Division of Neonatology, Department of Pediatrics, 24998 NYU Langone Hospital - Long Island, NYU Grossman Long Island School of Medicine , Mineola, NY, USA.
Division of Neonatology, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
J Pediatr Endocrinol Metab. 2024 Jul 8;37(8):686-692. doi: 10.1515/jpem-2023-0573. Print 2024 Aug 27.
Detecting and treating severe hypoglycemia promptly after birth is crucial due to its association with adverse long-term neurodevelopmental outcomes. However, limited data are available on the optimal timing of glucose screening in asymptomatic high-risk neonates prone to hypoglycemia. Risk factors associated with asymptomatic high-risk neonates include late prematurity ≥35 and <37 weeks gestation (LPT), small-for-gestational-age (SGA), large-for-gestational-age (LGA), and infant-of-a-diabetic mother (IDM). This study aims to determine the incidence and the impact of individual risk factors on early hypoglycemia (defined as blood glucose ≤25 mg/dL in the initial hour after birth) in asymptomatic high-risk neonates.
All asymptomatic high-risk neonates ≥35 weeks gestation underwent early blood glucose screening within the first hour after birth (n=1,690). A 2-year retrospective analysis was conducted to assess the incidence of early neonatal hypoglycemia in this cohort and its association with hypoglycemia risk factors.
Out of the 9,919 births, 1,690 neonates (17 %) had risk factors for neonatal hypoglycemia, prompting screening within the first hour after birth. Incidence rates for blood glucose ≤25 mg/dL and ≤15 mg/dL were 3.1 and 0.89 %, respectively. Of concern, approximately 0.5 % of all asymptomatic at-risk neonates had a blood glucose value of ≤10 mg/dL. LPT and LGA were the risk factors significantly associated with early neonatal hypoglycemia.
Asymptomatic high-risk neonates, particularly LPT and LGA neonates, may develop early severe neonatal hypoglycemia identified by blood glucose screening in the first hour of life. Additional investigation is necessary to establish protocols for screening and managing asymptomatic high-risk neonates.
由于严重低血糖与不良长期神经发育结局相关，因此及时发现和治疗出生后的严重低血糖至关重要。然而，无症状高危低血糖新生儿的最佳葡萄糖筛查时机的数据有限。与无症状高危新生儿相关的危险因素包括晚期早产儿≥35 周和<37 周（LPT）、小于胎龄儿（SGA）、大于胎龄儿（LGA）和糖尿病母亲婴儿（IDM）。本研究旨在确定个体危险因素对无症状高危新生儿早期低血糖（定义为出生后 1 小时内血糖≤25mg/dL）的发生率和影响。
所有≥35 周的无症状高危新生儿均在出生后 1 小时内进行早期血糖筛查（n=1690）。对该队列进行了为期 2 年的回顾性分析，以评估新生儿早期低血糖的发生率及其与低血糖危险因素的关系。
在 9919 例分娩中，1690 例（17%）新生儿有新生儿低血糖的危险因素，提示在出生后 1 小时内进行筛查。血糖≤25mg/dL 和≤15mg/dL 的发生率分别为 3.1%和 0.89%。值得关注的是，约 0.5%的所有无症状高危新生儿血糖值≤10mg/dL。LPT 和 LGA 是与早期新生儿低血糖显著相关的危险因素。
无症状高危新生儿，尤其是 LPT 和 LGA 新生儿，可能会在生命的头 1 小时内通过血糖筛查发现早期严重新生儿低血糖。需要进一步研究以制定筛查和管理无症状高危新生儿的方案。
