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

Abstract

Background: Brain mainly utilizes glucose to maintain its basic function as well as higher order executive functions. Among metabolic problem, hypoglycaemia in the most common in new-born nursery as well as Neonatal Intensive Care Unit (NICU). Hypoglycaemia may adversely affect developing brain and cause neurological impairment. Objectives: The aim of this study was to assess the neurodevelopmental outcome of new-borns with hypoglycaemia admitted in NICU. Methods: This prospective observational study was conducted in the department of Neonatology and Institute of Paediatric Neuro-disorder and Autism (IPNA), Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka from March 2020 to August 2021. The inclusion criteria were babies admitted in NICU with hypoglycaemia or developed hypoglycaemia. Consent was taken from the parents/guardians whose baby develop hypoglycaemia (blood glucose <2.6 mmol/L). Hypoglycaemia was detected by capillary blood glucose estimation by heel prick tests and confirmed by corresponding blood sugar (RBS). Hypoglycaemia was treated by ensuring feeding or glucose infusion as per standard departmental treatment protocol. New-borns were followed up at 6 and 12 months of age and their neurodevelopmental assessment was done by Bayley Scales of Infant and toddler Development III (BSID III). Data were analysed using the SPSS 22.0 version software. Result: Among 66 admitted hypoglycaemic neonates 62 babies neurodevelopmental assessment was done at 6 and 12 months by BSID III method. Among them 48.5% were males while 51.5 % were females, 24.24% were gestational age <34 weeks, 36.36% were between gestational age 34 – < 37 weeks and 39.39% were ≥37 weeks of gestation. 60 (90.9%) babies were inborn whereas 6 (9.1%) were out born. Among hypoglycaemic neonates, normal birth weight (≥2500 g) were 27.27%, low birth weight (1500 – <2500 g) were 39.39% and rest of the babies (33.33%) were < 1500 g. IDM was 42.4% and IUGR was 33.3%. Most patient developed hypoglycaemia within 24 hrs of age (48.55%), among them 13.6% were symptomatic and 46% required glucose infusion. At 1st follow up overall adverse outcome (composite score < 70 in BSID III) were 19.4% and at 2nd follow up overall adverse outcome were 12.9%. Hypoglycaemia with very low birth weight, hypothermia and symptomatic babies were significantly associated with adverse neurodevelopmental outcome. Conclusion: Among hypoglycaemic new-borns those were symptomatic, very low birth weight and hypothermic were more prone to develop adverse neurodevelopmental outcome.