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Early blood glucose screening in asymptomatic high-risk neonates
Rania El-Khawam1, Vikramaditya Dumpa2, Shahidul Islam3
1Division of Neonatology, Department of Pediatrics, 24998 NYU Langone Hospital - Long Island, NYU Grossman Long Island School of Medicine , Mineola, NY, USA.
Insights
Early screening for neonatal hypoglycemia is vital. Asymptomatic high-risk newborns, especially those with late prematurity (LPT) or large-for-gestational-age (LGA), can experience severe hypoglycemia within the first hour after birth.
Area of Science:
- Neonatal Medicine
- Pediatric Endocrinology
- Clinical Neonatology
Background:
- Prompt detection and management of severe neonatal hypoglycemia are critical to prevent adverse neurodevelopmental outcomes.
- Optimal glucose screening timing for asymptomatic, high-risk neonates remains under-investigated.
- Key risk factors include late prematurity (LPT), small-for-gestational-age (SGA), large-for-gestational-age (LGA), and infant-of-a-diabetic mother (IDM).
Purpose of the Study:
- To determine the incidence of early hypoglycemia in asymptomatic, high-risk neonates.
- To assess the impact of individual risk factors on early neonatal hypoglycemia.
- To identify specific risk factors associated with hypoglycemia in the initial hour of life.
Main Methods:
- A retrospective analysis of 1,690 asymptomatic high-risk neonates (≥35 weeks gestation) was conducted.
- Early blood glucose screening was performed within the first hour after birth for all included neonates.
- The study evaluated the association between hypoglycemia risk factors and early neonatal hypoglycemia incidence.
Main Results:
- The incidence of blood glucose ≤25 mg/dL was 3.1%, and ≤15 mg/dL was 0.89%.
- A concerning 0.5% of asymptomatic, at-risk neonates had blood glucose ≤10 mg/dL.
- Late prematurity (LPT) and large-for-gestational-age (LGA) were significantly associated with early neonatal hypoglycemia.
Conclusions:
- Asymptomatic neonates, particularly those with LPT or LGA, are susceptible to severe hypoglycemia in the first hour of life.
- Early blood glucose screening is essential for identifying at-risk infants.
- Further research is needed to establish optimal screening and management protocols for these neonates.
Objectives:
Detecting and treating severe hypoglycemia promptly after birth is crucial due to its association with adverse long-term neurodevelopmental outcomes. However, limited data are available on the optimal timing of glucose screening in asymptomatic high-risk neonates prone to hypoglycemia. Risk factors associated with asymptomatic high-risk neonates include late prematurity ≥35 and <37 weeks gestation (LPT), small-for-gestational-age (SGA), large-for-gestational-age (LGA), and infant-of-a-diabetic mother (IDM). This study aims to determine the incidence and the impact of individual risk factors on early hypoglycemia (defined as blood glucose ≤25 mg/dL in the initial hour after birth) in asymptomatic high-risk neonates.
Methods:
All asymptomatic high-risk neonates ≥35 weeks gestation underwent early blood glucose screening within the first hour after birth (n=1,690). A 2-year retrospective analysis was conducted to assess the incidence of early neonatal hypoglycemia in this cohort and its association with hypoglycemia risk factors.
Results:
Out of the 9,919 births, 1,690 neonates (17 %) had risk factors for neonatal hypoglycemia, prompting screening within the first hour after birth. Incidence rates for blood glucose ≤25 mg/dL and ≤15 mg/dL were 3.1 and 0.89 %, respectively. Of concern, approximately 0.5 % of all asymptomatic at-risk neonates had a blood glucose value of ≤10 mg/dL. LPT and LGA were the risk factors significantly associated with early neonatal hypoglycemia.
Conclusions:
Asymptomatic high-risk neonates, particularly LPT and LGA neonates, may develop early severe neonatal hypoglycemia identified by blood glucose screening in the first hour of life. Additional investigation is necessary to establish protocols for screening and managing asymptomatic high-risk neonates.
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