Incidence and Risk Factors for Glucose Disturbances in Premature Infants

Abstract

Background and Objectives: There are limited data regarding the incidence and risk factors for hypoglycemia, hyperglycemia, and unstable glycemia in preterm infants. The aim of the present study was to determine the incidence and risk factors associated with neonatal hypoglycemia, hyperglycemia, and unstable glycemia in preterm infants during the first seven days of life. Materials and Methods: This prospective study included preterm infants <37 weeks of gestation, admitted to the Neonatal Intensive Care Unit between January 2018 and December 2020. Based on blood glucose levels in the first week of life, infants were divided into the following four groups: normoglycemic, hypoglycemic, hyperglycemic, and unstable. Blood glucose levels were measured from capillary blood at the 1st, 3rd, 6th, and 12th hour of life during the first 24 h, and at least once a day from days 2 to 7, prefeed. Results: Of 445 enrolled infants, 20.7% (92/445) were categorized as hypoglycemic, 9.9% (44/445) as hyperglycemic, and 2.9% (13/445) as unstable, respectively. Hypoglycemia was most commonly observed among infants ≥34 weeks (27.9%), and hyperglycemia was most common among preterm infants <28 weeks (50%). Female gender increased the chances of developing hypoglycemia by three times. The decrease in gestational age by one week increased the chance of developing hyperglycemia by 1.9 times. Sepsis increased the chance of developing hyperglycemia seven times, respiratory distress syndrome five times, and mechanical ventilation three times, respectively. Conclusions: Glucose disturbances in the early neonatal period in preterm infants are common and mostly asymptomatic. Therefore, careful blood glucose level monitoring is required in those infants, especially in late preterm infants, in order to prevent possible neurological complications.

Predicting resolution of hypoglycemia with and without dextrose infusion in newborn infant of gestational diabetic mothers

“…Although the reason for this relationship is unclear, females may be more sensitive to in-utero exposure to increased glucose levels than males (14, 15). Our observation is consistent with Ahel et al, who found in a recent study that the chances of developing hypoglycemia are increased three times by females compared to males gender (16).…”

New-born with Hypoglycaemia and their Neurodevelopmental Outcome: A Prospective Study in a Tertiary Care Hospital in Bangladesh

“…Among 66 infants 48.5% were males while 51.5 % were females; 16 (24.24%) were gestational age <34 weeks, 24 (36.36%) were between gestational age 34-<37 and 26 (39.39%) were ≥37 weeks of gestation. Female gender increases the chances of developing hypoglycaemia by three times [21]. In the hypoglycaemia group, adjusted analysis showed a lower fine motor function for boys, β = − 16.4, p = 0.048 [22].…”

Systematic review of guidelines on neonatal hypoglycemia

“…In addition, abnormal physiological manifestations or disease states of the newborn such as hypothermia, underfeeding, acidosis, intrapartum hypoxia‐ischemia, fetal distress, erythrocytosis and respiratory distress, are also considered high‐risk factors by many guidelines 2,13,15,17–20 . It was found that sepsis, respiratory distress syndrome and mechanical ventilation increased the incidence of neonatal hypoglycemia by 7‐, 5‐ and 3‐fold, respectively 28 …”

“…2,13,15,[17][18][19][20] It was found that sepsis, respiratory distress syndrome and mechanical ventilation increased the incidence of neonatal hypoglycemia by 7-, 5-and 3-fold, respectively. 28 Early initiation of breastfeeding, ≤3 h between feedings, and early mother-infant SSC are widely recognised preventive measures against neonatal hypoglycemia. The gastric emptying time in newborns is about 2 h. A feeding interval of no more than 3 h is consistent with the gastric emptying patterns in newborns.…”