Factors Associated with Need for Intravenous Glucose Infusion for the Treatment of Early Neonatal Hypoglycemia in Late Preterm and Term Neonates

Abstract

Objective: To determine which late-preterm (35-36wk gestational age [GA]) and term neonates with early-onset hypoglycemia in the first 72 hours postnatal required a continuous glucose infusion in order to achieve and successfully maintain euglycemia. Study Design: Retrospective cohort study of late preterm and term neonates born in 2010-2014 and admitted to the Mother-Baby Unit at Parkland Hospital who had laboratory-proven blood glucose concentration <40 mg/dL (2.2 mmol/L) during the first 72h of life. Among the subgroup needing iv glucose infusion, we analyzed which factors predicted a maximum glucose infusion rate (GIR) ≥10 mg · kg-1 · min-1. The entire cohort was randomly divided into a derivation cohort (n=1288) and a validation cohort (n=1298). Results: In multivariate analysis, the need for intravenous glucose infusion was associated with small size for GA, low initial glucose concentration, early-onset infection and other perinatal variables in both cohorts. A GIR ≥10 mg · kg-1 · min-1 was required in 14% neonates with blood glucose value <20 mg/dL during the first 3h of observation. The likelihood of a GIR ≥10 mg · kg-1 · min-1 was associated with lower initial blood glucose value and lower umbilical arterial pH. Conclusion: Need for intravenous glucose infusion was associated with small size for GA, low initial glucose concentration, early-onset infection and variables associated with perinatal hypoxia-asphyxia. The likelihood of a maximum GIR ≥10 mg · kg-1 · min-1 was greater in neonates with lower blood glucose value during the first 3 hours of observation and lower umbilical arterial pH.