Incidence and Risk Factors for Hypoglycemia During Fetal-to-Neonatal Transition in Premature Infants

Mitchell, Nikki A.; Grimbly, Chelsey; Rosolowsky, Elizabeth; O’Reilly, Megan; Yaskina, Maryna; Cheung, Po–Yin; Schmölzer, Georg M.

doi:10.3389/fped.2020.00034

Cited by 32 publications

(23 citation statements)

References 44 publications

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“…In the last decades, the incidence of neonatal hypoglycemia in otherwise healthy infants is 5–15% [ 1 , 13 ]; in our experience this data is respected, because we found an incidence of 10% (39/389) in the historical group (Gr1) and 12% (37/308) in the cohort of infants managed with the new protocol (Gr2).…”

Section: Discussionsupporting

confidence: 60%

“…Hypoglycemia is the most frequent metabolic disorder in neonates, with an incidence of 5–15% in healthy term infants and up to 50% in infants with risk factors [ 1 ]. During the pregnancy the fetus receives glucose from placental circulation, but at birth this supply stops abruptly and the neonates need to become independent to produce energy.…”

Section: Introductionmentioning

confidence: 99%

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Management of asymptomatic hypoglycemia with 40% oral dextrose gel in near term at-risk infants to reduce intensive care need and promote breastfeeding

et al. 2021

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Background Neonatal hypoglycemia is a common disorder especially in at-risk infants and it can be associated with poor long-term neurological outcomes. Several therapeutic interventions are suggested, from the implementation of breastfeeding to the glucose intravenous administration. Oral dextrose gel massaged into the infant’s inner cheek is a recent treatment option of asymptomatic hypoglycemia, after which oral feeding is encouraged. This approach seems to reduce the admission of infants to neonatal intensive care unit (NICU) so favouring maternal bonding and breastfeeding success at discharge. Methods In our ward, we prospectively compared a group of near-term neonates, (Gr2, n = 308) at risk for hypoglycemia, treated with an innovative protocol based on the addition of 40% oral dextrose gel (Destrogel, Orsana®,Italy) administered by massaging gums and cheek with historical matching newborns (Gr1, n = 389) treated with a formerly used protocol, as control group. The primary outcome was occurrence of NICU admission and the requirement of intravenous glucose administration; while discharge with full breastfeeding was the secondary outcome. Results In Gr1, 39/389 (10%) infants presented with asymptomatic hypoglycemia, 19/39 were transferred to the NICU, and 14/39 required intravenous glucose treatment. In Gr2, among the 30/308 infants with asymptomatic hypoglycemia managed according to the new protocol, 3/30 were transferred to the NICU and received intravenous glucose infusion. The mean duration of hospitalization respectively was 6.43 (± 6.36) and 3.73 ± 1.53 days (p < 0.001). At discharge, 7.7% of the infants in Gr1 and 30% of the infants in Gr2 were exclusively breastfed (p = 0.02). Considering Gr1 vs Gr2, the number of patients that were transferred to NICU was 19 (48.7%) vs 3 (10%) (p = 0.001) and the number of infants that needed intravenous glucose infusion was 14 (35.9%) vs 3 (10%) (p = 0.01), respectively. Conclusions In our population of near term infants, the introduction of 40% oral dextrose gel to the protocol, helped in the safe management of asymptomatic hypoglycemia and, at the same time, implemented breastfeeding.

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Section: Discussionsupporting

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Management of asymptomatic hypoglycemia with 40% oral dextrose gel in near term at-risk infants to reduce intensive care need and promote breastfeeding

et al. 2021

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“…In the last decades, the incidence of neonatal hypoglycemia in otherwise healthy infants is 5-15% [1,13];…”

Section: Discussionmentioning

confidence: 99%

Management of Asymptomatic Hypoglycemia With Dextrose Oral Gel at 40% in Near Term at-risk Infants to Reduce Intensive Care Need and Promote Breastfeeding

Meneghin¹,

Manzalini²,

Acunzo³

et al. 2021

Preprint

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Background: Neonatal hypoglycemia is a common disorder especially in at-risk infants and it can be associated with poor long-term neurological outcomes. Several therapeutic interventions are suggested, from the implementation of breastfeeding to the glucose intravenous administration. Oral dextrose gel massaged into the infant’s inner cheek is a recent treatment option of asymptomatic hypoglycemia, after which oral feeding is encouraged. This approach seems to reduce the admission of infants to neonatal intensive care unit (NICU) so favouring maternal bonding and breastfeeding success at discharge. Methods: In our unit we recently implemented the protocol for the management of asymptomatic hypoglycemia with the introduction of dextrose oral gel at 40%. Therefore we compared two cohorts of near term at-risk infants with asymptomatic hypoglycemia: a historical group managed with our old protocol and the second one prospectively followed after the introduction of dextrose gel at 40%. Results: Primary outcome was occurrence of NICU admission and glucose intravenous needs; breastfeeding success was the secondary outcome. Infants in the dextrose oral gel group showed statistically lower need of NICU admission and higher prevalence of exclusive breastfeeding at discharge compared with infants of the historical group. Conclusions: In our population the introduction of dextrose oral gel at 40% to the protocol, helped in the safe management of asymptomatic hypoglycemia in near term infants and, at the same time, implemented breastfeeding.

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“…Premature infants are more prone to hypoglycemia due to low glycogen reserves and rapid consumption. 49 The mechanism of hypoglycemia and/or hyperglycemia leading to HL may be related to neuropathy and/or microvasculopathy. 50 Ionic homeostasis and adequate oxygen supply are key to hair cell mechanical transduction and cochlear function.…”

Section: Ototoxic Drugsmentioning

confidence: 99%

Change to Hearing Loss–Related Risks and Screening in Preterm Infants

2020

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Hearing loss is one of the most common congenital defects in infancy; it increases speech and language delays and adversely affects academic achievement and socialemotional development. The risk of hearing loss in premature infants is higher than that in normal newborns, and because of the fragility of the auditory nervous system, it is more vulnerable to different risk factors. The hearing screening guidelines in current use were proposed by the American Academy of Pediatrics and updated in 2007, but there are no uniform guidelines for hearing screening in preterm infants. This review focuses on the risk factors related to hearing loss in premature infants, hearing screening strategies, and reasons for failure. The aim is to provide a more comprehensive understanding of hearing development in preterm infants to achieve early detection and early intervention. At the same time, attention should be paid to delayed auditory maturation in preterm infants to avoid excessive intervention. Key Points

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Incidence and Risk Factors for Hypoglycemia During Fetal-to-Neonatal Transition in Premature Infants

Cited by 32 publications

References 44 publications

Management of asymptomatic hypoglycemia with 40% oral dextrose gel in near term at-risk infants to reduce intensive care need and promote breastfeeding

Management of asymptomatic hypoglycemia with 40% oral dextrose gel in near term at-risk infants to reduce intensive care need and promote breastfeeding

Management of Asymptomatic Hypoglycemia With Dextrose Oral Gel at 40% in Near Term at-risk Infants to Reduce Intensive Care Need and Promote Breastfeeding

Change to Hearing Loss–Related Risks and Screening in Preterm Infants

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