Impacts of Hypoglycemia in At-Risk Infants on Admissions to Level-3 Neonatal Units in a Tertiary-Care Hospital

Abstract

Introduction: Hypoglycemia is frequent in level-1 postnatal units (PNU), which can result in many transfers to the level-3 neonatal unit (NNU). Objectives: This study reports on hypoglycemia (capillary blood glucose <2.5 mmol/L in the first 24 h) in at-risk infants. Its main objective was to evaluate the impact of hypoglycemia in level-1 PNU on level-3 NNU admissions. Methods: The study was retrospective, conducted between January 01, 2018 and December 31, 2018. Inclusion criteria were infants in the PNU who were: 1) late-preterm (35≤ weeks’ gestation <37), 2) infants-of-diabetic mothers (IDM), and/or 3) low (2.0–2.5 kg) or high (>4.0 kg) birthweight. Results: Of the 3192 deliveries, 983 (31%) were eligible for study enrollment; 77% were IDM and 19% late-preterm. A total of 192 (19.5%) newborns had hypoglycemia in the first 4 h and 42 (4.3%) within 4–24 h. Twenty-two (2.2%) newborns were transferred to NNU, 17 in first 4 h and five within 4–24 h. Overall, independent predictors of NNU transfer were late-preterm, cesarean delivery, and glucose measurement <1.5 h ( P ≤ 0.019). Independent predictors of hypoglycemia in the first 4 h were late-preterm, cesarean delivery, glucose measurement before feeding, and glucose measurement <1.5 h ( P ≤ 0.045). The independent predictor of hypoglycemia within 4–24 h was cesarean delivery ( P = 0.017). Ten neonates had blood glucose ≤1.0 mmol/L; they all required NNU transfer for intravenous glucose. Conclusion: This study shows frequent low glucose readings in these infants (overall prevalence, 23.8%) and confirms the need for clinical observation and regular monitoring. It is prudent to initiate and maintain proper feeding and to adhere to evidence-based guidelines.