A Graded Approach to Intravenous Dextrose for Neonatal Hypoglycemia Decreases Blood Glucose Variability, Time in the Neonatal Intensive Care Unit, and Cost of Stay

Sen, Sarbattama; Cherkerzian, Sara; Turner, Daria; Monthé-Drèze, Carmen; Abdulhayoglu, Elisa; Zupancic, John A.F.

doi:10.1016/j.jpeds.2020.12.025

Cited by 7 publications

(3 citation statements)

References 7 publications

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“…The authors reported that the graded approach improved stability of blood glucose concentrations as well as shortened the stay in the neonatal intensive care unit, and reduced costs without changing the time to achieving normoglycaemia. 114 More trials of this and similar approaches are warranted.…”

Section: Intravenous Dextrosementioning

confidence: 99%

Neonatal hypoglycaemia

Harding,

Alsweiler,

Edwards

et al. 2024

bmjmed

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Low blood concentrations of glucose (hypoglycaemia) soon after birth are common because of the delayed metabolic transition from maternal to endogenous neonatal sources of glucose. Because glucose is the main energy source for the brain, severe hypoglycaemia can cause neuroglycopenia (inadequate supply of glucose to the brain) and, if severe, permanent brain injury. Routine screening of infants at risk and treatment when hypoglycaemia is detected are therefore widely recommended. Robust evidence to support most aspects of management is lacking, however, including the appropriate threshold for diagnosis and optimal monitoring. Treatment is usually initially more feeding, with buccal dextrose gel, followed by intravenous dextrose. In infants at risk, developmental outcomes after mild hypoglycaemia seem to be worse than in those who do not develop hypoglycaemia, but the reasons for these observations are uncertain. Here, the current understanding of the pathophysiology of neonatal hypoglycaemia and recent evidence regarding its diagnosis, management, and outcomes are reviewed. Recommendations are made for further research priorities.

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Section: Intravenous Dextrosementioning

confidence: 99%

Neonatal hypoglycaemia

Harding,

Alsweiler,

Edwards

et al. 2024

bmjmed

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“…Hyperglycemia and hypoglycemia are independent risk factors for early mortality. Infants with hypoglycemia and hyperglycemia are often subjected to extended hospital stays (238)(239)(240)(241). Untreated and/or persistent hyperglycemia is associated with intraventricular hemorrhage, retinopathy of prematurity, as well as neurological and behavioral development abnormalities (238,239,242,243).…”

Section: Glucosementioning

confidence: 99%

Influence of innate immune activation on endocrine and metabolic pathways in infancy

O’Connor

Ashoori

Dias

et al. 2021

American Journal of Physiology-Endocrinology and Metabolism

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Prematurity is the leading cause of neonatal morbidity and mortality worldwide. Premature infants often require extended hospital stays, with increased risk of developing infection compared with term infants. A picture is emerging of wide-ranging deleterious consequences resulting from innate immune system activation in the newborn infant. Those who survive infection have been exposed to a stimulus that can impose long-lasting alterations into later life. In this review, we discuss sepsis-driven alterations in integrated neuroendocrine and metabolic pathways and highlight current knowledge gaps in respect of neonatal sepsis. We review established biomarkers for sepsis and extend the discussion to examine emerging findings from human and animal models of neonatal sepsis that propose novel biomarkers for early identification of sepsis. Future research in this area is required to establish a greater understanding of the distinct neonatal signature of early and late-stage infection, to improve diagnosis, curtail inappropriate antibiotic use and promote precision medicine through a biomarker-guided empirical and adjunctive treatment approach for neonatal sepsis. There is an unmet clinical need to decrease sepsis-induced morbidity in neonates, to limit and prevent adverse consequences in later life and decrease mortality.

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“…In a follow-up study, 36% of newborns with NH had neurosensory impairment, including neurodevelopmental delay, visual impairment and behavioral problems ( 2 , 8 , 9 ). The separation of neonates with transitional hypoglycemia from their mothers to Neonatal Intensive Care Unit results in a great burden on both the family and society with family distress and increased medical costs ( 10 , 11 ). Therefore, it is important to prevent its occurrence, minimize the risk factors and improve prenatal measures.…”

Section: Introductionmentioning

confidence: 99%

Development of a prediction model for neonatal hypoglycemia risk factors: a retrospective study

et al. 2023

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BackgroundIt’s challenging for healthcare workers to detect neonatal hypoglycemia due to its rapid progression and lack of aura symptoms. This may lead to brain function impairment for the newborn, placing a significant care burden on the family and creating an economic burden for society. Tools for early diagnosis of neonatal hypoglycemia are lacking. This study aimed to identify newborns at high risk of developing neonatal hypoglycemia early by developing a risk prediction model.MethodsUsing a retrospective design, pairs (470) of women and their newborns in a tertiary hospital from December 2021 to September 2022 were included in this study. Socio-demographic data and clinical data of mothers and newborns were collected. Univariate and multivariate logistic regression were used to screen optimized factors. A neonatal hypoglycemia risk nomogram was constructed using R software, and the calibration curve and receiver operator characteristic curve (ROC) was utilized to evaluate model performance.ResultsFactors integrated into the prediction risk nomogram were maternal age (odds ratio [OR] =1.10, 95% CI: 1.04, 1.17), fasting period (OR=1.07, 95% CI: 1.03, 1.12), ritodrine use (OR=2.00, 95% CI: 1.05, 3.88), gestational diabetes mellitus (OR=2.13, 95% CI: 1.30, 3.50), gestational week (OR=0.80, 95% CI: 0.66, 0.96), fetal distress (OR=1.76, 95% CI: 1.11, 2.79) and neonatal body mass index (OR=1.50, 95% CI: 1.24, 1.84). The area under the curve (AUC) was 0.79 (95% confidence interval [CI]: 0.75, 0.82), specificity was 0.82, and sensitivity was 0.62.ConclusionThe prediction model of this study demonstrated good predictive performance. The development of the model identifies advancing maternal age, an extended fasting period before delivery, ritodrine use, gestational diabetes mellitus diagnosis, fetal distress diagnosis and an increase in neonatal body mass index increase the probability of developing neonatal hypoglycemia, while an extended gestational week reduces the probability of developing neonatal hypoglycemia.

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A Graded Approach to Intravenous Dextrose for Neonatal Hypoglycemia Decreases Blood Glucose Variability, Time in the Neonatal Intensive Care Unit, and Cost of Stay

Cited by 7 publications

References 7 publications

Neonatal hypoglycaemia

Neonatal hypoglycaemia

Influence of innate immune activation on endocrine and metabolic pathways in infancy

Development of a prediction model for neonatal hypoglycemia risk factors: a retrospective study

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