Incidence and risk factors for early hypoglycemia in very preterm infants: the Hyporisk study

Abstract

Abstract Purpose: To determine incidence, timing and potential risk factors associated with hypoglycemia in the first day of life in very premature infants. Methods: Retrospective cohort study including all infants born before 32 weeks of gestation between 1 July 2017 and 31 December 2020 in the Erasmus MC Sophia Children’s Hospital (Rotterdam, the Netherlands). Excluded were those who died within 24 hours after birth or with no glucose data available. We collected maternal and neonatal characteristics from patient files, as well as all routine glucose values for the first 24 hours. Hypoglycemia was defined as blood glucose value below 2.6 mmol/L. Risk factors were selected using univariable and multivariable logistic regression with stepwise backward elimination. Kaplan-Meier survival analysis was performed to examine time-to-event after birth. Results: Of 714 infants included (median gestational age 29.3 weeks, mean weight 1200 grams), 137 (19%) had at least one episode of hypoglycemia, with a median time-to-event of 126 minutes [95%-CI 105-216]. Relevant independent risk factors for hypoglycemia included two maternal (insulin-dependent diabetes [OR 2.8; 95%-CI 1.3-6.1]; antenatal steroid administration [OR 1.7, 95%-CI 1.1 - 2.7]), and four neonatal factors (no IV-access in delivery room [OR 6.1, 95% CI-3.2-11.7], gestational age in weeks [OR 1.3, 95% CI-1.2-1.5], small-for-gestational-age [OR 2.6, 95%-CI 1.4-4.8], and no respiratory support (versus non-invasive support) [OR 2.3, 95%-CI 1.0-5.3]). Conclusion: Six risk factors were identified for hypoglycemia in the first 24 hours of life in very preterm infants, that can be used for development of prediction models, risk-based screening and updating guidelines.