Department of Pediatrics, Neonatal Intensive Care Unit of the Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands.
Department of Pediatrics and Neonatology, OLVG, Amsterdam, the Netherlands.
Clin Nutr ESPEN. 2023 Aug;56:67-72. doi: 10.1016/j.clnesp.2023.05.001. Epub 2023 May 11.
To determine incidence, timing and potential risk factors associated with hypoglycemia in the first day of life in very premature infants.
Retrospective cohort study including all infants born before 32 weeks of gestation between 1 July 2017 and 31 December 2020 in the Erasmus MC Sophia Children's Hospital (Rotterdam, the Netherlands). Excluded were those who died within 24 h after birth or with no glucose data available. We collected maternal and neonatal characteristics from patient files, as well as all routine glucose values for the first 24 h. Hypoglycemia was defined as blood glucose value below 2.6 mmol/L. Risk factors were selected using univariable and multivariable logistic regression with stepwise backward elimination. Kaplan-Meier survival analysis was performed to examine time-to-event after birth.
Of 714 infants included (median gestational age 29.3 weeks, mean weight 1200 g), 137 (19%) had at least one episode of hypoglycemia, with a median time-to-event of 126 min [95%-CI 105-216]. Relevant independent risk factors for hypoglycemia included two maternal (insulin-dependent diabetes [OR 2.8; 95%-CI 1.3-6.1]; antenatal steroid administration [OR 1.7, 95%-CI 1.1-2.7]), and four neonatal factors (no IV-access in delivery room [OR 6.1, 95% CI-3.2-11.7], gestational age in weeks [OR 1.3, 95% CI-1.2-1.5], small-for-gestational-age [OR 2.6, 95%-CI 1.4-4.8], and no respiratory support (versus non-invasive support) [OR 2.3, 95%-CI 1.0-5.3]).
Six risk factors were identified for hypoglycemia in the first 24 h of life in very preterm infants, that can be used for development of prediction models, risk-based screening and updating guidelines.
确定极低出生体重儿生后第 1 天内发生低血糖的发生率、时间和潜在危险因素。
本研究为回顾性队列研究，纳入 2017 年 7 月 1 日至 2020 年 12 月 31 日在荷兰鹿特丹伊拉斯谟 MC 索菲亚儿童医院出生的所有胎龄<32 周的早产儿。排除生后 24 小时内死亡或无血糖数据的患儿。我们从病历中收集产妇和新生儿特征，以及生后 24 小时内的所有常规血糖值。低血糖定义为血糖值<2.6mmol/L。采用单变量和多变量逻辑回归进行逐步向后消除法筛选危险因素。采用 Kaplan-Meier 生存分析法检测生后时间与事件的关系。
本研究纳入 714 例患儿（中位胎龄 29.3 周，平均体重 1200g），137 例（19%）至少发生 1 次低血糖，中位时间为 126 分钟[95%可信区间 105-216]。低血糖的独立危险因素包括母亲的 2 个因素（依赖胰岛素的糖尿病[比值比 2.8；95%可信区间 1.3-6.1]；产前皮质激素治疗[比值比 1.7，95%可信区间 1.1-2.7]）和 4 个新生儿因素（产房无静脉通路[比值比 6.1，95%可信区间-3.2-11.7]，胎龄[比值比 1.3，95%可信区间-1.2-1.5]，小于胎龄儿[比值比 2.6，95%可信区间 1.4-4.8]，无呼吸支持（与非侵入性支持相比）[比值比 2.3，95%可信区间 1.0-5.3]）。
极低出生体重儿生后 24 小时内发生低血糖的 6 个危险因素可用于开发预测模型、基于风险的筛查和更新指南。
