Department of Neonatology, Ruth Rappaport Children's Hospital, Haifa Israel, Rambam Health Care Campus, Bat-Galim, Haifa, 31096, Israel.
The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
World J Pediatr. 2017 Oct;13(5):433-438. doi: 10.1007/s12519-017-0016-7. Epub 2017 Feb 14.
Neonatal hypoglycemia (NH) and cutoffs remain undefined. Our center screens all cesarean-delivered (CD) neonates for NH. We sought to define standards of admission capillary blood glucose levels (ACBGLs) in CD neonates who were at the lowest risk for hypoglycemia.
Of 4947 neonates, 519 met all 14 inclusion criteria. These highly-selected neonates were apparently the healthiest, least-stressed, earliest to be admitted to nursery and at lowest-risk for hypoglycemia. For each CD, cord blood gases and glucose were determined and each infant was screened for blood glucose at nursery admission.
Sampling age was 41.6±15.3 minutes, a mean ACBGL of 52.3±10.7 mg/dL, and percentiles as follows: 1st percentile, 29.2; 3rd, 33.6; 5th, 35.0; 10th, 39.0; 25th, 46.0; 50th, 51.0; 75th, 58.0; 90th, 67.0; 95th, 71.0; 97th, 73.0, and 99th, 84.4. ACBGL rose significantly with increasing gestational age (P=0.004), increasing cord blood glucose (P<0.001), decreasing cord blood pH (P<0.001) and decreasing sampling age (P=0.027).
Setting uniform ACBGL cutoffs for NH definition is unachievable due to the enormous heterogeneity among newborns. Hence, we provide group-based ACBGL standards in CD neonates. We propose setting ACBGL cutoffs for use in CD neonates: 1) hypoglycemia: ACBGL <5th percentile (<35 mg/dL); and 2) interventional hypoglycemia: ACBGL <1st percentile (<30 mg/dL).
新生儿低血糖（NH）和切点仍未定义。我们中心对所有剖宫产分娩（CD）的新生儿进行 NH 筛查。我们旨在为低血糖风险最低的 CD 新生儿定义入院毛细血管血糖水平（ACBGL）的标准。
在 4947 名新生儿中，有 519 名符合所有 14 项纳入标准。这些高度选择的新生儿显然是最健康、压力最小、最早进入新生儿科病房且低血糖风险最低的。对于每个 CD，我们测定脐血血气和葡萄糖，并在新生儿科病房入院时筛查每个婴儿的血糖。
采样年龄为 41.6±15.3 分钟，平均 ACBGL 为 52.3±10.7mg/dL，百分位数如下：第 1 百分位数，29.2；第 3 百分位，33.6；第 5 百分位，35.0；第 10 百分位，39.0；第 25 百分位，46.0；第 50 百分位，51.0；第 75 百分位，58.0；第 90 百分位，67.0；第 95 百分位，71.0；第 97 百分位，73.0，第 99 百分位，84.4。ACBGL 随胎龄（P=0.004）、脐血葡萄糖（P<0.001）、脐血 pH（P<0.001）和采样年龄（P=0.027）的增加而显著升高。
由于新生儿之间存在巨大的异质性，因此为 NH 定义设定统一的 ACBGL 切点是不可能的。因此，我们为 CD 新生儿提供基于组的 ACBGL 标准。我们建议为 CD 新生儿设定 ACBGL 切点：1）低血糖：ACBGL<第 5 百分位（<35mg/dL）；2）干预性低血糖：ACBGL<第 1 百分位（<30mg/dL）。
