Risk factors for hyperglycemia in extremely low birth weight infants during the first 14 days

Abstract

Background: There are limited data regarding the risk factors for hyperglycemia in extremely low birth weight infants (ELBWIs). The aim of this observational study was to investigate the incidence of hyperglycemia among ELBWIs during the first 14 days of life and identify independent risk factors for hyperglycemia development. Methods: We retrospectively evaluated 55 ELBWIs (32 male infants) between January 2015 and March 2020. Hyperglycemia was diagnosed when the glucose level was 180 mg/dL. Demographic and clinical data were extracted from the patients' medical records. The risk factors associated with the onset of hyperglycemia were identified by Cox proportional hazards regression analysis with variables that had previously been identified as risk factors for hyperglycemia. Results: Hyperglycemia developed in 23 patients (41.8%) within the first 14 days of life. Gestational age, chorioamnionitis, postnatal intravenous glucocorticoids, and probiotic type were included in the analysis. The results indicated that hyperglycemia was significantly associated with gestational age (hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.48e0.87; P Z 0.004). Further, Bifidobacterium breve (B. breve M-16V) use was related to hyperglycemia in ELBWIs (HR, 2.95; 95% CI, 1.10e7.87; P Z 0.031). Conclusion:Hyperglycemia was strongly associated with lower gestational age and B. breve M-16V use in our study population. Although probiotic supplementation may be beneficial for preterm infants to reduce the incidence of necrotizing enterocolitis, the dextrin used as an excipient in B. breve M-16V may lead to an undesirable carbohydrate load in ELBWIs.

Incidence and Risk Factors for Glucose Disturbances in Premature Infants

“…Hyperglycemia most commonly affects ELBW infants in the first week of life. In previous reports, the incidence of hyperglycemia in ELBW in the neonatal period ranges from 38% to 85% [9,37,38]. The incidence of hyperglycemia in our study was 9.9%, which is significantly lower than in other similar studies [5,19].…”

“…It has been associated with significant morbidity and mortality, including intraventricular hemorrhage, retinopathy of prematurity, necrotizing enterocolitis, and abnormal neurologic examination at two years of age [5][6][7][8]. Several risk factors contribute to the development of hyperglycemia in preterm infants, including gestational age, low birth weight, stress, excessive glucose administration, parenteral nutrition, and the administration of some drugs, such as corticosteroids, phenytoin, or theophylline [9][10][11]. Hypoglycemia is a very common, usually transient, metabolic disturbance in newborn infants as a result of an adjustment to the extrauterine environment.…”

Clinical Characteristics of Necrotizing Enterocolitis Diagnosed by Independent Adjudication of Abdominal Radiographs, Laparotomy, or Autopsy in Preterm Infants in the “Connection Trial”

“…Multiple risk factors for and complications of NEC have been described. 10 33 34 35 36 37 38 When the associations with confirmed NEC were explored with regression models, confirmed NEC showed a stronger association with BW than previously reported with approximately 20 to 30% reduced incidence for every 100-g increment and approximately 10 to 20% for every GA week at birth. 35 Overall, confirmed NEC associated with up to 4.7 times increased risks, e.g., GI perforation, intestinal obstruction, hypotension, hypokalemia, hyponatremia, and LOS.…”

Neonatal hyperglycaemia in extremely preterm and extremely low birth weight infants: A report of a rare case and a review of the literature

“…A study in Tokyo, Japan examined the factors affecting hyperglycaemia in ELBW in the first 14 DOL (37). That study found significant associations between hyperglycaemia and various parameters.…”

“…That study found significant associations between hyperglycaemia and various parameters. Specifically, factors such as gestational duration, birth weight, chorioamnionitis and postnatal glucocorticoid use were identified as key factors influencing the outcome (37). Additionally, maternal preeclampsia, the premature rupture of membranes and antepartum haemorrhage have also been found to be notable risk factors for hyperglycaemia (5).…”