College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.
Division of Neonatology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee.
Am J Perinatol. 2024 May;41(S 01):e2842-e2849. doi: 10.1055/a-2173-8360. Epub 2023 Sep 12.
Preterm infants have a higher rate of hypoglycemia and hyperglycemia, both of which have been associated with increased neonatal morbidities. The aim of this study was to evaluate the incidence of abnormal glucose homeostasis during the first 72 hours of life and study its association with major morbidities in infants admitted to our neonatal intensive care unit (NICU).
This was a retrospective single-center study. We extracted demographic, maternal, and patient information and blood glucose levels for the first 72 hours of life for all infants with birth weight ≤1,000 g admitted to the NICU from January 2017 to December 2019. Continuous data were presented as mean ± standard deviation or as median with interquartile range. Categorical data were presented as frequency and percentage. Student's -tests and Mann-Whitney U test were used to analyze continuous data and chi-squared test or Fisher's exact test were used to analyze categorical data. Logistic regression analysis was performed to study the relation between hyperglycemia and various morbidities after controlling for gestational age (GA). Statistical significance was set at < 0.05.
Of the 235 infants included in the study, 49% were hypoglycemic at admission to the NICU. Infants that were small for GA and those with history of maternal β-blocker use had a higher incidence of hypoglycemia. Hypoglycemia at admission was not associated with increased mortality or any major morbidities. Seventy-three percent infants who were hypoglycemic or euglycemic at birth developed iatrogenic hyperglycemia during the first 72 hours of life. The incidence of retinopathy of prematurity (ROP) and severe ROP was higher in infants with hyperglycemia on univariate analysis. However, on multivariate analysis, after adjusting for GA, no difference was noted in the incidence of ROP between the two groups. Multivariate analysis could not be performed for severe ROP due to inadequate sample size.
Hyperglycemia in the initial 3 days of life is associated with an increased incidence of severe ROP in preterm infants. Neonatologists should aim to maintain euglycemia in these infants to decrease the risk of adverse outcomes.
· Preterm infants have a high rate of both hypoglycemia and hyperglycemia.. · Majority of infants who were euglycemic or hypoglycemic at birth develop iatrogenic hyperglycemia.. · Hyperglycemia in the initial 3 days of life is associated with an increased incidence of severe ROP in preterm infants..
早产儿低血糖和高血糖的发生率均较高，两者均与新生儿发病率增加有关。本研究的目的是评估出生后前 72 小时内异常血糖稳态的发生率，并研究其与入住新生儿重症监护病房（NICU）的婴儿的主要并发症之间的关系。
这是一项回顾性单中心研究。我们提取了 2017 年 1 月至 2019 年 12 月所有出生体重≤1000g 的婴儿在 NICU 住院期间的人口统计学、产妇和患者信息以及前 72 小时的血糖水平。连续数据表示为平均值±标准差或中位数及四分位距。分类数据表示为频率和百分比。采用学生 t 检验和曼-惠特尼 U 检验分析连续数据，采用卡方检验或 Fisher 确切概率法分析分类数据。在校正胎龄（GA）后，采用 logistic 回归分析研究高血糖与各种并发症之间的关系。统计显著性水平设置为 P＜0.05。
在 235 名纳入研究的婴儿中，49%在入住 NICU 时出现低血糖。GA 较小的婴儿和有使用β受体阻滞剂史的婴儿低血糖发生率较高。入院时的低血糖与死亡率增加或任何主要并发症无关。出生时低血糖或血糖正常的婴儿中有 73%在出生后前 72 小时内发生医源性高血糖。在单变量分析中，高血糖婴儿的早产儿视网膜病变（ROP）和重度 ROP 的发生率较高。然而，在校正 GA 后，两组间 ROP 的发生率无差异。由于样本量不足，无法对重度 ROP 进行多变量分析。
出生后前 3 天的高血糖与早产儿重度 ROP 的发生率增加有关。新生儿科医生应努力使这些婴儿保持血糖正常，以降低不良结局的风险。
· 早产儿低血糖和高血糖的发生率均较高。
· 出生时血糖正常或低血糖的婴儿中，大多数在出生后第 1 至 3 天发生医源性高血糖。
· 出生后前 3 天的高血糖与早产儿重度 ROP 的发生率增加有关。
