Irvine Lauren M, Harris Deborah L
School of Nursing, Midwifery, and Health Practice, Faculty of Health, Victoria University of Wellington - Te Herenga Waka, Deborah Harris Level 7, Clinical Services Block, Wellington Regional Hospital, Newtown, Wellington, 6021, New Zealand.
Liggins Institute, University of Auckland, Auckland, New Zealand.
Matern Health Neonatol Perinatol. 2023 Jun 1;9(1):8. doi: 10.1186/s40748-023-00162-4.
Over 25 years ago, the World Health Organization (WHO) acknowledged the importance of effective prevention, detection and treatment of neonatal hypoglycaemia, and declared it to be a global priority. Neonatal hypoglycaemia is common, linked to poor neurosensory outcomes and, if untreated, can cause seizures and death. Neonatal mortality in low and lower-middle income countries constitutes an estimated 89% of overall neonatal deaths. Factors contributing to high mortality rates include malnutrition, infectious diseases, poor maternal wellbeing and resource constraints on both equipment and staff, leading to delayed diagnosis and treatment. The incidence of neonatal hypoglycaemia in low and lower-middle income countries remains unclear, as data are not collected.Data from high-resource settings shows that half of all at-risk babies will develop hypoglycaemia, using accepted clinical thresholds for treatment. Most at-risk babies are screened and treated, with treatment aiming to increase blood glucose concentration and, therefore, available cerebral fuel. The introduction of buccal dextrose gel as a first-line treatment for neonatal hypoglycaemia has changed the care of millions of babies and families in high-resource settings. Dextrose gel has now also been shown to prevent neonatal hypoglycaemia.In low and lower-middle income countries, there are considerable barriers to resources which prevent access to reliable blood glucose screening, diagnosis, and treatment, leading to inequitable health outcomes when compared with developed countries. Babies born in low-resource settings do not have access to basic health care and are more likely to suffer from unrecognised neonatal hypoglycaemia, which contributes to the burden of neurosensory delay and death.
25 多年前，世界卫生组织（WHO）就认识到有效预防、检测和治疗新生儿低血糖的重要性，并将其列为全球重点事项。新生儿低血糖很常见，与不良的神经感觉预后相关，若不治疗，可能导致癫痫发作和死亡。在低收入和中低收入国家，新生儿死亡人数估计占全球新生儿死亡总数的 89%。导致高死亡率的因素包括营养不良、传染病、孕产妇健康状况不佳以及设备和人员方面的资源限制，进而导致诊断和治疗延误。由于未收集相关数据，低收入和中低收入国家新生儿低血糖的发病率尚不清楚。高资源环境下的数据显示，按照公认的治疗临床阈值，所有有风险的婴儿中有一半会出现低血糖。大多数有风险的婴儿都接受了筛查和治疗，治疗旨在提高血糖浓度，从而增加大脑可用的能量来源。颊部葡萄糖凝胶作为新生儿低血糖的一线治疗方法的引入，改变了高资源环境下数百万婴儿及其家庭的护理状况。现已证明葡萄糖凝胶还能预防新生儿低血糖。在低收入和中低收入国家，获取资源存在相当大的障碍，这妨碍了获得可靠的血糖筛查、诊断和治疗，与发达国家相比，导致了不公平的健康结果。在资源匮乏地区出生的婴儿无法获得基本医疗保健，更有可能患有无症状的新生儿低血糖，这增加了神经感觉发育迟缓及死亡的负担。
