Keywords
Risk Factors
Newborn
How to Cite
Abstract
Introduction: Hypoglycemia in newborns is a frequent pathology, and it may present as transient or persistent. Many different cut-off points are used to define blood glucose, usually set at less than 47 mg/dL. There is evidence for both maternal and neonatal risk factors that increase the risk of developing the disease by 14.7% to 83.2%, as compared to 5% in patients without those risk factors. Likewise, it has been demonstrated that delay in the treatment of hypoglycemia is associated with neurodevelopmental alterations.
Objective: To determine the risk factors associated with transient neonatal hypoglycemia in term infants with no risk factors as defined by the American American Academy of Pediatrics guidelines, at Hospital Universitario Clínica San Rafael during the period between January, 2015 and January, 2019.
Methodology: Observational, analytical, retrospective case-control study conducted between January, 2015 and January, 2019. Sample calculation was performed and 35 cases and 35 controls were obtained using the Real Statistics software 6.9 of January, 2020.
Results: The highest proportion of patients in the study was female (61.43%), 20 cases and 23 controls. Average glucose level on admission of the cases was 40.8 mg/dL. Risk factors included maternal overweight with an odds ratio (OR) of 1.2; caesarean section, performed in 15 cases (42.8%), with an OR of 2.5; and pregnancy-induced hypertension, found in 4 cases and 1 control, with an OR of 4.38. There was evidence of a significant association with an Apgar score of 5 in the first minute in 3 cases (8.57%); the first energy intake by the newborn, with 25 (71.4%) of the cases receiving breastfeeding; transient tachypnea of the newborn (TTN) in 6 (17.14%) cases; and polycythemia in 10 (28.57%) cases, as neonatal variables, and skin-to-skin contact as a maternal variable in 7 cases (20%) that did not receive it.
Conclusions: In the term population considered healthy that developed transient neonatal hypoglycemia, an association was found with an Apgar score of 5 in the first minute, the first energy intake, TTN, polycythemia and skin-to-skin contact. The effects of variables that mostly influence metabolic glucose utilization can be seen in the long term in the motor skills and neurodevelopment of the population affected by this pathology. It is a wake-up call to be more vigilant of this group of newborns who, despite having a lower incidence of hypoglycemia, require surveillance and follow-up given the influence of various different factors.
References
Adamkin DH. Neonatal hypoglycemia. Semin Fetal Neonatal Med. 2017;22(1):36-41.
Hiersch L, Krispin E, Aviram A, Wiznitzer A, Yogev Y, Ashwal E. Effect of Meconium-Stained Amniotic Fluid on Perinatal Complications in Low-Risk Pregnancies at Term. Am J Perinatol. 2016;33(4):378-84.
Committee on Fetus and Newborn, Adamkin DH. Postnatal glucose homeostasis in late-preterm and term infants. Pediatrics. 2011;127(3):575-9.
Duvanel CB, Fawer CL, Cotting J, Hohlfeld P, Matthieu JM. Long-term effects of neonatal hypoglycemia on brain growth and psychomotor development in small-for-gestational-age preterm infants. J Pediatr. 1999;134(4):492-8.
McKinlay CJD, Alsweiler JM, Anstice NS, Burakevych N, Chakraborty A, Chase JG, et al. Association of Neonatal Glycemia With Neurodevelopmental Outcomes at 4.5 Years. JAMA Pediatr. 2017;171(10):972-983.
Thompson-Branch A, Havranek T. Neonatal Hypoglycemia. Pediatr Rev. 2017;38(4):147-157.
Stomnaroska O, Petkovska E, Jancevska S, Danilovski D. Neonatal Hypoglycemia: Risk Factors and Outcomes. Pril (Makedon Akad Nauk Umet Odd Med Nauki). 2017;38(1):97-101.
Flores-le Roux JA, Sagarra E, Benaiges D, Hernandez-Rivas E, Chillaron JJ, Puig de Dou J, et al. A prospective evaluation of neonatal hypoglycaemia in infants of women with gestational diabetes mellitus. Diabetes Res Clin Pract. 2012;97(2):217-22.
McKinlay CJD, Chase JG, Dickson J, Harris DL, Alsweiler JM, Harding JE. Continuous glucose monitoring in neonates: a review. Matern Health Neonatol Perinatol. 2017;3:18.
Cornblath M, Odell GB, Levin EY. Symptomatic neonatal hypoglycemia associated with toxemia of pregnancy. J Pediatr. 1959;55:545-62.
Coors SM, Cousin JJ, Hagan JL, Kaiser JR. Prophylactic Dextrose Gel Does Not Prevent Neonatal Hypoglycemia: A Quasi-Experimental Pilot Study. J Pediatr. 2018;198:156-161.
Turner D, Monthé-Drèze C, Cherkerzian S, Gregory K, Sen S. Maternal obesity and cesarean section delivery: additional risk factors for neonatal hypoglycemia? J Perinatol. 2019;39(8):1057-1064.
Berttoloto-Cepeda A, Vargas-Vaca Y, Guzmán-Cruz P, Murillo-Casas A, Muñoz-Peña L. Factores asociados a hipoglucemia neonatal transitoria en recién nacidos sanos, en el Hospital Universitario San Ignacio, estudio de casos y controles. Universitas Médica. 2017;58(3):1-5.
García-Patterson A, Aulinas A, María MÁ, Ubeda J, Orellana I, Ginovart G, et al. Maternal body mass index is a predictor of neonatal hypoglycemia in gestational diabetes mellitus. J Clin Endocrinol Metab. 2012;97(5):1623-8.
Gilstrap LC 3rd, Leveno KJ, Burris J, Williams ML, Little BB. Diagnosis of birth asphyxia on the basis of fetal pH, Apgar score, and newborn cerebral dysfunction. Am J Obstet Gynecol. 1989;161(3):825-30.
Hosagasi NH, Aydin M, Zenciroglu A, Ustun N, Beken S. Incidence of hypoglycemia in newborns at risk and an audit of the 2011 American academy of pediatrics guideline for hypoglycemia. Pediatr Neonatol. 2018;59(4):368-374.
Puchalski ML, Russell TL, Karlsen KA. Neonatal Hypoglycemia: Is There a Sweet Spot? Crit Care Nurs Clin North Am. 2018;30(4):467-480.
Fung GP, Chan LM, Ho YC, To WK, Chan HB, Lao TT. Does gestational diabetes mellitus affect respiratory outcome in late-preterm infants? Early Hum Dev. 2014;90(9):527-30.
Michael Weindling A. Offspring of diabetic pregnancy: short-term outcomes. Semin Fetal Neonatal Med. 2009;14(2):111-8.
Cordero L, Treuer SH, Landon MB, Gabbe SG. Management of infants of diabetic mothers. Arch Pediatr Adolesc Med. 1998;152(3):249-54.
Sweet LR, Keech C, Klein NP, Marshall HS, Tagbo BN, Quine D, et al. Respiratory distress in the neonate: Case definition & guidelines for data collection, analysis, and presentation of maternal immunization safety data. Vaccine. 2017;35(48 Pt A):6506-6517.
Ahimbisibwe A, Coughlin K, Eastabrook G. Respiratory Morbidity in Late Preterm and Term Babies Born by Elective Caesarean Section. J Obstet Gynaecol Can. 2019;41(8):1144-1149.
Hopfeld-Fogel A, Kasirer Y, Mimouni FB, Hammerman C, Bin-Nun A. Neonatal Polycythemia and Hypoglycemia in Newborns: Are They Related? Am J Perinatol. 2020. Publicación electrónica antes de la impresión.
Black VD, Lubchenco LO, Luckey DW, Koops BL, McGuinness GA, Powell DP, et al. Developmental and neurologic sequelae of neonatal hyperviscosity syndrome. Pediatrics. 1982;69(4):426-31.
Dalsgaard BT, Rodrigo-Domingo M, Kronborg H, Haslund H. Breastfeeding and skin-to-skin contact as non-pharmacological prevention of neonatal hypoglycemia in infants born to women with gestational diabetes; a Danish quasi-experimental study. Sex Reprod Healthc. 2019;19:1-8.
Moore ER, Bergman N, Anderson GC, Medley N. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev. 2016;11(11):CD003519.
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