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Natural progress of blood glucose in full-term low-grade low-birthweight infants
1Department of Pediatrics, Yukiguni-Yamato General Hospital, Niigata, Japan. yamato_i@mail.tiara.or.jp
Insights
Hypoglycemia risk in low-birthweight infants is often overstated. This study found no cases requiring treatment in full-term infants, suggesting frequent blood glucose monitoring is unnecessary for this group.
Area of Science:
- Neonatal Medicine
- Pediatric Endocrinology
Background:
- The clinical significance of hypoglycemia in low-birthweight infants is debated.
- Existing evidence lacks recent definitions of hypoglycemia.
Purpose of the Study:
- To assess the risk of hypoglycemia in low-grade low-birthweight infants (LGLBWI).
- To evaluate the necessity of frequent blood glucose monitoring in LGLBWI.
Main Methods:
- Whole blood glucose (BGw) was measured in 49 LGLBWI and 38 normal birthweight infants.
- Measurements were taken at multiple time points after birth and before feeding.
Main Results:
- Full-term LGLBWI (gestational age 38-40 weeks) showed no lower blood glucose than controls.
- No LGLBWI required hypoglycemia treatment, even small for gestational age infants.
- Premature LGLBWI (37 weeks) had transiently lower BGw but normalized without intervention.
Conclusions:
- Gestational age is a key factor in hypoglycemia risk for LGLBWI.
- Full-term LGLBWI, including those small for gestational age, do not appear to require intensive glucose monitoring.
- The risk of significant hypoglycemia in term LGLBWI may be lower than previously assumed.
Background:
Although various authors have suggested the risk of hypoglycemia in practical medicine for low-birthweight infants is exaggerated, convincing evidence using recent definitions of hypoglycemia is not documented.
Methods:
To evaluate the risk of hypoglycemia in low grade low-birthweight infants (LGLBWI) (2100 g < birthweight < 2500 g) whose only abnormality is low-birthweight, whole blood glucose (BGw) was measured five times (0, 0.5, 1, and 4 h after birth and just before the first bottle feeding) in 49 LGLBWI and 38 normal birthweight infants.
Results:
Whole blood glucose was not lower in LGLBWI with a gestational age of 38-40 weeks (GT38LGLBWI) than in normal birthweight individuals with a gestational age of 38-40 weeks at each of the five measuring times. No case of GT38LGLBWI, not even in small for gestational age infants, required treatment for hypoglycemia. The BGw was significantly lower in 37-week gestational age LGLBWI than in GT38LGLBWI at 0.5 h and 1 h after birth (P < 0.05). However, in all cases with low BGw value (below 30 mg/dL at 1 h after birth), BGw value increased naturally to the normal level 1.5 h after birth. No symptoms of hypoglycemia were observed.
Conclusions:
In the care of hypoglycemia in LGLBWI, attention should be paid first to gestational age, namely, tendency to prematurity. In this study, however, no hypoglycemia that required treatment was found among full-term normal LGLBWI, even those who were small for gestational age. Frequent blood glucose measurement for those infants is therefore unnecessary.