Neonatal hypoglycemia in children with risk factors

Objective: The analysis of clinical-laboratory peculiarities and the dynamics of glycemia clarifying the terms of blood glucose stabilization during the early neonatal period in children having risk factors of the development of such state.Methods: Open, retrospective , continuous, single-center study was conducted. It was aimed at getting preliminary data that is important for planning further tactics of examining newborns having risk factors on hypoglycemia development (kids having large body weight at birth, children whose mothers have diabetes, newborns having intrauterine growth retardation).The target group of the survey included 522 newborns of both genders in the early neonatal period (from 0 to 7 days of life).Results: There is data on the frequency of first indicated hypoglycemia in newborns having risk factors of the development of such state, clinicallaboratory peculiarities, the dynamics of glycemia during early neonatal period, and also the period of blood glucose stabilization (the age of reaching normoglycemia). Neonatal hypoglycemia was detected in 40.2% of examined children. Laboratory manifestation during the first day of life was noticed 62.9% of cases with the further normalization of glucose level in blood in 24 hours in 73.3% of newborns. Significant reduction of blood glucose was observed in 54.8% of cases requiring hypoglycemia therapy with parenteral prescription of 10% glucose solution. Hypoglycemia jugulated against oral correction of 5% glucoses solution in 40.5 % of cases. 4.8% of children got the level of glucose stabilized after introduction of supplementary feeding.Conclusion: The results of the newborns having risk factors on hypoglycemia development (kids having large body weight at birth, children whose mothers have diabetes, newborns having intrauterine growth retardation) examinations are presented. The peculiarities of neonatal hypoglycemia are: the absence of a typical clinical symptoms among 89% of children. Asymptomatic course of hypoglycemia confirms the importance and necessity of glycemia monitoring in the early neonatal period in order to conduct timely and adequate therapy.

Role of the fetal pancreas size in prediction of early neonatal hypoglycemia in maternal diabetes mellitus

Введение. Поджелудочная железа (ПЖ) плода играет роль в регуляции гликемии как у плода, так и у матери. Гипергликемия матери, независимо от типа сахарного диабета (CД) сопровождается гипергликемией у плода. Напряжение функции ПЖ плода обусловливает компенсаторное увеличение eё размеров, формирование фетальной гиперинсулинемии и развитие в первые часы жизни неонатальной гипогликемии. Клинические симптомы гипогликемии присутствуют в 25-33% случаев, частота лабораторной гипогликемии - в 21-60%. Цель - оценка прогностического значения увеличения размеров ПЖ плода накануне родов в качестве предиктора неонатальной гипогликемии при CД у матери. Методика. Проведена ультразвуковая морфометрия ПЖ у 241 беременной c CД (основная группа) и у 427 здоровых беременных (контрольная группа). В основной группе у 141 (58,5%) беременной родились дети c признаками диабетической фетопатии (ДФ). Оценивались размеры ПЖ плода. У новорождённых оценивалась гликемия в динамике в 1-e и 3-и сут жизни. Проведён ретроспективный корреляционный анализ размеров поджелудочной железы плода и характер гликемии новорожденных в 1-e и 3-и cут жизни. Результаты. Выявлена отрицательная корреляция толщины ПЖ и гипогликемии новорождённого в 1-e сут жизни c линейным коэффициентом корреляции (R) минус 0,66. В 1-e сут жизни у 87,5 % этих детей возникает гипогликемия, более выраженная у недоношенных, у 50% из них, сохраняющаяся к 3-м сут жизни. Заключение. Толщина ПЖ плода более информативный и воспроизводимый показатель, чем её длина, статистически значимый как в группе ДФ, так и без неё. Неудовлетворительный контроль за течением CД у матерей увеличивает риск гипогликемии новорождённого до 100%. Более выраженная гипогликемия выявляется у недоношенных детей, у половины которых гипогликемия сохраняется к 3-м сут жизни. Background. The fetal pancreas is involved in regulation of glucose levels in both fetal and maternal plasma. Maternal hyperglycemia, regardless of the type of diabetes mellitus (DM), is accompanied by fetal hyperglycemia. This stress of the fetal pancreatic function causes a compensatory increase in the pancreas size, the development of fetal hyperinsulinemia and of neonatal hypoglycemia in the first hours of life. The frequency of laboratory hypoglycemia varies 21-60%, while its clinical symptoms are present in 25-33% of cases. Aim. To assess the prognostic value of the increase in fetal pancreas size on the eve of delivery as a predictor of neonatal hypoglycemia in maternal DM. Methods. Ultrasound of the fetal pancreas was performed in 241 pregnant women with DM (main group) and in 427 healthy pregnant women (control group). In the main group, 141 (58.5%) pregnant women had children with signs of diabetic fetopathy (DF). The size of the fetal pancreas was estimated. In newborns, glycemia was measured on the 1st and 3rd days of life. A retrospective correlation analysis of the fetal pancreas size and the neonatal glycemia was performed on the 1st and the 3rd days of life. Results. A negative linear correlation was found between the pancreas thickness and neonatal hypoglycemia on the 1st day of life (linear correlation coefficient, R, -0.66). On the 1st day of life in 87.5-100% of these newborns, hypoglycemia is observed, which is more pronounced in premature infants and which remains through the 3rd day of life in 50% of them. Conclusion. The thickness of the fetal pancreas is a more informative and reproducible indicator than its length, which was statistically significant in groups both with and without DF. Poor glycemic control in mothers increases the risk of neonatal hypoglycemia up to 100%. More pronounced hypoglycemia is observed in premature infants and persists through the 3rd day of life in half of them.

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

<b><i>Introduction:</i></b> 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. <b><i>Methods:</i></b> 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. <b><i>Results:</i></b> Of the 830 included infants, 31 (3.7%) ultimately received intravenous dextrose (IVD). Most screened infants (<i>n</i> = 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. <b><i>Conclusions:</i></b> 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.