Neonatal hypoglycemia

Risk Factor Assessment and the Incidence of Neonatal Hypoglycemia in the Postnatal Period

Objectives

The aim of this study was to evaluate risk factors used for the assessment of neonatal hypoglycemia and to examine the follow-up outcomes observed in the first 48 hours of postnatal life.

Methods

The records of infants born between 2015 and 2017 (3 years) at Şişli Hamidiye Etfal Training and Research Hospital who had a blood glucose level test performed within the first 24 hours after birth and who had follow-up results for 48 hours were included in the study. Data of gestational age; birth weight; gender; antenatal, natal and postnatal characteristics; blood glucose measurement method and time during the first 48 hours postpartum; glucose values and follow-up; nutritional status; and the need for hospitalization due to a low blood glucose value were recorded. Groups were created based on data of a diabetic mother, small for gestational age (SGA), large for gestational age (LGA), late preterm birth (34-36+6/7 gestational weeks), fetal distress, and feeding intolerance. Blood glucose measurement values and reasons for hypoglycemia and assessment were compared in subgroups.

Results

The data of 9480 infants were reviewed and included in the study. It was determined that blood levels were checked in 28.7% (n=2720). The mean birth weight and gestational age of the infants was 3143±804 g and 37.7±2.5 weeks, respectively. In the study group, 54.7% were male, and 57.5% were delivered via cesarean section. The most frequent factors prompting blood glucose measurement were LGA status (25.9%), prematurity (18%), transient tachypnea (17.3%), and SGA status (11.6%). Results revealed that the blood glucose values of 2009 (73.9%) infants were within normal limits, and there was no further monitoring of blood glucose level during the first 48 hours. In 711 (26.1%), a low blood glucose level finding led to follow-up assessment. The incidence of hospitalization with a preliminary diagnosis of hypoglycemia was 2.5% (n=67). Subgroup analysis indicated that at the first hour, the mean blood glucose value of the patients with multiple factors that were risks for hypoglycemia suggesting further evaluation was lower than those with transient tachypnea and fetal distress (p<0.001), and the mean blood glucose value of premature and LGA neonates were significantly lower than the infants of diabetic mothers at the sixth hour (p<0.001).

Conclusion

In the postnatal period, the rate of monitoring blood glucose levels in newborn babies was found to be 28.7% and the most commonly predicted risk factor was LGA babies. The frequency of postpartum hospitalization due to hypoglycemia was found to be 2.5%, and blood sugar levels were lower in the first hour in groups with multiple causes.

Inborn Errors of Metabolism

Inborn errors of metabolism are single gene disorders resulting from the defects in the biochemical pathways of the body. Although these disorders are individually rare, collectively they account for a significant portion of childhood disability and deaths. Most of the disorders are inherited as autosomal recessive whereas autosomal dominant and X-linked disorders are also present. The clinical signs and symptoms arise from the accumulation of the toxic substrate, deficiency of the product, or both. Depending on the residual activity of the deficient enzyme, the initiation of the clinical picture may vary starting from the newborn period up until adulthood. Hundreds of disorders have been described until now and there has been a considerable clinical overlap between certain inborn errors. Resulting from this fact, the definite diagnosis of inborn errors depends on enzyme assays or genetic tests. Especially during the recent years, significant achievements have been gained for the biochemical and genetic diagnosis of inborn errors. Techniques such as tandem mass spectrometry and gas chromatography for biochemical diagnosis and microarrays and next-generation sequencing for the genetic diagnosis have enabled rapid and accurate diagnosis. The achievements for the diagnosis also enabled newborn screening and prenatal diagnosis. Parallel to the development the diagnostic methods; significant progress has also been obtained for the treatment. Treatment approaches such as special diets, enzyme replacement therapy, substrate inhibition, and organ transplantation have been widely used. It is obvious that by the help of the preclinical and clinical research carried out for inborn errors, better diagnostic methods and better treatment approaches will high likely be available.