Neonatal hypoglycemia: What can we improve?

Abstract

Abstract Background: Neonatal hypoglycemia is a frequent problem with potential neurological adverse effects, and it involves a significant number of admissions to neonatal units with the consequent mother-child separation, difficulty in establishing breastfeeding, and increased hospital expenditure. Although any newborn can suffer hypoglycemia, certain patients are at higher risk, such as late preterm infants, those born with low birth weight or high birth weight for their gestational age, or children of mothers with diabetic pathology. Strategies to detect and prevent hypoglycemia in this subgroup of patients is a common practice in neonatology units. This study aims to analyze the impact of this situation in our center, in order to identify , areas for improvement. Material and methods: we performed a retrospective review of medical charts of newborns, at term or near term, admitted for hypoglycemia in a tertiary hospitalization center during 2019 and 2020. Results: 232 patients were admitted for hypoglycemia during this period, accounting for 11.5% of total admissions. Of these, 185 (79%) had known risk factors for hypoglycaemia. The median gestational age was 37 (interquartile range (IQR) 36-38) and weight 2450 g (IQR 2255 - 2935 g). The most frequent risk factor was late prematurity (30.8%), followed by low birht weight (26%). Ninety percent had a pathological first blood glucose level, the value of which correlated inversely with the time of fluid therapy and, also, with the age at admission (p=0.02. Pearson correlation (PC) -0.172). The median cronological age at admission was 6 (RIQ 4-10). 16.75% of the patients (31/185) had not taken early enteral feedings (neither formula bottle nor breastfeeding) before the first glycemic control. A total of 42.7% were exclusively breastfed (BF), 31.3% fed with adapted formula (AF), and in 9.5% of the patients it could not be determined whether they had received or not an early feeding. The mean of the first glycemic value was significantly lower in those who did not take an early feed (mean 28.4, SD 1.7) than those who did (mean 35.2 SD 0.88) and was lower in those who were admitted earlier (mean 5.9 hours SD 0.44 vs. 8 hours SD 0.56). Conclusion: Admissions for neonatal hypoglycemia are frequent. Early intake was associated with a higher first glycemic control. This measure was only fulfilled within some patients in our center, so there is an opportunity for improvement. Trial registration: Retrospectively registered