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The frequency of hypoglycemia in full-term large and small for gestational age newborns
1Department of Pediatrics, William Beaumont Hospital, Royal Oak, MI 48073-6769.
Insights
Screening for hypoglycemia in newborns requires specific durations: stop after 12 hours for large for gestational age (LGA) infants and continue for 48 hours for small for gestational age (SGA) infants.
Area of Science:
- Neonatal Medicine
- Pediatric Endocrinology
- Clinical Chemistry
Background:
- Limited data exist on hypoglycemia frequency and screening duration in large for gestational age (LGA) and small for gestational age (SGA) newborns.
- Current recommendations for hypoglycemia screening in LGA and SGA infants lack precise duration guidelines based on recent definitions.
Purpose of the Study:
- To determine the frequency of hypoglycemia in full-term LGA and SGA infants using a recent definition.
- To establish the appropriate duration for hypoglycemia screening in these at-risk newborn populations.
Main Methods:
- Blood glucose levels were measured using chromogen test strips at multiple time points (1-48 hours) in full-term LGA and SGA infants of non-diabetic mothers.
- Serum glucose confirmation was performed for test strip readings below 40 mg/dl.
- Hypoglycemia was defined based on serum glucose levels relative to infant age (<35 mg/dl at <3 hours, <40 mg/dl at 3-24 hours, <45 mg/dl at >24 hours).
Main Results:
- Hypoglycemia occurred in 8.1% of LGA infants and 14.7% of SGA infants.
- The mean age of hypoglycemia onset was 2.9 hours for LGA and 6.1 hours for SGA infants.
- Risk factors like meconium-stained amniotic fluid, maternal preeclampsia, and male sex were more common in hypoglycemic SGA infants.
Conclusions:
- Hypoglycemia screening in non-diabetic mothers' LGA infants can cease after 12 hours.
- Continuous hypoglycemia screening for up to 48 hours is recommended for SGA infants.
- These findings provide evidence-based guidelines for optimizing hypoglycemia surveillance in at-risk newborns.
Abstract:
Although various authors recommend screening for hypoglycemia in large for gestational age (LGA) and small for gestational age (SGA) newborns, the frequency of hypoglycemia in these infants, using a recent definition of hypoglycemia, and the proper duration of screening are not documented. We determined chromogen test strip blood glucose values at ages 1, 2, 3, 6, 12, 24, 36, and 48 hours in full-term LGA and SGA infants whose mothers were not diabetic. Serum glucose determination was immediately done if a test strip reading was less than 40 mg/dl. Hypoglycemia was defined as a serum glucose less than 35 mg/dl at less than 3 hours of age, less than 40 mg/dl at 3 to 24 hours of age, and less than 45 mg/dl at more than 24 hours of age. The frequency of hypoglycemia in LGA infants was 8.1% (95% confidence interval [CI] 5.0 to 11.2%), and in SGA infants, 14.7% (95% CI 9.8 to 19.6%). The mean age at which hypoglycemia occurred was 2.9 hours (range, 0.8 to 8.5) in LGA infants, and 6.1 hours (range, 0.8 to 34.2) in SGA infants. There were no differences in other possible risk factors between the hypoglycemic and euglycemic infants except that in SGA infants meconium-stained amniotic fluid (40% vs 20%, p = .001), maternal preeclampsia (27% vs 8%, p = 0.0056), and male sex (29% vs 9%, p = 0.029) were more common in hypoglycemic than in euglycemic infants. These data suggest that screening for hypoglycemia in LGA infants whose mothers are not diabetic may be stopped after 12 hours, but should continue for 48 hours in SGA infants.