Incidence of hypoglycaemia within 72 hours after birth in low birth weight babies who are appropriate for gestational age

Abstract

Background: Neonatal hypoglycemia is a very common metabolic disorder which is due to inability to maintain a normal glucose homeostasis. The most effective method of preventing hypoglycemia is early breast feeding which is preferred to formula feeding. Therefore, author conducted this study to document incidence of hypoglycemia both symptomatic and asymptomatic in exclusively fed with breast milk, low birth weight neonates who are appropriate for gestational age. Aims and objectives of this study was to determine incidence of hypoglycaemia in first 72 hrs of life in low birth weight neonates (1500-2499gm) who are appropriate for gestational age and who are exclusively fed with breast milk. Methods: Prospective cohort study conducted in between December 2015 to November 2017 in which 150 consecutive neonates with a birth weight between 1500 to 2499 grams and appropriate for gestational age, being fed exclusively with breast milk were studied. Results: Out of 150 neonates, 36 (24%) developed one episode of hypoglycemia, 14 (9.4%) newborns had recurrent episodes while 13 (8.66%), and 1 (0.7%) newborn had two and three episodes of hypoglycemia respectively. Applying a cut-off of blood glucose level of 40 mg/dl, the incidence of hypoglycemia was 24%. The less is the gestational age there is higher chance of occurrence of hypoglycemia. PIH is the most common maternal risk factor for neonatal hypoglycemia. Incidence of hypoglycemia is highest during the first 24hrs after birth and jitteriness is the most common symptom of neonatal hypoglycemia. Conclusions: Healthy new-borns in postnatal wards can be exclusively breastfed, but there is needing to closely monitor their blood glucose levels at least in first 72 hrs and asymptomatic hypoglycaemia in new-borns can be managed with frequent breastfeeding without any formula feeds. Amarendra M et al. Int J Contemp Pediatr. 2018 May;5(3):944-948 International Journal of Contemporary Pediatrics | May-June 2018 | Vol 5 | Issue 3 Page 945 hypoglycaemia in the neonates has remained controversial. Keywords 3The operational threshold for hypoglycaemia is currently believed to be a blood glucose value of <40mg/dl (plasma glucose <45mg/dl). 4 Mothers are often in dilemma and apprehensive whether new-borns at risk for hypoglycaemia, like neonates of diabetic mothers, large for gestation age, low birth weight and late-preterm neonates, could be sustained on exclusive breast feeding. Hence, they often offer supplemental feeding, leading to low exclusive breastfeeding rates in the community, especially during first two to three days. Even though occurrence and incidence of hypoglycaemia in neonates is well documented, its occurrence in exclusively breastfed low birth weight new-borns remains undervalued.These new-borns are recommended to be screened for hypoglycaemia, as it has been shown to be associated with poor neurological outcome and low IQ. The most effective method of preventing hypoglycaemia is early breast feeding which is preferred to formula feeding. Therefore, aut...

Clinico-biochemical profile of hypoglycemia in neonates admitted in NICU

“…8,12,15 Pre-eclampsia was also present in Amarendra M, Manjunatha BR et al, Singh YP et al and Bhand SA et al which is similar to the current study. 16,12,15,8 PROM as maternal risk factor was only present in Amarendra M et al study which is similar to current study.…”

“…This correlation of blood sugar level at admission and repeat episode of hypoglycemia has not been discussed in other studies. 13,16,8,10,19 Most of hypoglycemic neonates had experienced only one episode in repeat episode of hypoglycemic group in current study which is similar to study done by Amarendra et al 16 In the current study, oral feeding or intravenous dextrose bolus was effective in single episode of hypoglycemia and intravenous D10 bolus or glucose infusion drip was effective in more than one episode. Intravenous D10 bolus was equally effective in both single episode and more than one episode of hypoglycemia.…”

“…In current study birth asphyxia was more common neonatal risk factor than early septicaemia and RDS which was similar to study done by Dhananjaya CP et al, Burden et al and Manjunatha BR et al 11,14,12 Early septicemia was more common in the study done by Indira P et al and Stomnaroska et al and RDS was more common in the study by Bhand SA et al so that these are not similar to current study. 13,17,16 Most common symptoms of hypoglycemia were poor feeding, lethargy, jitteriness, seizure and respiratory abnormality which was similar to study done by Dhananjaya 11,13,16,18,12,8,10,15 In the current study, blood glucose level below 30 mg/dl was more commonly seen in neonates having more than one episode of hypoglycemia. The blood glucose levels at admission were in lower range in neonates who later had repeat episode of hypoglycemia.…”

Berat badan lahir dan kejadian hipoglikemia pada neonatus

“…(18) Dari penelitian yang dilakukan oleh Amarendrajuga didapatkan bahwa bayi dengan berat badan lahir rendah insidensi mengalami hipoglikemia adalah terbanyak (72.22%) jauh lebih tinggi dari berat badan lahir normal. (19) Semakin rendah berat badan lahir seorang bayi semakin tinggi risiko bayi tersebut mengalami hipoglikemia. Didapatkan juga pada bayi berat lahir rendah, 24% di antaranya mengalami hipoglikemia berkelanjutan di hari pertama lahir.…”

“…Didapatkan juga pada bayi berat lahir rendah, 24% di antaranya mengalami hipoglikemia berkelanjutan di hari pertama lahir. (19) Bayi dengan berat lahir kurang dari 1800 gr memiliki daya hisap dan menelan yang inaktif, lemah dan tidak terkoordinasi dengan baik karena sistem saraf pusat yang belum mature.…”