Department of Pediatrics, Chi Mei Medical Center, Tainan City, Taiwan; Center for General Education, Southern Taiwan University of Science and Technology, Tainan City, 71005, Taiwan; School of Medicine, Kaohsiung Medical University, Kaohsiung City, 81201, Taiwan.
Department of Pediatrics, Chi Mei Medical Center, Tainan City, Taiwan; School of Medicine, Kaohsiung Medical University, Kaohsiung City, 81201, Taiwan; Department of Childhood Education and Nursery, Chia Nan University of Pharmacy and Science, Rende, Tainan City, 71710, Taiwan.
Pediatr Neonatol. 2023 Sep;64(5):538-546. doi: 10.1016/j.pedneo.2022.09.021. Epub 2023 Feb 22.
Neonatal hypoglycemia is a common metabolic occurrence among small for gestational age (SGA) neonates. This study aims to determine the incidence of early neonatal hypoglycemia and confirms the potential risk factors among term and late preterm SGA neonates in a well-baby newborn nursery of a tertiary medical center in Southern Taiwan.
We performed a retrospective medical record review of term and late preterm SGA (birth weight <10 percentile) neonates, born between January 1, 2012 and December 31, 2020, in the well-baby newborn nursery, of a tertiary medical center in Southern Taiwan. Blood glucose monitoring was routinely performed at 0.5, 1, 2, and 4 h of life. Antenatal and postnatal risk factors were recorded. Mean blood glucose level, age of occurrence, symptomatic hypoglycemia, and need for intravenous glucose treatment of early hypoglycemia in SGA neonates were documented.
690 SGA neonates in the nursery met the criteria and were retrospectively enrolled in the study, 358 of whom (51.80%) were male and 332 (48.10%) female. Of 690 enrolled SGA neonates, 134(19.42%) SGA neonates developed hypoglycemia during a well-baby nursery stay. Among these neonates, 97% of early hypoglycemic episodes occur during the first 2 h of life. The lowest blood glucose level was 46.78 ± 11.13 mg/dL, recorded in the first hour of life. Among the hypoglycemic 134 neonates, 26 (19.40%) neonates had to be transferred from the nursery to the neonatal ward and they required intravenous glucose treatment to achieve euglycemia. 14 (10.40%) neonates had symptomatic hypoglycemia. A multivariate logistic regression analysis revealed that cesarean delivery, small head circumference, small chest circumference, and low 1-min Apgar score were significant risk factors for early hypoglycemia in these neonates.
Periodic routine blood glucose level monitoring within the first 4 h of life in term and late preterm SGA neonates is required, especially those with cesarean delivery and low Apgar score.
小于胎龄儿（SGA）新生儿中，新生儿低血糖是一种常见的代谢异常。本研究旨在确定在台湾南部一家三级医学中心的新生儿重症监护病房中足月和晚期早产儿 SGA 新生儿中早期新生儿低血糖的发生率，并确定其潜在的危险因素。
我们对 2012 年 1 月 1 日至 2020 年 12 月 31 日期间在台湾南部一家三级医学中心新生儿重症监护病房出生的足月和晚期早产儿（出生体重<第 10 百分位）SGA 新生儿进行了回顾性病历回顾。在出生后 0.5、1、2 和 4 小时常规进行血糖监测。记录了产前和产后的危险因素。记录了 SGA 新生儿的平均血糖水平、发病年龄、症状性低血糖和需要静脉葡萄糖治疗的早期低血糖的发生率。
在新生儿重症监护病房中，有 690 名 SGA 新生儿符合标准并被回顾性纳入研究，其中 358 名（51.80%）为男性，332 名（48.10%）为女性。在纳入的 690 名 SGA 新生儿中，有 134 名（19.42%）在新生儿重症监护病房期间发生低血糖。在这些新生儿中，97%的早期低血糖发作发生在生命的前 2 小时内。记录到的最低血糖水平为 46.78±11.13mg/dL，发生在生命的第一个小时内。在 134 名低血糖的新生儿中，有 26 名（19.40%）新生儿需要从新生儿重症监护病房转入新生儿病房，并需要静脉葡萄糖治疗以达到血糖正常。14 名（10.40%）新生儿出现症状性低血糖。多变量逻辑回归分析显示，剖宫产、小头围、小胸围和低 1 分钟 Apgar 评分是这些新生儿早期低血糖的显著危险因素。
需要对足月和晚期早产儿 SGA 新生儿在生命的前 4 小时内定期进行常规血糖水平监测，尤其是那些剖宫产和低 Apgar 评分的新生儿。
