Risk Factors for Neonatal Hypoglycemia Following Exposure to Antenatal Corticosteroids [14D]

Objectives: Recurrent episodes of neonatal hypoglycemia are strongly associated with long termphysical and neuro-developmental deficits. (1) Moreover in neonates hypoglycemia can be overlooked as it may havenonspecific symptoms only. (2) This study was therefore carried out to analyse the risk factors associated with neonatalhypoglycemia and to evaluate the risk factors which have predictive value in its diagnosis. .Design: Based case controlstudy. Period: Six months from January 2005 to June 2005. Setting CMH Pano Aqil. Material and Methods: 385newborns were studied. Newborns of both civilians as well as military personnel were included in the study. 11newborns were excluded. Out of remaining 347 patients 101 were found to be hypoglycemia. Five risk factors (low birthweight, Birth Asphyxia, Neonatal sepsis, Meconeum aspiration syndrome delayed feeding ) strongly and independentlypredicated the risk of hypoglycemia. Results: The most common associated risk factor was low birth weight (47.47%)followed by delayed feeding (46.29%). Blood sampling for glucose estimation was done at birth / admission at 6 hours,12 hours, 24 hours and 48 hours. Test was initially performed by glucometer, the reading which were confirmed bylaboratory testing in border line case. Conclusions: In neonates with associated risk factors it is cost affective to carryout blood glucose levels at the time of birth and follow up readings taken as indicated by clinical progress later on.

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Development and Validation of a Prediction Rule for Growth Hormone Deficiency Without Need for Pharmacological Stimulation Tests in Children With Risk Factors

Frontiers in Endocrinology ◽

10.3389/fendo.2020.624684 ◽

2021 ◽

Vol 11 ◽

Author(s):

Florencia Clément ◽

Romina P. Grinspon ◽

Daniel Yankelevich ◽

Sabrina Martín Benítez ◽

María Carolina De La Ossa Salgado ◽

...

Keyword(s):

Risk Factors ◽

Growth Hormone ◽

Anterior Pituitary ◽

Growth Failure ◽

Prediction Rule ◽

Hormone Deficiency ◽

Neonatal Hypoglycemia ◽

Cranial Radiotherapy ◽

Stimulation Tests ◽

Sellar Tumor

IntroductionPractice guidelines cannot recommend establishing a diagnosis of growth hormone deficiency (GHD) without performing growth hormone stimulation tests (GHST) in children with risk factors, due to the lack of sufficient evidence.ObjectiveOur goal was to generate an evidence-based prediction rule to diagnose GHD in children with growth failure and clinically identifiable risk factors.MethodsWe studied a cohort of children with growth failure to build the prediction model, and a second, independent cohort to validate the prediction rule. To this end, we assessed the existence of: pituitary dysgenesis, midline abnormalities, (supra)sellar tumor/surgery, CNS infection, traumatic brain injury, cranial radiotherapy, chemotherapy, genetic GHD, pituitary hormone deficiencies, and neonatal hypoglycemia, cholestasis, or hypogenitalism. Selection of variables for model building was performed using artificial intelligence protocols. Specificity of the prediction rule was the main outcome measure in the validation set.ResultsIn the first cohort (n=770), the resulting prediction rule stated that a patient would have GHD if (s)he had: pituitary dysgenesis, or two or more anterior pituitary deficiencies, or one anterior pituitary deficiency plus: neonatal hypoglycemia or hypogenitalism, or diabetes insipidus, or midline abnormalities, or (supra)sellar tumor/surgery, or cranial radiotherapy ≥18 Gy. In the validation cohort (n=161), the specificity of the prediction rule was 99.2% (95% CI: 95.6–100%).ConclusionsThis clinical rule predicts the existence of GHD with high specificity in children with growth disorders and clinically identifiable risk factors, thus providing compelling evidence to recommend that GHD can be safely diagnosed without recurring to GHST in neonates and children with growth failure and specific comorbidities.

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Vaginal Delivery and Low Gestational Age are Key Risk Factors for Hypernatremia in Neonates < 32 Weeks

Klinische Pädiatrie ◽

10.1055/a-1443-6208 ◽

2021 ◽

Author(s):

Nadia S. Eugster ◽

Florence Corminboeuf ◽

Gilbert Koch ◽

Julia E. Vogt ◽

Thomas Sutter ◽

...

Keyword(s):

Risk Factors ◽

Birth Weight ◽

Vaginal Delivery ◽

Gestational Age ◽

Preterm Neonates ◽

Multiple Birth ◽

Plasma Sodium ◽

Delivery Mode ◽

Antenatal Corticosteroids ◽

Clinical Complications

Abstract Background Preterm neonates frequently experience hypernatremia (plasma sodium concentrations >145 mmol/l), which is associated with clinical complications, such as intraventricular hemorrhage. Study design In this single center retrospective observational study, the following 7 risk factors for hypernatremia were analyzed in very low gestational age (VLGA, below 32 weeks) neonates: gestational age (GA), delivery mode (DM; vaginal or caesarian section), sex, birth weight, small for GA, multiple birth, and antenatal corticosteroids. Machine learning (ML) approaches were applied to obtain probabilities for hypernatremia. Results 824 VLGA neonates were included (median GA 29.4 weeks, median birth weight 1170 g, caesarean section 83%). 38% of neonates experienced hypernatremia. Maximal sodium concentration of 144 mmol/l (interquartile range 142–147) was observed 52 hours (41–65) after birth. ML identified vaginal delivery and GA as key risk factors for hypernatremia. The risk of hypernatremia increased with lower GA from 22% for GA ≥ 31–32 weeks to 46% for GA < 31 weeks and 60% for GA < 27 weeks. A linear relationship between maximal sodium concentrations and GA was found, showing decreases of 0.29 mmol/l per increasing week GA in neonates with vaginal delivery and 0.49 mmol/l/week after cesarean section. Sex, multiple birth and antenatal corticosteroids were not associated hypernatremia. Conclusion VLGA neonates with vaginal delivery and low GA have the highest risk for hypernatremia. Early identification of neonates at risk and early intervention may prevent extreme sodium excursions and associated clinical complications.

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

Tropical Medicine and Health ◽

10.1186/s41182-020-00275-y ◽

2020 ◽

Vol 48 (1) ◽

Author(s):

David Mukunya ◽

Beatrice Odongkara ◽

Thereza Piloya ◽

Victoria Nankabirwa ◽

Vincentina Achora ◽

...

Keyword(s):

Risk Factors ◽

Blood Glucose ◽

Cross Sectional Study ◽

Northern Uganda ◽

Sectional Study ◽

Neonatal Hypoglycemia ◽

Community Based ◽

Cross Sectional ◽

Factors Associated ◽

Child Age

Abstract Background Neonatal 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. Objective To determine the prevalence and risk factors for neonatal hypoglycemia in Lira District, Northern Uganda. Methods This 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. Results We 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]. Conclusion The 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.

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The association of antenatal corticosteroids with neonatal hypoglycemia and hyperbilirubinemia

The Journal of Maternal-Fetal & Neonatal Medicine ◽

10.3109/14767058.2013.832750 ◽

2013 ◽

Vol 27 (7) ◽

pp. 683-686 ◽

Cited By ~ 16

Author(s):

Kate E. Pettit ◽

Susan H. Tran ◽

Erin Lee ◽

Aaron B. Caughey

Keyword(s):

Neonatal Hypoglycemia ◽

Antenatal Corticosteroids

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Risk factors for patent ductus arteriosus in preterm neonates

Paediatrica Indonesiana ◽

10.14238/pi54.3.2014.132-6 ◽

2014 ◽

Vol 54 (3) ◽

pp. 132 ◽

Cited By ~ 1

Author(s):

Novia Bernati ◽

Ria Nova ◽

Julniar M. Tasli ◽

Theodorus Theodorus

Keyword(s):

Risk Factors ◽

Birth Weight ◽

Patent Ductus Arteriosus ◽

Ductus Arteriosus ◽

Prevalence Ratio ◽

Hyaline Membrane Disease ◽

Preterm Neonates ◽

Antenatal Corticosteroids ◽

Cross Sectional ◽

Patent Ductus

Background The reported prevalences of patent ductus arteriosus(PDA) in preterm neonates vaty, and are currently unknown inPalembang. Birth weight, ges tational age, asphyxia, histoty ofantenatal steroid use, hyaline membrane disease (HMD), raceand ethnicity, are potential risk factors for PDA.Objective To determine the prevalence of PDA and its riskfactors in preterm neonates at Mohammad Hoesin Hospital,Palembang.Methods This cross-sectional study was conducted from October2011 to April 2012. Echocardiographic examinations wereperformed on 242 preterm neonates aged 15 hours to 7 days. Datawas taken from medical records and interviews, and analyzed byChi square and logistic regression analyses.Results Patent ductus arteriosus was found in 142 (58.7%)preterm neonates with a prevalence ratio of 1.43. Neonates withbirthweight ::;;2,000 grams tended to have 1.9 (95% CI 1.17 to3.32) rimes higher risk for PDA (P=0.01). Neonates ::;;JO weeksgestation were also at 1.9 rimes higher risk for PDA (P=0.16).Probabilities for PDA occurrence in neonates with asphyxia,without antenatal corticosteroids and HMD were 1.6 (95%CI 1.13 to 3.36) rimes, 1.3 (95%CI 0.73 to 2.50) times and 2.2(95%CI 1.29 to 3.72) rimes higher risk for PDA, respectively(P=0.22, 0.41, and 0.005, respectively).Conclusion Birth weight and HMD are statistically significantrisk factors of PDA, but the more significant one is HMD.

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Evaluation of Risk Factors and Approach to Screening for Asymptomatic Neonatal Hypoglycemia

Neonatology ◽

10.1159/000520512 ◽

2021 ◽

pp. 1-7

Author(s):

Christopher T. Cummings ◽

Victor Ritter ◽

Sherri LeBlanc ◽

Ashley G. Sutton

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Data Extraction ◽

Care Center ◽

Strong Association ◽

Tertiary Care ◽

Neonatal Hypoglycemia ◽

Screening Protocol ◽

Severe Degree ◽

Intravenous Dextrose

Introduction: Protocols to identify asymptomatic neonatal hypoglycemia (NH) rely on the presence of established risk factors (late preterm gestation, large or small for gestational age, and infant of a diabetic mother) for inclusion. We analyzed the performance of these risk factors in identifying hypoglycemia in modern practice, and additionally evaluated the optimal duration of screening blood glucose measurements. Methods: We analyzed a retrospective cohort of 830 infants with 1 or more known risk factor(s) for NH admitted to the mother-baby unit of a single tertiary-care center from May 2017 to April 2018. Manual chart review was performed for data extraction and confirmation of risk factor(s). Infants were excluded if glucose measurements were obtained for any reason other than screening for asymptomatic NH. Results: Of the 830 included infants, 31 (3.7%) ultimately received intravenous dextrose (IVD). Most screened infants (n = 510, 61.4%) did not develop hypoglycemia. None of the established risk factors showed strong association with hypoglycemia. Cesarean delivery was associated with hypoglycemia, although not strongly. All infants who received IVD for feeding-refractory hypoglycemia were identified by the first 2 measurements with nearly all (30/31, 97%) identified at the initial measurement. Conclusions: Currently accepted risk factors are limited in their ability to identify infants who subsequently develop hypoglycemia, and as a result, most screened infants do not develop hypoglycemia. The majority of infants in our cohort who did develop hypoglycemia achieved normoglycemia with feeding-based interventions and did not require IVD. Those that received IVD were more likely to develop hypoglycemia early and to a more severe degree. Together, our data suggest further refinement of protocol duration and risk factors utilized for screening as potential areas of screening protocol optimization.

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Early neonatal hypoglycemia: incidence of and risk factors. A cohort study using universal point of care screening

The Journal of Maternal-Fetal & Neonatal Medicine ◽

10.1080/14767058.2017.1391781 ◽

2017 ◽

Vol 32 (5) ◽

pp. 786-792 ◽

Cited By ~ 7

Author(s):

Ruben Bromiker ◽

Assaf Perry ◽

Yair Kasirer ◽

Sharon Einav ◽

Gil Klinger ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Point Of Care ◽

Neonatal Hypoglycemia

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Changes in Neonatal Morbidity and Neonatal Care Practices of Infants Born Very Preterm in the Netherlands in the 1980s and 2000s

10.21203/rs.3.rs-627101/v1 ◽

2021 ◽

Author(s):

Reka Sexty ◽

Sylvia van der Pal ◽

Sijmen A. Reijneveld ◽

Dieter Wolke ◽

Guido Lüchters ◽

...

Keyword(s):

Risk Factors ◽

The Netherlands ◽

Neonatal Morbidity ◽

Neonatal Care ◽

Multiple Birth ◽

Antenatal Corticosteroids ◽

Maternal Characteristics ◽

Very Preterm ◽

Perinatal Data ◽

Care Practices

Abstract This study evaluates changes in neonatal morbidity and care practices of very preterm (VP) infants born in the Netherlands in the 1980s and 2000s and analyzes whether these changes were associated with infant and maternal characteristics, risk factors during pregnancy, and obstetrical outcomes.The community-based cohorts of POPS (1983) and LOLLIPOP (2002-03) provided perinatal data for the study. The analysis enrolled 1,228 participants born VP (before 32 weeks of gestation) and survived to 2 years of age. In 2003, mothers were on average 3.3 years older when giving birth than in 1983. Multiple birth rates increased by 50% and significantly more parents had higher education. Prevalence of severe IVH and sepsis decreased in VP infants between 1983 and 2003. LOLLIPOP infants received more often continuous positive airway pressure (CPAP), mechanical ventilation, and caffeine therapy than POPS infants. Antenatal corticosteroids and surfactant therapy were introduced only in the LOLLIPOP cohort. In 2002-03, length of stay in the NICU was reduced by 57% in LOLLIPOP (median 16 days) compared to POPS (median 38 days). LOLLIPOP infants also spent 11 days less total time in hospital after birth (median 54 days). This is a reduction of 17% compared to POPS (median 65 days). Differences persisted after adjustment for infant and maternal characteristics, risk factors during pregnancy, and obstetrical outcomes.Conclusions: Infant and mother characteristics changed considerably as well as obstetric and neonatal care practices. Outcomes of several severe neonatal morbidities improved. Length of NICU and hospital stay were significantly shorter in the 2000s.

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