occurred in 9.1% of cases. The relationship between birthweight and WLR Z-scores and neonatal risk of hypoglycemia adjusted for maternal treatment was a U-shaped curve. Adjusted odds ratios for the risk of hypoglycemia were 9.6 (95% CI 3.5, 26.8) and 2.3 (95% CI 1.1, 4.9) for WLR Z-score below -1.28 and above 1.28, respectively, compared with WLR Z-score between -1.28 and 1.28. Conclusion: Birthweight Z-score was associated with the risk of neonatal hypoglycemia in neonates from mothers treated for gestational diabetes. The risk of neonatal hypoglycemia was increased for both extreme birthweight Z-scores, regardless of maternal treatment. Small for gestational age neonates of diabetic mothers require special attention for the risk of neonatal hypoglycemia. What is Known: • Macrosomia in neonates of diabetic women is a risk factor for neonatal hypoglycemia, with an over-risk for asymmetric macrosomia. Few retrospective studies have assessed the risk for neonatal hypoglycemia among small for gestational age neonates born to diabetic mothers. What is New: • The risk of neonatal hypoglycemia among neonates of diabetic mothers increased for both low and high weight-length ratio, regardless of maternal medicinal treatment, gestational age at birth, and sex of the newborn.

Cross-cultural validity and reliability of the BRIEF-P at age 2 and 4.5 years in children born at risk of neonatal hypoglycemia

ABSTRACT Executive function (EF) encompasses several neurocognitive processes that are important in self-regulation of behavior and the attainment of social and cognitive competencies. While much progress has been made in developing valid measures for adult and adolescent EF, there is a dearth of valid measures for preschool children. Given the steep trajectory of neuropsychological development among this age group and the importance of EF, a valid measure for clinical assessment and research is needed that can capture EF in the everyday context of early childhood. The Behavior Rating Inventory of Executive Function Preschool Version (BRIEF-P) measures parent and teacher observations of children’s everyday self-regulatory behaviors. The BRIEF-P has been validated in a range of normative and non-normative samples, but further validation is needed across cultures. This study aimed to evaluate the cross-cultural validity and reliability of the BRIEF-P when used by New Zealand Māori (n = 131) and European (n = 193) parents of children born with risk factors of neonatal hypoglycemia. Parents of children who participated in the prospective, longitudinal Children with Hypoglycemia and their Later Development (CHYLD) study completed the BRIEF-P when the child was 2 years ±4 weeks and 4.5 years ±8 weeks old. Results showed that the BRIEF-P is a highly reliable and valid instrument. Comparisons between Māori and New Zealand European samples revealed biases, which could be a source of further work to improve the construct validity of this measure, such as the development of norms and item validation for non-European and non-Western samples.

A cross-sectional study on the frequency and risk factors for neonatal hypoglycemia in babies born in rural Kerala.

Glucose is the main source of energy for the developing brain. Hypoglycemia is a commonly encountered and treatable problem in the neonatal period. The newborn baby should be breastfed soon after delivery and continued on demand breastfeeding. As families become nuclear, mothers may not have the necessary skills and knowledge about the importance of exclusive breastfeeding. Health care workers play an important role in preparing the mothers for exclusive breastfeeding and ensuring that the newborn remains euglycemic. Problems encountered during breastfeeding should be corrected on an individual basis, and uninterrupted feeding should be ensured as per BFHI guidelines. To find out the frequency and risk factors of hypoglycemia and its relation to feeding in babies of GDM mothers, large for gestational age, and small for gestational age babies in a baby-friendly hospital adhering to the BFHI guidelines. A single-center, observational study was carried out among 160 consecutively born babies born to mothers with gestational diabetes, large for gestational age and small for gestational age for a period of one year from October 2018 to September 2019. Data was collected using an interviewer administered proforma and from antenatal and postnatal records. Glucose monitoring was done and values were recorded. Data was analysed using SPSS software. Qualitative data was expressed as percentage. and quantitative data was expressed as mean and standard deviation. Association with risk factors was studied using the Chi-squared test. The overall incidence of hypoglycemia was 15.3% in our study. The main risk factors identified were prematurity and small for gestational age. Maximum incidence of hypoglycemia was noted in the first 24 hours after birth. Incidence of hypoglycemia in exclusively breastfed babies was only 10.5% compared to those on formula feeds where breastfeeding was contraindicated due to medical reasons and where the incidence was found to be 33.3%. Incidence of hypoglycemia was 50%. The most common symptoms of hypoglycemia were jitteriness and poor feeding. Eleven per cent of babies had asymptomatic hypoglycemia. In babies detected to have hypoglycemia, prompt treatment with oral feeds or intravenous (IV) dextrose was started. There was no mortality in the study population. Incidence of hypoglycemia was maximum in the first hour of life, highlighting the need to start early feeds and to do meticulous monitoring in high-risk babies like pre-term babies, small for gestational age, large for gestational age and babies of diabetic mothers. The incidence of hypoglycemia in exclusively the breastfed group was 10.5%. This showed that confident and successful breastfeeding with the support of health care staff should be the norm to prevent hypoglycemia, and preparation for breastfeeding should begin right from the antenatal period.

Neonatal Hypoglycemia After Antenatal Late Preterm Steroids

Compared to term infants, late preterm infants have a higher risk of morbidity. Intramuscular betamethasone (BMZ) has been shown to decrease neonatal respiratory distress but has been associated with neonatal hypoglycemia. This study sought to determine clinical risk factors for neonatal hypoglycemia after administration of antenatal late preterm steroids (ALPS). A secondary analysis was performed to assess outcomes associated with partial dose ALPS.

Challenges in management of transient hyperinsulinism- a retrospective analysis of 36 severely affected children.

Transient hyperinsulinism (THI) is a hypoglycemia disorder which resolves spontaneously within the first weeks or months of life. The pathomechanism of THI is not elucidated yet; however, it is known that perinatal stress predisposes for THI. We aimed to characterize the clinical phenotype and treatment of children with THI, and to identify options for improved management. A retrospective analysis of 36 children with THI treated at the University Children's Hospital Düsseldorf between 2007 and 2019 was performed. All children had risk factors for neonatal hypoglycemia or indicators of perinatal stress. Eighty three percent were diagnosed with hypoglycemia on day of life (DOL)1. None of the six diagnosed later had routine blood glucose screening and showed significantly lower blood glucose levels at the time of first blood glucose measurement compared to the children diagnosed on DOL1. Ninety seven percent of all children received intravenous glucose, 42% received continuous glucagon and 81% were started on diazoxide. Diazoxide withdrawal and subsequent fasting tests lacked standardization and were based on clinical experience. Three patients had a subsequent episode of hypoglycemia, after fasting studies only demonstrated "clinical" remission without proving the ability to ketogenesis. Any kind of perinatal stress might pose a risk to develop THI, and postnatal monitoring for hypoglycemia still needs to be improved. Diazoxide is effective in children with THI; however, further studies are needed to guide the development of criteria and procedures for the initiation and discontinuation of treatment. Furthermore, establishing consensus diagnostic criteria/definitions for THI would improve comparability between studies.

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.

Incidence and Risk Factors of Neonatal Hypoglycemia During the First 48 Hours of Life in a Tertiary Level Hospital

Neonatal hypoglycemia is one of the common metabolic problems causing neonatal mortality and neurodevelopmental impairments. In developing countries, where the classic risk factors for neonatal hypoglycemia prevail; understanding the prevalence and association of hypoglycemia in different settings is essential. Our aim of this study was to identify the incidence and associated risk factors that predicted the occurrence of neonatal hypoglycemia during the first 48 hours of life. This hospital-based prospective case-control study was undertaken in the Department of Pediatrics in Faridpur Medical College Hospital, Bangladesh; from June 1, 2019 to July 31, 2019. Blood glucose levels of all the admitted newborns were noted on two occasions at 24 hours apart. Hypoglycemic neonates were selected as case and 3 euglycemic neonates for each case with similar age and sex were selected as control. Clinical characteristics of the mother and the baby were analyzed statistically in relation to the occurrence of hypoglycemia. We have found the incidence of neonatal hypoglycemia was 17.2%. Prematurity, low birth weight, small and large for gestational age, perinatal asphyxia, hypothermia, and delay in the initiation of breast feeding were significant neonatal factors. Maternal factors such as gestational diabetes mellitus, eclampsia, and fever during delivery had strong association as well. Understanding the incidence and risk factors may help prompt identification of hypoglycemic baby may also help to take early and effective measures to prevent the sequels of neonatal hypoglycemia.&#x0D; Faridpur Med. Coll. J. Jan 2020;15(1): 12-15

Impact of Maternal HbA1c Levels ≤6% and Race in Nondiabetic Pregnancies on Birthweight and Early Neonatal Hypoglycemia

To evaluate whether pregnancy glycated hemoglobin (HbA1c) levels of ≤6% and maternal race impacts neonatal hypoglycemia and birthweight, and whether diabetes and beta blocker use during pregnancy additively impacts neonatal outcomes. Retrospective chart review of 4769 infants born at ≥34weeks; 21 482 glucose measurements were assessed. Predefined groups were infants born to mothers without documented pregnancy conditions (group N), prenatal exposure of beta blockers (group B), diabetes (group D), or both (group DB). In group N, both in Caucasian (Caucasian, n=1756; β=2.6, P<.001) and African American (n=1872; β=2.2, P=.002) race, there was a direct relationship between pregnancy HbA1c levels and birthweight. HbA1c (aOR 1.8; 95% CI [1.3-2.5]) levels, maternal race, prematurity, cesarean delivery, and birth weight predicted hypoglycemia. Each 0.1% increase in HbA1c levels between 4.8 and 6 increased the odds of neonatal hypoglycemia by 6.4% in African American (β 0.62, SE 0.22, P=.01) and by 12.0% in Caucasian (β 1.13, SE 0.23 P<.001) population. The odds of neonatal hypoglycemia were 1.7 (group B), 2.1 (group D), and 3.1 (group DB) times higher compared with group N. Pregnancy HbA1c levels between 4.8% and 6.0% considered acceptable during pregnancy impacts neonatal hypoglycemia and birthweight especially in Caucasian race. A third trimester HbA1c >5.2 is a potential risk factor for neonatal hypoglycemia, especially in preterm infants. Although we report new findings on the relationship between maternal HbA1c levels and neonatal outcomes, a prospective study is required to validate our findings and determine "optimal" HbA1C levels during pregnancy.