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Azevedo N, Liberatore Junior RDR, Camelo Junior JS, Aragon DC, Martinelli Junior CE. Continuous interstitial glucose monitoring for term newborns: analysis of the first day of life. Arch Dis Child Fetal Neonatal Ed 2023; 109:100-105. [PMID: 37580119 DOI: 10.1136/archdischild-2022-325191] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 08/04/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVE Glycaemia in newborns changes significantly after birth; however, little is known about these changes. The objective was to describe continuous interstitial glucose values in term newborns who were exclusively breast fed on the first day of life. DESIGN We studied 159 newborns with appropriate weights for gestational age, who were exclusively breast fed on the first day of life, using a continuous glucose monitoring device that calculates interstitial glucose every 5 min. The device was removed after 24 hours, and the results were analysed using the R program, which provides the minimum, maximum, median and a standard curve with centiles. RESULTS At the second hour of life, the moment in which the sensor started to identify the newborn's glycaemia, interstitial glucose levels were 2.59-4.43 mmol/L (46.7-79.9 mg/dL). The median interstitial glucose level of the newborns during the first day of life was 3.33±0.48 mmol/L (60±8.6 mg/dL). Interstitial glucose levels dropped until the sixth hour of life, reaching 2.19-3.95 mmol/L (39.5-71.1 mg/dL), and then increased again. The maximum values were found at the 20th and 21st hours of life, which were 2.81-4.64 mmol/L (50.6-83.6 mg/dL). CONCLUSION The interstitial glucose during the first 24 hours of life declined until the sixth hour of life, then increased around the 20th hour and remained stable until the end of the first day of life.
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Affiliation(s)
- Nathália Azevedo
- Department of Pediatrics, Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto, Ribeirao Preto, São Paulo, Brazil
| | | | - José Simon Camelo Junior
- Department of Pediatrics, Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto, Ribeirao Preto, São Paulo, Brazil
| | - Davi Casale Aragon
- Department of Pediatrics, Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto, Ribeirao Preto, São Paulo, Brazil
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Hauschild M, Monnard C, Eldridge AL, Antoniou MC, Bouthors T, Hansen E, Dwyer AA, Rytz A, Darimont C. Glucose variability in 6-12-month-old healthy infants. Front Nutr 2023; 10:1128389. [PMID: 37502727 PMCID: PMC10369064 DOI: 10.3389/fnut.2023.1128389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/15/2023] [Indexed: 07/29/2023] Open
Abstract
Background Metabolic programming of glucose homeostasis in the first 1,000 days of life may impact lifelong metabolic and cardiovascular health. Continuous glucose monitoring (CGM) devices may help measure the impact of dietary intake on glucose rhythms and metabolism in infants during the complementary feeding period. Objectives Demonstrate the feasibility of CGM to measure and quantify glucose variability in response to infant feeding and to evaluate associations between macronutrient meal composition and glucose variability. Methods The "FreeStyle Libre Pro®" device interstitial glucose meter was applied to the anterior thigh of 10 healthy 6-12-month-old infants. Parents recorded food intake, time of feeding, and used daily dairies to record sleep time and duration. Descriptive statistics were employed for food intake, sleep and key glycemic parameters over three full days. Mixed linear models were used to assess glycemic changes. Results Mid-day, afternoon, and evening feeds contained >30 g carbohydrate and induced higher 2-h iAUC (3.42, 3.41, and 3.50 mmol/L*h respectively) compared to early and mid-morning feedings with ≤25 g carbohydrates (iAUC 2.72 and 2.81 mmol/L*h, p < 0.05). Early morning and evening milk feedings contained approximately 9 g of fat and induced a longer time to reach maximal glucose value (Tmax; 75 and 68 min, respectively) compared to lower fat feedings (2.9-5.9 g; Tmax range: 34-60 min; p < 0.05). Incremental glucose value at time of food intake (C0) increased significantly from 0.24 ± 0.39 mM in early morning to 1.07 ± 0.57 mM in the evening (p < 0.05). Over the day, 70% of glucose values remained within the normal range (3.5-5.5 mmol/L), 10% were between 5.5-10 mmol/L, and 20% were < 3.5 mmol/L. Conclusion Our data support the feasibility of using CGM to measure glucose in 6-12-month-old infants. The observation of possible diurnal glucose variability and typical glucose values may have implications for future studies investigating metabolic adaptation to nutritional intake in early life.
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Affiliation(s)
- Michael Hauschild
- Pediatric Endocrinology, Diabetes and Obesity Unit, Department Woman-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Cathriona Monnard
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland
| | - Alison L. Eldridge
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland
| | - Maria Christina Antoniou
- Pediatric Endocrinology, Diabetes and Obesity Unit, Department Woman-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Thérèse Bouthors
- Pediatric Endocrinology, Diabetes and Obesity Unit, Department Woman-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Erik Hansen
- Pediatric Endocrinology, Diabetes and Obesity Unit, Department Woman-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Andrew A. Dwyer
- Boston College, William F. Connell School of Nursing, Chestnut Hill, MA, United States
| | - Andreas Rytz
- Clinical Research Unit, Nestlé Research, Lausanne, Switzerland
| | - Christian Darimont
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland
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Damhuis SE, Kamphof HD, Ravelli ACJ, Gordijn SJ, Ganzevoort WJ. Perinatal mortality rate and adverse perinatal outcomes presumably attributable to placental dysfunction in (near) term gestation: A nationwide 5-year cohort study. PLoS One 2023; 18:e0285096. [PMID: 37141189 PMCID: PMC10159202 DOI: 10.1371/journal.pone.0285096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/14/2023] [Indexed: 05/05/2023] Open
Abstract
INTRODUCTION Placental dysfunction can lead to perinatal hypoxic events including stillbirth. Unless there is overt severe fetal growth restriction, placental dysfunction is frequently not identified in (near) term pregnancy, particularly because fetal size is not necessarily small. This study aimed to evaluate, among (near) term births, the burden of hypoxia-related adverse perinatal outcomes reflected in an association with birth weight centiles as a proxy for placental function. MATERIAL AND METHOD A nationwide 5-year cohort of the Dutch national birth registry (PeriNed) including 684,938 singleton pregnancies between 36+0 and 41+6 weeks of gestation. Diabetes, congenital anomalies, chromosomal abnormalities and non-cephalic presentations at delivery were excluded. The main outcome was antenatal mortality rate according to birthweight centiles and gestational age. Secondary outcomes included perinatal hypoxia-related outcomes, including perinatal death and neonatal morbidity, analyzed according to birthweight centiles. RESULTS Between 2015 and 2019, 1,074 perinatal deaths (0.16%) occurred in the study population (n = 684,938), of which 727 (0.10%) antenatally. Of all antenatal- and perinatal deaths, 29.4% and 27.9% occurred in birthweights below the 10th centile. The incidence of perinatal hypoxia-related outcomes was highest in fetuses with lowest birthweight centiles (18.0%), falling gradually up to the 50th and 90th centile where the lowest rates of hypoxia-related outcomes (5.4%) were observed. CONCLUSION Perinatal hypoxia-related events have the highest incidence in the lowest birthweight centiles but are identifiable throughout the entire spectrum. In fact, the majority of the adverse outcome burden in absolute numbers occurs in the group with a birthweight above the 10th centile. We hypothesize that in most cases these events are attributable to reduced placental function. Additional diagnostic modalities that indicate placental dysfunction at (near) term gestation throughout all birth weight centiles are eagerly wanted.
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Affiliation(s)
- Stefanie Elisabeth Damhuis
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Amsterdam Reproduction and Development Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Hester Dorien Kamphof
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anita C. J. Ravelli
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, University of Amsterdam, Amsterdam, The Netherlands
- Department of Medical Informatics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Sanne Jehanne Gordijn
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Wessel J. Ganzevoort
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, University of Amsterdam, Amsterdam, The Netherlands
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Muacevic A, Adler JR, P. Murthi S, Alsaffar H, Al Mandhari H. Predictors of the Need to Use Medications in the Management of Neonatal Hypoglycemia. Cureus 2022; 14:e32197. [PMID: 36620829 PMCID: PMC9811335 DOI: 10.7759/cureus.32197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2022] [Indexed: 12/12/2022] Open
Abstract
Background and objective Neonatal hypoglycemia (NH) is one of the most common causes of admission to the neonatal intensive care unit (NICU). Persistent NH despite adequate feeding and intravenous dextrose may often require medications to maintain normal blood glucose levels (BGL). Several medications are used in the management of persistent NH, such as glucagon, diazoxide, and octreotide. In this study, we aimed to determine the factors that predict the need for medications to treat persistent NH. Methods This was a retrospective cohort study conducted at the Sultan Qaboos University Hospital (SQUH), Muscat, Oman. Infants admitted to the NICU between 2015 and 2019 with hypoglycemia (capillary blood glucose <2.6 mmol/l) were eligible to be included in the study. A prespecified dataset was collected from electronic patient records, including birth weight (BW), APGAR scores, gestational age, BGL, maternal risk factors such as diabetes mellitus (DM), hypertension, or antenatal use of medications, and the NICU management during admission. Data analysis was performed using SPSS Statistics for Windows, version 27.0 (IBM Corp., Armonk, NY). Results A total of 89 neonates were admitted due to NH during the study period. Of them, 10 (11.2%) patients had received medication (diazoxide). Use of medication for persistent NH was significantly associated with maternal gestational diabetes/diabetes mellitus (GDM/DM) status (p=0.041), higher BW (p=0.001), and large for gestational age [LGA (defined as BW >90th percentile)] (p=0.014), severe hypoglycemia (mean glucose level of 1-1.5 mmol/l) at two hours of life and at admission, and elevated maximum glucose infusion rate (GIR). GIR for the medication-requiring cohort was 12.95 mg/kg/min and that for the non-medication-requiring cohort was 6.77 mg/kg/min (p<0.001). Conclusion Based on our findings, the need for using certain medications to treat persistent NH, such as diazoxide in neonates admitted with NH, can be predicted by factors such as maternal GDM/DM status, BW >90th percentile, very low BGL at two hours of age and on admission, and elevated GIR. Elevated maximum GIR was a leading indicator for using medications in the treatment of NH.
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Ruiz NM, García Íñiguez JP, Rite Gracia S, Samper Villagrasa MP. Prospective study on influence of perinatal factors on the development of early neonatal hypoglycemia in late preterm and term infants. An Pediatr (Barc) 2022; 96:230-241. [DOI: 10.1016/j.anpede.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 04/06/2021] [Indexed: 10/18/2022] Open
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Horwitz J, Mardiros L, Musa A, Welch VA, Hodgson A, Narvey M, Ghazzawi A, Shea B, Saginur M. Scoping review of evidence for managing postnatal hypoglycaemia. BMJ Open 2022; 12:e053047. [PMID: 35135768 PMCID: PMC8830267 DOI: 10.1136/bmjopen-2021-053047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To identify what is known empirically about the screening, treatment and harm of exposure to neonatal hypoglycaemia. DESIGN Scoping review that applied a preregistered protocol based on established frameworks. DATA SOURCES Medline and Embase, up to 12 May 2020. STUDY SELECTION Comparative and case-series studies, as well as guidelines, published in English or French, on the topic of immediate inpatient postnatal glucose screening in newborns. DATA GATHERING Article selection and characterisation were performed in duplicate using predefined data extraction forms specific to primary studies and guidelines. RESULTS 12 guidelines and 74 primary studies were included. A neurodevelopmental outcome was primary in 32 studies: 30 observational studies followed up posthypoglycaemic, and the 2 intervention studies included 1 randomised controlled trial (RCT) about treatment thresholds. Three other RCTs assessed dextrose gel (two) and oral sucrose (one). 12 of 30 studies that evaluated non-neurodevelopmental primary outcomes were intervention studies. Only one cohort study compared outcomes in screened vs unscreened newborns. The guidelines did not arrive at a consensus definition of postnatal hypoglycaemic, and addressed potential harms of screening more often than primary studies. CONCLUSIONS The primary literature that informs hypoglycaemia screening is a series of studies that relate neurodevelopmental outcomes to postnatal hypoglycaemia. Further research is needed to better define an optimal threshold for hypoglycaemia that warrants intervention, based on long-term neurodevelopmental outcomes and a better delineation of potential screening harms.
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Affiliation(s)
- Jennifer Horwitz
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Linda Mardiros
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ahmed Musa
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Vivian A Welch
- Bruyère Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Michael Narvey
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Andrea Ghazzawi
- Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada
| | - Beverley Shea
- Bruyère Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Michael Saginur
- Montfort Hospital, Ottawa, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Meneghin F, Manzalini M, Acunzo M, Daniele I, Bastrenta P, Castoldi F, Cavigioli F, Zuccotti GV, Lista G. Management of asymptomatic hypoglycemia with 40% oral dextrose gel in near term at-risk infants to reduce intensive care need and promote breastfeeding. Ital J Pediatr 2021; 47:201. [PMID: 34627324 PMCID: PMC8500822 DOI: 10.1186/s13052-021-01149-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 09/13/2021] [Indexed: 11/23/2022] Open
Abstract
Background Neonatal hypoglycemia is a common disorder especially in at-risk infants and it can be associated with poor long-term neurological outcomes. Several therapeutic interventions are suggested, from the implementation of breastfeeding to the glucose intravenous administration. Oral dextrose gel massaged into the infant’s inner cheek is a recent treatment option of asymptomatic hypoglycemia, after which oral feeding is encouraged. This approach seems to reduce the admission of infants to neonatal intensive care unit (NICU) so favouring maternal bonding and breastfeeding success at discharge. Methods In our ward, we prospectively compared a group of near-term neonates, (Gr2, n = 308) at risk for hypoglycemia, treated with an innovative protocol based on the addition of 40% oral dextrose gel (Destrogel, Orsana®,Italy) administered by massaging gums and cheek with historical matching newborns (Gr1, n = 389) treated with a formerly used protocol, as control group. The primary outcome was occurrence of NICU admission and the requirement of intravenous glucose administration; while discharge with full breastfeeding was the secondary outcome. Results In Gr1, 39/389 (10%) infants presented with asymptomatic hypoglycemia, 19/39 were transferred to the NICU, and 14/39 required intravenous glucose treatment. In Gr2, among the 30/308 infants with asymptomatic hypoglycemia managed according to the new protocol, 3/30 were transferred to the NICU and received intravenous glucose infusion. The mean duration of hospitalization respectively was 6.43 (± 6.36) and 3.73 ± 1.53 days (p < 0.001). At discharge, 7.7% of the infants in Gr1 and 30% of the infants in Gr2 were exclusively breastfed (p = 0.02). Considering Gr1 vs Gr2, the number of patients that were transferred to NICU was 19 (48.7%) vs 3 (10%) (p = 0.001) and the number of infants that needed intravenous glucose infusion was 14 (35.9%) vs 3 (10%) (p = 0.01), respectively. Conclusions In our population of near term infants, the introduction of 40% oral dextrose gel to the protocol, helped in the safe management of asymptomatic hypoglycemia and, at the same time, implemented breastfeeding.
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Affiliation(s)
- Fabio Meneghin
- NICU, Department of Pediatrics, V. Buzzi Children's Hospital, ASST-FBF-Sacco, Milan, Italy.
| | - Martina Manzalini
- Department of Pediatrics, University of Milan, V. Buzzi Children's Hospital, ASST-FBF-Sacco, Milan, Italy
| | - Miriam Acunzo
- Department of Pediatrics, University of Milan, V. Buzzi Children's Hospital, ASST-FBF-Sacco, Milan, Italy
| | - Irene Daniele
- NICU, Department of Pediatrics, V. Buzzi Children's Hospital, ASST-FBF-Sacco, Milan, Italy
| | - Petrina Bastrenta
- NICU, Department of Pediatrics, V. Buzzi Children's Hospital, ASST-FBF-Sacco, Milan, Italy
| | - Francesca Castoldi
- NICU, Department of Pediatrics, V. Buzzi Children's Hospital, ASST-FBF-Sacco, Milan, Italy
| | - Francesco Cavigioli
- NICU, Department of Pediatrics, V. Buzzi Children's Hospital, ASST-FBF-Sacco, Milan, Italy
| | - Gian Vincenzo Zuccotti
- Department of Pediatrics, University of Milan, V. Buzzi Children's Hospital, ASST-FBF-Sacco, Milan, Italy
| | - Gianluca Lista
- NICU, Department of Pediatrics, V. Buzzi Children's Hospital, ASST-FBF-Sacco, Milan, Italy
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Yang J, Hammoud B, Li C, Ridler A, Yau D, Kim J, Won KJ, Stanley CA, Hoshi T, Stanescu DE. Decreased KATP Channel Activity Contributes to the Low Glucose Threshold for Insulin Secretion of Rat Neonatal Islets. Endocrinology 2021; 162:6301135. [PMID: 34134142 PMCID: PMC8276892 DOI: 10.1210/endocr/bqab121] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Indexed: 12/12/2022]
Abstract
Transitional hypoglycemia in normal newborns occurs in the first 3 days of life and has clinical features consistent with hyperinsulinism. We found a lower threshold for glucose-stimulated insulin secretion from freshly isolated embryonic day (E) 22 rat islets, which persisted into the first postnatal days. The threshold reached the adult level by postnatal day (P) 14. Culturing P14 islets also decreased the glucose threshold. Freshly isolated P1 rat islets had a lower threshold for insulin secretion in response to 2-aminobicyclo-(2, 2, 1)-heptane-2-carboxylic acid, a nonmetabolizable leucine analog, and diminished insulin release in response to tolbutamide, an inhibitor of β-cell KATP channels. These findings suggested that decreased KATP channel function could be responsible for the lower glucose threshold for insulin secretion. Single-cell transcriptomic analysis did not reveal a lower expression of KATP subunit genes in E22 compared with P14 β cells. The investigation of electrophysiological characteristics of dispersed β cells showed that early neonatal and cultured cells had fewer functional KATP channels per unit membrane area. Our findings suggest that decreased surface density of KATP channels may contribute to the observed differences in glucose threshold for insulin release.
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Affiliation(s)
- Juxiang Yang
- Division of Endocrinology and Diabetes, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Batoul Hammoud
- Division of Endocrinology and Diabetes, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Changhong Li
- Division of Endocrinology and Diabetes, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Abigail Ridler
- Division of Endocrinology and Diabetes, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Daphne Yau
- Division of Endocrinology and Diabetes, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Junil Kim
- Biotech Research & Innovation Centre, University of Copenhagen, DK-2200 Copenhagen N, Denmark
- School of Systems Biomedical Science, Soongsil University, Seoul 06978, South Korea
| | - Kyoung-Jae Won
- Biotech Research & Innovation Centre, University of Copenhagen, DK-2200 Copenhagen N, Denmark
| | - Charles A Stanley
- Division of Endocrinology and Diabetes, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Toshinori Hoshi
- Department of Physiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Diana E Stanescu
- Division of Endocrinology and Diabetes, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Correspondence: Diana Elena Stanescu, MD, The Children's Hospital of Philadelphia, Abramson Pediatric Research Center, 3615 Civic Center Blvd, #802G, Philadelphia, PA 19104, USA.
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Reyes-Sotelo B, Mota-Rojas D, Mora-Medina P, Ogi A, Mariti C, Olmos-Hernández A, Martínez-Burnes J, Hernández-Ávalos I, Sánchez-Millán J, Gazzano A. Blood Biomarker Profile Alterations in Newborn Canines: Effect of the Mother's Weight. Animals (Basel) 2021; 11:2307. [PMID: 34438764 PMCID: PMC8388527 DOI: 10.3390/ani11082307] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/28/2021] [Accepted: 07/28/2021] [Indexed: 11/16/2022] Open
Abstract
This study aims to determine the effect of the weight of bitches on liveborn and stillbirth puppies from eutocic births, and physiological blood alterations during the first minute postpartum. A total of 52 female dogs were evaluated and distributed in four categories: C1 (4.0-8.0 kg, n = 19), C2 (8.1-16.0 kg, n = 16), C3 (16.1-32.0 kg, n = 11), and C4 (32.1-35.8 kg, n = 6). The dams produced 225 liveborn puppies and 47 were classified as stillbirth type II. Blood samples were taken from the umbilical vein to evaluate the concentration of gases, glucose, lactate, calcium, hematocrit levels, and blood pH. The liveborn puppies in C2, C3, and C4 had more evident physiological alterations (hypercapnia, acidosis) than those in C1 (p < 0.05). These signs indicate a process of transitory asphyxiation. The stillborn pups in all four categories had higher weights than their liveborn littermates. C3 and C4 had the highest mean weights (419.86 and 433.79 g, respectively) and mortality rates (C3 = 20.58%, C4 = 24.58%). Results suggest that if the weight of the bitch is >16.1 kg in eutocic births, there is a higher risk of intrapartum physiological alterations and death. The results of this study allowed us to identify that the weight of dams before birth determines the weight of the puppies at birth.
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Affiliation(s)
- Brenda Reyes-Sotelo
- Science Program “Maestria en Ciencias Agropecuarias”, Xochimilco Campus, Universidad Autónoma Metropolitana, Mexico City 04960, Mexico;
| | - Daniel Mota-Rojas
- Neurophysiology, Behavior and Animal Welfare Assesment, DPAA, Xochimilco Campus, Universidad Autónoma Metropolitana, Mexico City 04960, Mexico
| | - Patricia Mora-Medina
- Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de Mexico (UNAM), Cuautitlán Izcalli 54714, Mexico; (P.M.-M.); (I.H.-Á.); (J.S.-M.)
| | - Asahi Ogi
- Department of Veterinary Sciences, University of Pisa, 56124 Pisa, Italy; (A.O.); (C.M.); (A.G.)
| | - Chiara Mariti
- Department of Veterinary Sciences, University of Pisa, 56124 Pisa, Italy; (A.O.); (C.M.); (A.G.)
| | - Adriana Olmos-Hernández
- Division of Biotechnology-Bioterio and Experimental Surgery, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra (INR-LGII), Mexico City 14389, Mexico;
| | - Julio Martínez-Burnes
- Animal Health Group, Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma de Tamaulipas, Victoria City 87000, Mexico;
| | - Ismael Hernández-Ávalos
- Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de Mexico (UNAM), Cuautitlán Izcalli 54714, Mexico; (P.M.-M.); (I.H.-Á.); (J.S.-M.)
| | - Jose Sánchez-Millán
- Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de Mexico (UNAM), Cuautitlán Izcalli 54714, Mexico; (P.M.-M.); (I.H.-Á.); (J.S.-M.)
| | - Angelo Gazzano
- Department of Veterinary Sciences, University of Pisa, 56124 Pisa, Italy; (A.O.); (C.M.); (A.G.)
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10
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Pinchefsky EF, Schneider J, Basu S, Tam EWY, Gale C. Nutrition and management of glycemia in neonates with neonatal encephalopathy treated with hypothermia. Semin Fetal Neonatal Med 2021; 26:101268. [PMID: 34301501 DOI: 10.1016/j.siny.2021.101268] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Adequate nutrition and glycemic homeostasis are increasingly recognized as potentially neuroprotective for the developing brain. In the context of hypoxia-ischemia, evidence is scarce regarding optimal nutritional support and administration route, as well as the short- and long-term consequences of such interventions. In this review, we summarize current knowledge on disturbances of brain metabolism of glucose and substrates by hypoxia-ischemia, and compound effects of these mechanisms on brain injury characterized by specific patterns on EEG and MRI. Risks and benefits of nutrition delivery via parenteral or enteral routes are examined. Nutrition could mitigate adverse neurodevelopmental outcomes, and the impact of nutritional strategies and specific nutritional interventions are reviewed. Limited literature highlights the need for further studies to understand the changes in energy metabolism during and after hypoxic-ischemic injury, to optimize nutritional regimens and glucose management, and to inform the neuroprotective role of nutrition.
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Affiliation(s)
- E F Pinchefsky
- Division of Neurology, Department of Paediatrics, CHU Sainte-Justine, University of Montréal, CHU Sainte-Justine Research Center, Department of Neurosciences, Montreal, QC, Canada.
| | - J Schneider
- Department of Woman-Mother-Child, Clinic of Neonatology, University Hospital Center and University of Lausanne, Lausanne, Switzerland.
| | - S Basu
- Department of Paediatrics, The George Washington University. Division of Neonatology, Children's National Hospital, Washington, DC, USA.
| | - E W Y Tam
- Division of Neurology, Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Program in Neurosciences and Mental Health, SickKids Research Institute, Toronto, ON, Canada.
| | - C Gale
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK.
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Abstract
This review provides an update on neonatal hypoglycemia in the term infant, including discussion of glucose metabolism, definitions of hypoglycemia, identification of infants commonly at risk, and the screening, treatment, and potential neurologic outcomes of postnatal hypoglycemia. Neonatal hypoglycemia is a common metabolic condition that continues to plague clinicians because there is no clear relationship between low glucose concentrations or their duration that determines adverse neurologic outcomes. However, severely low, prolonged, recurrent low glucose concentrations in infants who also have marked symptoms such as seizures, flaccid hypotonia with apnea, and coma clearly are associated with permanent brain damage. Early identification of at-risk infants, early and continued breastfeeding augmented with oral dextrose gel, monitoring prefeed glucose concentrations, treating symptomatic infants who have very low and recurrent low glucose concentrations, and identifying and aggressively managing infants with persistent hyperinsulinemia and metabolic defects may help prevent neuronal injury.
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12
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Narasimhan SR, Flaherman V, McLean M, Nudelman M, Vallejo M, Song D, Jegatheesan P. Practice Variations in Diagnosis and Treatment of Hypoglycemia in Asymptomatic Newborns. Hosp Pediatr 2021; 11:595-604. [PMID: 34011565 DOI: 10.1542/hpeds.2020-004101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To describe variations in the practice of hypoglycemia screening and treatment in asymptomatic infants in the United States. METHODS During the time period from February 2018 to June 2018, we surveyed representatives of hospitals participating in the Better Outcomes through Research for Newborns Network, a national research network of clinicians providing hospital care to term and late-preterm newborns. The survey included 22 questions evaluating practices related to hypoglycemia screening and management of asymptomatic infants. RESULTS Of 108 network sites, 84 (78%) responded to the survey; 100% had a hypoglycemia protocol for screening at-risk infants in the well-baby nursery. There were wide variations between sites regarding the definition of hypoglycemia (mg/dL) (<45 [24%]; <40 [23%]; <40 [0-4 hours] and <45 [4-24 hours] [27%]; <25 [0-4 hours] and <35 [4-24 hours] [8%]), timing of first glucose check (<1 hour [18%], 1-2 hours [30%], 30 minutes post feed [48%]), and threshold glucose level for treatment (<45 [19%]; <40 [18%]; <40 [0-4 hours] and <45 [4-24 hours] [20%]; <25 [0-4 hours] and <35 [4-24 hours] [15%]). All respondents used breast milk as a component of initial therapy. Criteria for admission to the NICU for hypoglycemia included the need for dextrose containing intravenous fluids (52%), persistent hypoglycemia despite treatment (49%), and hypoglycemia below a certain value (37%). CONCLUSIONS There is a significant practice variation in hypoglycemia screening and management across the United States.
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Affiliation(s)
- Sudha Rani Narasimhan
- Department of Pediatrics, Newborn Medicine, Santa Clara Valley Medical Center, San Jose, California;
| | - Valerie Flaherman
- Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | | | - Matthew Nudelman
- Department of Pediatrics, Newborn Medicine, Santa Clara Valley Medical Center, San Jose, California
- Department of Pediatrics, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia
| | - Maricela Vallejo
- Department of Pediatrics, Newborn Medicine, Santa Clara Valley Medical Center, San Jose, California
| | - Dongli Song
- Department of Pediatrics, Newborn Medicine, Santa Clara Valley Medical Center, San Jose, California
| | - Priya Jegatheesan
- Department of Pediatrics, Newborn Medicine, Santa Clara Valley Medical Center, San Jose, California
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13
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Martín Ruiz N, García Íñiguez JP, Rite Gracia S, Samper Villagrasa MP. [Prospective study on influence of perinatal factors on the development of early neonatal hypoglycemia in late-preterm and term infants]. An Pediatr (Barc) 2021; 96:S1695-4033(21)00170-3. [PMID: 34001463 DOI: 10.1016/j.anpedi.2021.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/27/2020] [Accepted: 04/06/2021] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE Neonatal hypoglycemia offers multiple controversies. The study aims to assess the main factors involved in the development of early hypoglycemia in term and late preterm infants, and the implication of different environmental circumstances. METHODS A prospective cohort study, in infants born between 34 0/7 weeks and 36 6/7 weeks of gestation. Three capillary blood glucose determinations were performed during the eight first hours after birth. SAMPLE SIZE 207; 59 neonates developed hypoglycemia. RESULTS Prenatal risk factors include gestational diabetes with poor glycemic control, twin pregnancy and gestational age. The presence of meconium amniotic fluid and planned cesarean delivery are associated with a higher probability of hypoglycemia. After birth, skin to skin contact, breastfeeding, soft lightening, and normothermia are described as protective factors. The predictive model that combines the type of lightening, body temperature and the excess of bases level, correctly classifies 98% of the severe hypoglycemia cases, with a high Nagelkerke R2 value (0.645) and specificity of 99.5%. CONCLUSIONS Postnatal environmental factors seem to be directly related to early hypoglycemia development, so it is essential to support the maternal-child union and breastfeeding. Our results allow better identification of neonates who are not subsidiary to performing blood glucose determinations because they have little risk of developing it.
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Affiliation(s)
| | | | - Segundo Rite Gracia
- Unidad de Cuidados Intensivos Neonatales, Hospital Infantil Miguel Servet, Zaragoza, España
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14
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Wight NE. ABM Clinical Protocol #1: Guidelines for Glucose Monitoring and Treatment of Hypoglycemia in Term and Late Preterm Neonates, Revised 2021. Breastfeed Med 2021; 16:353-365. [PMID: 33835840 DOI: 10.1089/bfm.2021.29178.new] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical conditions that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
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Affiliation(s)
- Nancy E Wight
- Sharp Health Care Lactation Services, Sharp Mary Birch Hospital for Women and Newborns, San Diego, California, USA
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15
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De Angelis LC, Brigati G, Polleri G, Malova M, Parodi A, Minghetti D, Rossi A, Massirio P, Traggiai C, Maghnie M, Ramenghi LA. Neonatal Hypoglycemia and Brain Vulnerability. Front Endocrinol (Lausanne) 2021; 12:634305. [PMID: 33796072 PMCID: PMC8008815 DOI: 10.3389/fendo.2021.634305] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 02/15/2021] [Indexed: 12/17/2022] Open
Abstract
Neonatal hypoglycemia is a common condition. A transient reduction in blood glucose values is part of a transitional metabolic adaptation following birth, which resolves within the first 48 to 72 h of life. In addition, several factors may interfere with glucose homeostasis, especially in case of limited metabolic stores or increased energy expenditure. Although the effect of mild transient asymptomatic hypoglycemia on brain development remains unclear, a correlation between severe and prolonged hypoglycemia and cerebral damage has been proven. A selective vulnerability of some brain regions to hypoglycemia including the second and the third superficial layers of the cerebral cortex, the dentate gyrus, the subiculum, the CA1 regions in the hippocampus, and the caudate-putamen nuclei has been observed. Several mechanisms contribute to neuronal damage during hypoglycemia. Neuronal depolarization induced by hypoglycemia leads to an elevated release of glutamate and aspartate, thus promoting excitotoxicity, and to an increased release of zinc to the extracellular space, causing the extensive activation of poly ADP-ribose polymerase-1 which promotes neuronal death. In this review we discuss the cerebral glucose homeostasis, the mechanisms of brain injury following neonatal hypoglycemia and the possible treatment strategies to reduce its occurrence.
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Affiliation(s)
- Laura Costanza De Angelis
- Neonatal Intensive Care Unit, Department Mother and Child, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Giorgia Brigati
- Neonatal Intensive Care Unit, Department Mother and Child, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Giulia Polleri
- Neonatal Intensive Care Unit, Department Mother and Child, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Mariya Malova
- Neonatal Intensive Care Unit, Department Mother and Child, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Alessandro Parodi
- Neonatal Intensive Care Unit, Department Mother and Child, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Diego Minghetti
- Neonatal Intensive Care Unit, Department Mother and Child, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Andrea Rossi
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Neuroradiology Unit, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Paolo Massirio
- Neonatal Intensive Care Unit, Department Mother and Child, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Cristina Traggiai
- Neonatal Intensive Care Unit, Department Mother and Child, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Mohamad Maghnie
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Luca Antonio Ramenghi
- Neonatal Intensive Care Unit, Department Mother and Child, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
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16
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Vain NE, Chiarelli F. Neonatal Hypoglycaemia: A Never-Ending Story? Neonatology 2021; 118:522-529. [PMID: 33752207 DOI: 10.1159/000514711] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 01/22/2021] [Indexed: 11/19/2022]
Abstract
Neonatal hypoglycaemia is a common metabolic disorder presenting in the first days of life and one potentially preventable cause of brain injury. However, a universal approach to diagnosis and management is still lacking. The rapid decrease in blood glucose (BG) after birth triggers homeostatic mechanisms. Most episodes of hypoglycaemia are asymptomatic, and symptoms, when they occur, are nonspecific. Therefore, neonatologists are presented with the challenge of identifying infants at risk who might benefit from a rapid and effective therapy while sparing others unnecessary sampling and overtreatment. There is much controversy regarding the definition of hypoglycaemia, and one level does not fit all infants since postnatal age and clinical situations trigger different accepted thresholds for therapy. The concentration and duration of BG which cause neurological damage are unclear. Recognizing which newborn infants are at risk of hypoglycaemia and establishing protocols for treatment are essential to avoid possible deleterious effects on neurodevelopment. Early breastfeeding may reduce the risk of hypoglycaemia, but in some cases, the amount of breast milk available immediately after birth is insufficient or non-existent. In these situations, other therapeutic alternatives such as oral dextrose gel may lower the risk for NICU admissions. Current guidelines continue to be based on expert opinion and weak evidence. However, malpractice litigation related to neurodevelopmental disorders is frequent in children who suffered hypoglycaemia in the neonatal period even if they had other important factors contributing to the poor outcome. This review is aimed to help the practicing paediatricians and neonatologists to comprehend neonatal hypoglycaemia from physiology to therapy, hoping it will result in a rational decision-making process in an area not sufficiently supported by evidence.
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Affiliation(s)
- Nestor E Vain
- School of Medicine, University of Buenos Aires, Buenos Aires, Argentina, .,Department of Paediatrics and Newborn Medicine, Hospitals Sanatorio Trinidad Palermo, San Isidro and Ramos Mejía, Buenos Aires, Argentina,
| | - Florencia Chiarelli
- Newborn Medicine, Hospital Sanatorio Trinidad Ramos Mejía, Buenos Aires, Argentina
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17
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Song D, Hurley JC, Lia M. Estimated Treatment Effects of Tight Glycaemic Targets in Mild Gestational Diabetes Mellitus: A Multiple Cut-Off Regression Discontinuity Study Design. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7725. [PMID: 33105782 PMCID: PMC7660094 DOI: 10.3390/ijerph17217725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 10/01/2020] [Accepted: 10/16/2020] [Indexed: 12/11/2022]
Abstract
Background: We investigated the treatment effects of tight glycaemic targets in a population universally screened according to the International Association of Diabetes and Pregnant Study Groups (IADPSG)/World Health Organisation (WHO) gestational diabetes mellitus (GDM) guidelines. As yet there, have been no randomized control trials evaluating the effectiveness of treatment of mild GDM diagnosed under the IADPSG/WHO diagnostic thresholds. We hypothesize that tight glycaemic control in pregnant women diagnosed with GDM will result in similar clinical outcomes to women just below the diagnostic thresholds. Methods: A multiple cut-off regression discontinuity study design in a retrospective observational cohort undergoing oral glucose tolerance tests (OGTT) (n = 1178). Treatment targets for women with GDM were: fasting capillary blood glucose (CBG) of ≤5.0 mmol/L and the 2-h post-prandial CBG of ≤6.7 mmol/L. Regression discontinuity study designs estimate treatment effects by comparing outcomes between a treated group to a counterfactual group just below the diagnostic thresholds with the assumption that covariates are similar. The counterfactual group was selected based on a composite score based on OGTT plasma glucose categories. Results: Women treated for GDM had lower rates of newborns large for gestational age (LGA), 4.6% versus those just below diagnostic thresholds 12.6%, relative risk 0.37 (95% CI, 0.16-0.85); and reduced caesarean section rates, 32.2% versus 43.0%, relative risk 0.75 (95% CI, 0.56-1.01). This was at the expense of increases in induced deliveries, 61.8% versus 39.3%, relative risk 1.57 (95% CI, 1.18-1.9); notations of neonatal hypoglycaemia, 15.8% versus 5.9%, relative risk 2.66 (95% CI, 1.23-5.73); and high insulin usage 61.1%. The subgroup analysis suggested that treatment of women with GDM with BMI ≥30 kg/m2 drove the reduction in caesarean section rates: 32.9% versus 55.9%, relative risk 0.59 (95%CI, 0.4-0.87). Linear regression interaction term effects between non-GDM and treated GDM were significant for LGA newborns (p = 0.001) and caesarean sections (p = 0.015). Conclusions: Tight glycaemic targets reduced rates of LGA newborns and caesarean sections compared to a counterfactual group just below the diagnostic thresholds albeit at the expense of increased rates of neonatal hypoglycaemia, induced deliveries, and high insulin usage.
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Affiliation(s)
- David Song
- Internal Medicine Service, Ballarat Base Hospital, Ballarat, Victoria 3350, Australia;
- Dorevitch Pathology, Chemical Pathology, Melbourne, Victoria 3084, Australia
- School of Medicine, Deakin University, Geelong, Victoria 3217, Australia
| | - James C Hurley
- Internal Medicine Service, Ballarat Base Hospital, Ballarat, Victoria 3350, Australia;
- Department of Rural Health|Melbourne Medical School, University of Melbourne, Ballarat, Victoria 3350, Australia
| | - Maryanne Lia
- Peninsula Health, Melbourne, Victoria 3199, Australia;
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18
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Harris DL, Weston PJ, Gamble GD, Harding JE. Glucose Profiles in Healthy Term Infants in the First 5 Days: The Glucose in Well Babies (GLOW) Study. J Pediatr 2020; 223:34-41.e4. [PMID: 32381469 DOI: 10.1016/j.jpeds.2020.02.079] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/16/2020] [Accepted: 02/27/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To determine postnatal changes in plasma and interstitial glucose concentrations of healthy infants receiving current recommended care and to compare the incidence of low concentrations with recommended thresholds for treatment of at-risk infants. STUDY DESIGN A prospective masked observational study in Hamilton, New Zealand. Healthy, term, appropriately grown singletons had continuous glucose monitoring and repeated heel-prick plasma glucose measurements (4 in the first 24 hours then twice daily using the glucose oxidase method) from birth to 120 hours. RESULTS The 67 infants had a mean birth weight of 3584 ± 349 g, and gestational age of 40.1 ± 1.2 weeks. The mean glucose concentrations increased over the first 18 hours, remained stable to 48 hours (59 ± 11 mg/dL; 3.3 ± 0.6 mmol/L)] before increasing to a new plateau by the fourth day (89 ± 13 mg/dL; 4.6 ± 0.7 mmol/L). Plasma glucose concentrations of 47 mg/dL (2.6 mmol/L) approximated the 10th percentile in the first 48 hours, and 39% of infants had ≥1 episode below this threshold. Early term infants had lower mean glucose concentrations than those born at later gestational ages and were more likely to have episodes <47 mg/dL (<2.6 mmol/L) (19/32 [59%] vs 7/35 [20%]; relative risk, 3.0; 95% CI, 1.4-6.1; P = .001). CONCLUSIONS Healthy infants seem to complete their metabolic transition by day 4. Many have glucose concentrations below the accepted thresholds for treatment of hypoglycemia. TRIAL REGISTRATION ACTRN: 12615000986572.
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Affiliation(s)
- Deborah L Harris
- Newborn Intensive Care Unit, Waikato District Health Board, Hamilton, New Zealand; Liggins Institute, University of Auckland, Auckland, New Zealand; School of Nursing, Midwifery and Health Practice, Victoria University of Wellington, Wellington, New Zealand.
| | - Philip J Weston
- Newborn Intensive Care Unit, Waikato District Health Board, Hamilton, New Zealand
| | - Greg D Gamble
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Jane E Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
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19
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Abstract
PURPOSE OF REVIEW Infants of women with diabetes are at risk for specific morbidities including congenital anomalies, abnormalities of fetal growth, neonatal hypoglycemia, electrolyte abnormalities, polycythemia, hyperbilirubinemia, and respiratory distress syndrome. Recent studies have shed light on long-term outcomes of these infants and presented advances in treatment. The purpose of this review is to outline the most common neonatal morbidities affecting infants of women with diabetes, the pathophysiology and prevalence of these conditions, and contemporary approaches to treatment. RECENT FINDINGS Recent investigative findings have led to advances in treatment approaches for these infants, particularly regarding risks of neonatal hypoglycemia. Optimizing maternal glycemic control during pregnancy is imperative to improving infant outcomes. However, on a population level, maternal diabetes still poses significant risks to the infant. Timely and appropriate treatment of infants of women with diabetes is imperative to decrease short- and long-term morbidity.
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Affiliation(s)
- Sydney Peters
- Tufts University, 419 Boston Avenue, Medford, MA, USA
| | - Chloe Andrews
- Department of Newborn Medicine, Brigham & Women's Hospital, 75 Francis St, Boston, MA, USA
| | - Sarbattama Sen
- Department of Newborn Medicine, Brigham & Women's Hospital, 75 Francis St, Boston, MA, USA.
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
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20
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Collins SA, Hildes-Ripstein GE, Thompson JR, Edmunds S, Miners A, Rockman-Greenberg C, Arbour L. Neonatal hypoglycemia and the CPT1A P479L variant in term newborns: A retrospective cohort study of Inuit newborns from Kivalliq Nunavut. Paediatr Child Health 2020; 26:218-227. [PMID: 34131458 DOI: 10.1093/pch/pxaa039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 02/12/2020] [Indexed: 11/14/2022] Open
Abstract
Introduction Neonatal hypoglycemia (NH) in the first days of life can largely be prevented by recognizing those at risk and managing accordingly. The CPT1A P479L variant is prevalent in northern Indigenous populations and is a possible risk factor for hypoglycemia. We report on NH incidence in the Kivalliq region of Nunavut, where all Inuit newborns are screened for NH. Methods We reviewed clinical charts of 728 Inuit newborns from Kivalliq (January 1, 2010 to December 31, 2013) for blood glucose (BG) levels and infant/maternal characteristics, linking to CPT1A genotype; 616 newborns had BG data from 2 to 48 hours of life. NH was defined using Canadian Paediatric Society guidelines (≤2.0 mmol/L at 2 hours, <2.6 mmol/L at 2 to 48 hours). Results NH was documented in 21.4% overall, 24.4% of at-risk newborns and 19.5% of term newborns with no risk factors (≥37 weeks gestation, term-NRF). NH was documented in 22.0% of CPT1A P479L homozygous, 19.8% of P479L heterozygous and 4.8% of noncarrier term-NRF newborns. With multivariable logistic regression, the adjusted ORs for developing NH in term-NRF newborns was 4.97 for CPT1A P479L homozygotes (95% confidence interval [CI]:0.65-38.35, P=0.19) and 4.71 for P479L heterozygotes (95% CI:0.57-37.89, P=0.15). Conclusion Term-NRF newborns had a higher NH incidence than previously reported, similar to that for at-risk newborns, possibly due to the CPT1A P479L variant. Since only Inuit newborns from Kivalliq are screened for NH, further study of long-term outcomes of NH in this population and the role of the P479L variant are warranted to determine if neonatal BG screening is indicated in all Inuit newborns.
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Affiliation(s)
- Sorcha A Collins
- Department of Medical Genetics, University of British Columbia, Victoria, British Columbia
| | | | | | - Sharon Edmunds
- Department of Social and Cultural Development, Nunavut Tunngavik Inc., Iqaluit, Nunavut
| | - Amber Miners
- Department of Health, Government of Nunavut, Iqaluit, Nunavut
| | | | - Laura Arbour
- Department of Medical Genetics, University of British Columbia, Victoria, British Columbia
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21
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Narvey MR, Marks SD. The screening and management of newborns at risk for low blood glucose. Paediatr Child Health 2019; 24:536-554. [PMID: 31844395 DOI: 10.1093/pch/pxz134] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 05/21/2019] [Indexed: 11/12/2022] Open
Abstract
Hypoglycemia in the first hours to days after birth remains one of the most common conditions facing practitioners across Canada who care for newborns. Many cases represent normal physiologic transition to extrauterine life, but another group experiences hypoglycemia of longer duration. This statement addresses key issues for providers of neonatal care, including the definition of hypoglycemia, risk factors, screening protocols, blood glucose levels requiring intervention, and managing care for this condition. Screening, monitoring, and intervention protocols have been revised to better identify, manage, and treat infants who are at risk for persistent, recurrent, or severe hypoglycemia. The role of dextrose gels in raising glucose levels or preventing more persistent hypoglycemia, and precautions to reduce risk for recurrence after leaving hospital, are also addressed. This statement differentiates between approaches to care for hypoglycemia during the 'transitional' phase-the first 72 hours post-birth-and persistent hypoglycemia, which occurs or presents for the first time past that point.
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Affiliation(s)
- Michael R Narvey
- Canadian Paediatric Society, Fetus and Newborn Committee, Ottawa, Ontario
| | - Seth D Marks
- Canadian Paediatric Society, Fetus and Newborn Committee, Ottawa, Ontario
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22
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Narvey MR, Marks SD. Le dépistage et la prise en charge des nouveau-nés à risque d’hypoglycémie. Paediatr Child Health 2019. [DOI: 10.1093/pch/pxz135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Résumé
L’hypoglycémie entre les premières heures et les premiers jours suivant la naissance demeure l’une des principales affections qu’observent les praticiens du Canada qui s’occupent de nouveau-nés. Bien des cas vivent une transition physiologique normale à la vie extra-utérine, mais un groupe présente une hypoglycémie pendant une plus longue période. Le présent document de principes expose les principaux enjeux auxquels sont exposés les dispensateurs de soins néonatals, y compris la définition d’hypoglycémie, les facteurs de risque, les protocoles de dépistage, les valeurs de glycémie nécessitant une intervention et la gestion des soins pour cette affection. Les auteurs passent en revue le dépistage, la surveillance et les protocoles d’intervention pour mieux distinguer, prendre en charge et traiter les nouveau-nés à risque d’hypoglycémie persistante, récurrente ou marquée. Ils abordent également le rôle des gels de dextrose pour accroître la glycémie ou prévenir une hypoglycémie plus persistante, de même que les précautions à prendre pour réduire les risques de récurrence après le congé de l’hôpital. Le présent document de principes distingue les approches des soins de l’hypoglycémie pendant la « phase de transition » (les 72 premières heures de vie) de celles de l’hypoglycémie persistante, qui se manifeste ou est constatée pour la première fois après cette période.
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Affiliation(s)
- Michael R Narvey
- Société canadienne de pédiatrie, comité d’étude du fœtus et du nouveau-né, Ottawa (Ontario)
| | - Seth D Marks
- Société canadienne de pédiatrie, comité d’étude du fœtus et du nouveau-né, Ottawa (Ontario)
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23
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Abstract
There is evidence to support the use of antenatal corticosteroids prior to late preterm birth at 35+0 to 36+6 weeks' gestation and for specific 'at-risk' populations, such as planned cesarean section birth and infants of women with diabetes in pregnancy, to reduce short-term neonatal respiratory morbidity. However, the overall size of effect at late preterm and term gestational ages is less than for early and moderate preterm birth and should be countered against the potential harms. Evidence from randomized trials suggest an increase in the incidence of neonatal hypoglycemia after corticosteroid use prior to late preterm birth; any effect of antenatal corticosteroids on neonatal glycemic control after planned cesarean section birth or for infants born to mothers with diabetes in pregnancy is unknown. Accumulating evidence suggests neonatal hypoglycemia may adversely affect childhood development. To date, no trials of antenatal corticosteroids after 34 weeks' gestation have reliably assessed outcomes beyond the neonatal period.
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Affiliation(s)
- Katie M Groom
- Liggins Institute, University of Auckland and National Women's Health, Auckland City Hospital, Private Bag 92019, Auckland, New Zealand.
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24
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Dalsgaard BT, Rodrigo-Domingo M, Kronborg H, Haslund H. Breastfeeding and skin-to-skin contact as non-pharmacological prevention of neonatal hypoglycemia in infants born to women with gestational diabetes; a Danish quasi-experimental study. SEXUAL & REPRODUCTIVE HEALTHCARE 2019; 19:1-8. [PMID: 30928129 DOI: 10.1016/j.srhc.2018.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 10/10/2018] [Accepted: 10/31/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To investigate the effect on infant blood glucose levels of an intervention consisting of early, frequent breastfeeding and two hours of immediate uninterrupted skin-to-skin contact following birth of term infants born to mothers with diet-treated gestational diabetes (GDM). STUDY DESIGN Quasi-experimental study design with a historical control group (n = 132) and an intervention group (n = 401) testing a procedure to prevent neonatal hypoglycemia. MAIN OUTCOME MEASURES Data collection on blood glucose levels, hypoglycemia incidence with a cut-off of <2.5 mmol/l, breastfeeding within the first two hours after birth, breastfeeding frequency within the first six hours, and amount of formula given to hypoglycemic infants. RESULTS Mean blood glucose levels in the intervention group at two and four hours were within safe limits: 3.37 mmol/l (95% CI: [3.30, 3.44]) and 3.40 mmol/l (95% CI: [3.34, 3.46]), respectively. Infants suffering a hypoglycemic event within four hours after birth decreased from 22.7% (n = 30/132) in the control group to 10.2% (n = 41/401) in the intervention group. The mean number of breastfeeds in the intervention group (six hours) was 2.41 compared to 1.34 in the control group (seven hours), an increase of 80%. Only 41 of 401 infants in the intervention group were interrupted in immediate interaction with their mother because of hypoglycemia. We failed to obtain sufficient data on skin-to-skin contact. CONCLUSION Maintaining skin-to-skin contact for infants of mothers with diet-treated GDM, monitoring blood glucose levels until obtaining two values >2.4 mmol/l and encouraging early frequent breastfeeding is a safe strategy to prevent hypoglycemia.
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Affiliation(s)
- Bente Thorup Dalsgaard
- Maternity Ward, Clinic for Woman-Child Diseases and Urology, Aalborg University Hospital, Denmark.
| | | | - Hanne Kronborg
- Department of Public Health, Section for Nursing, Aarhus University, Denmark
| | - Helle Haslund
- Clinical Nursing Research Unit, Clinical Institute, Aalborg University, Denmark; Maternity Ward, Clinic for Woman-Child Diseases and Urology, Aalborg University Hospital, Denmark
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Puchalski ML, Russell TL, Karlsen KA. Neonatal Hypoglycemia: Is There a Sweet Spot? Crit Care Nurs Clin North Am 2019; 30:467-480. [PMID: 30447807 DOI: 10.1016/j.cnc.2018.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Hypoglycemia is one of the most common neonatal problems. Despite increasing evidence that hypoglycemia is linked to neurologic impairment, knowledge regarding the specific value or duration of hypoglycemia that results in injury to the brain remains unclear. Current published statements/guidelines focused on preventing clinically significant hypoglycemia are conflicting and continue to be based on low evidence. This article reviews transitional events leading to extrauterine euglycemia, risk factors contributing to transient or persistent hypoglycemia, and common treatment approaches. Current information related to neurodevelopmental outcomes and screening strategies to prevent significant hypoglycemia with early treatment is described.
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Affiliation(s)
- Mary L Puchalski
- Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Neonatology, 25 East Chicago Avenue, Chicago, IL 60611, USA; Department of Women, Children, and Family Health Science, University of Illinois at Chicago, 845 South Damen Avenue, M/C 802, Chicago, IL 60612, USA.
| | - Terri L Russell
- Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Neonatology, 25 East Chicago Avenue, Chicago, IL 60611, USA; Department of Women, Children, and Family Health Science, University of Illinois at Chicago, 845 South Damen Avenue, M/C 802, Chicago, IL 60612, USA
| | - Kristine A Karlsen
- The S.T.A.B.L.E. Program, 3070 Rasmussen Road, Suite 120, Park City, UT 84098, USA; Primary Children's Hospital, Neonatal Intensive Care Unit, 100 Mario Capecchi Drive, Salt Lake City, UT 84113, USA
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Yager JY. Glucose and Perinatal Brain Injury—Questions and Controversies. Neurology 2019. [DOI: 10.1016/b978-0-323-54392-7.00009-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Stewart ZA, Thomson L, Murphy HR, Beardsall K. A Feasibility Study of Paired Continuous Glucose Monitoring Intrapartum and in the Newborn in Pregnancies Complicated by Type 1 Diabetes. Diabetes Technol Ther 2019; 21:20-27. [PMID: 30620640 DOI: 10.1089/dia.2018.0221] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIM To describe the continuous glucose monitoring (CGM) profiles of type 1 diabetes (T1D) offspring in the early neonatal period and its association with maternal intrapartum glucose control. METHODS A prospective observational study of T1D pregnant women and their neonatal offspring. Women had a CGM sensor inserted 2-3 days before delivery. Infants had a masked CGM sensor inserted as soon as possible after delivery. Maternal glycemic outcomes were time-in-target (70-140 mg/dL [3.9-7.8 mmol/L]), hyperglycemia >140 mg/dL (7.8 mmol/L), and mean CGM glucose during the 24 h preceding delivery. Neonatal outcomes included lowest recorded blood glucose concentration, and CGM measures (glucose <47 mg/dL [2.6 mmol/L], time-in-target (47-144 mg/dL [2.6-8.0 mmol/L]), glucose standard deviation [SD]) during the first 72 h of life. RESULTS Data were available for 16 mother-infant pairs. Mothers had a mean age (SD) 32.3 (4.3) years, T1D duration 17.6 (6.8) years, first antenatal glycated hemoglobin 7.4 (0.8)% (57 [8.5] mmol/mol). In the 24 h preceding delivery, mothers spent mean (SD) 72 (20)% time-in-target (70-140 mg/dL [3.9-7.8 mmol/L]), 19 (15)% time >140 mg/dL (7.8 mmol/L), and 9 (9)% time <70 mg/dL (3.9 mmol/L) with mean (SD) CGM glucose 113 (9) mg/dL (6.3 [0.7] mmol/L). Fifteen infants (93.8%) had ≥1 blood glucose concentration <47 mg/dL (2.6 mmol/L), and five had ≥1 blood glucose concentration <18 mg/dL (1.0 mmol/L). The mean infant CGM glucose on days 1, 2, and 3 of life was 63 (14), 67 (13), 76 (11) mg/dL (3.5 [0.8], 3.7 [0.7], and 4.2 [0.6] mmol/L). Four infants (25%) spent >50% time with CGM glucose levels <47 mg/dL (2.6 mmol/L) on day 1. CONCLUSIONS CGM detected widespread neonatal hypoglycemia, even among mothers with good intrapartum glucose control.
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Affiliation(s)
- Zoe A Stewart
- 1 Department of Clinical Biochemistry, Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Lynn Thomson
- 2 Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
- 3 Neonatal Unit, University of Cambridge Addenbrookes Hospital NHS Trust, Cambridge, United Kingdom
| | - Helen R Murphy
- 1 Department of Clinical Biochemistry, Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
- 4 Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Kathryn Beardsall
- 2 Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
- 3 Neonatal Unit, University of Cambridge Addenbrookes Hospital NHS Trust, Cambridge, United Kingdom
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Hosagasi NH, Aydin M, Zenciroglu A, Ustun N, Beken S. Incidence of hypoglycemia in newborns at risk and an audit of the 2011 American academy of pediatrics guideline for hypoglycemia. Pediatr Neonatol 2018; 59:368-374. [PMID: 29198616 DOI: 10.1016/j.pedneo.2017.11.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 08/22/2017] [Accepted: 11/10/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Hypoglycemia is low blood glucose level that may negatively affect neurological and developmental prognosis. The American Academy of Pediatrics (AAP), Committee on Fetus and Newborn defined the safe glucose concentrations in the 2011 guideline for newborns at risk for hypoglycemia. This study aimed to investigate the incidence and associated risk factors for hypoglycemia in newborn infants having risk and to assess compliance with the AAP guideline. METHODS According to 2011 AAP guideline for hypoglycemia, the newborns at risk for hypoglycemia included in this study were divided to four groups [infant of diabetic mother (IDM), large-for-gestational-age (LGA) infants, small-for-gestational-age (SGA) infants, and late preterm infants (LPI)]. RESULTS Of the 207 newborn infants, there were 12 cases in IDM group (5.7%), 79 cases in LGA group (38.1%), 66 cases in SGA group (31.8%) and 50 cases in LPI group (24.1%). The incidences of hypoglycemia in these four groups were 2 (16.6%), 10 (12.7%), 8 (12.2%) and 17 (34%), respectively. Although the gender, delivery method, birth weight and 5-min Apgar score at 5-min were not found to be associated with hypoglycemia (P > 0.05), lower gestational age was determined to be associated with higher incidence of hypoglycemia (P = 0.02). Median first feeding time was 55 min and time between first nutrition and blood glucose measurement was 30 min in all cases. CONCLUSION Highest risk for hypoglycemia in early postnatal period was present especially in LPI group. Our compliance levels with the AAP guideline was found to be satisfactory.
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Affiliation(s)
- Nihan Hilal Hosagasi
- Department of Neonatology, Dr. Sami Ulus Maternity and Children Hospital, 06000, Ankara, Turkey.
| | - Mustafa Aydin
- Department of Neonatology, Firat University School of Medicine, 23119, Elazig, Turkey.
| | - Aysegul Zenciroglu
- Department of Neonatology, Dr. Sami Ulus Maternity and Children Hospital, 06000, Ankara, Turkey.
| | - Nuran Ustun
- Department of Neonatology, Dr. Sami Ulus Maternity and Children Hospital, 06000, Ankara, Turkey.
| | - Serdar Beken
- Department of Neonatology, Dr. Sami Ulus Maternity and Children Hospital, 06000, Ankara, Turkey.
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LeBlanc S, Haushalter J, Seashore C, Wood KS, Steiner MJ, Sutton AG. A Quality-Improvement Initiative to Reduce NICU Transfers for Neonates at Risk for Hypoglycemia. Pediatrics 2018; 141:peds.2017-1143. [PMID: 29437908 PMCID: PMC5847088 DOI: 10.1542/peds.2017-1143] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/11/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Neonatal hypoglycemia is a common problem, often requiring management in the NICU. Nonpharmacologic interventions, including early breastfeeding and skin-to-skin care (SSC), may prevent hypoglycemia and the need to escalate care. Our objective was to maintain mother-infant dyads in the mother-infant unit by decreasing hypoglycemia resulting in NICU transfer. METHODS Inborn infants ≥35 weeks' gestation with at least 1 risk factor for hypoglycemia were included. Using quality-improvement methodology, a bundle for at-risk infants was implemented, which included a protocol change focusing on early SSC, early feeding, and obtaining a blood glucose measurement in asymptomatic infants at 90 minutes. The primary outcome was the overall transfer rate of at-risk infants to the NICU. Secondary outcomes were related to protocol adherence. Balancing measures, including the rate of symptomatic hypoglycemia and sepsis evaluations, were monitored. Statistical process control charts using standard interpretation rules were used to monitor for improvement in key aims. RESULTS For infants at risk for hypoglycemia, the NICU transfer rate decreased from 17% to 3% overall. Documented early feeding and SSC in at-risk newborns increased. The percent of at-risk infants transferred to the NICU who did not require intravenous dextrose decreased from 5% at baseline to 0.7% after intervention. There were no adverse outcomes observed in the period before or after the intervention. CONCLUSIONS The implementation of a quality-improvement intervention promoting SSC and early feeding in at-risk infants was associated with a decreased rate of transfer to the NICU for hypoglycemia.
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Affiliation(s)
- Sherry LeBlanc
- University of North Carolina Health Care, Chapel Hill, North Carolina; and .,Divisions of Neonatology and
| | - Jamie Haushalter
- University of North Carolina Health Care, Chapel Hill, North Carolina; and,General Pediatrics and Adolescent Medicine, Department of Pediatrics, School of Medicine, and,School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Carl Seashore
- General Pediatrics and Adolescent Medicine, Department of Pediatrics, School of Medicine, and
| | | | - Michael J. Steiner
- General Pediatrics and Adolescent Medicine, Department of Pediatrics, School of Medicine, and
| | - Ashley G. Sutton
- General Pediatrics and Adolescent Medicine, Department of Pediatrics, School of Medicine, and
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Karlsen KA, Puchalski M. Letters. Neonatal Netw 2018; 37:67-69. [PMID: 29615153 DOI: 10.1891/0730-0832.37.2.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Rudolph AM. Cerebral glucose deficiency versus oxygen deficiency in neonatal encephalopathy. J Neonatal Perinatal Med 2018; 11:115-120. [PMID: 29710737 DOI: 10.3233/npm-17109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Hypoxic-ischemic encephalopathy (HIE) in newborn infants is generally considered to result from decreased arterial oxygen content or cerebral blood flow. Cerebral injury similar to that of HIE has been noted with hypoglycemia. Studies in fetal lambs have shown that ventilation with 3% oxygen did not change cerebral blood flow, but ventilation with 100% oxygen resulted in marked reduction in cerebral blood flow, glucose delivery and glucose consumption. Blood glucose concentration falls markedly after birth; this, associated with the fall in cerebral blood flow, greatly reduces glucose supply to the brain. In preterm infants, blood glucose levels tend to be very low. Also persistent patency of the ductus arteriosus may reduce cerebral flow in diastole, thus exaggerating the decrease in glucose supply. I propose that glycopenic-ischemic encephalopathy is a more appropriate term for the cerebral insult. We should consider more aggressive management of the low blood glucose concentrations in the neonate, and particularly in preterm infants. Administration of high levels of oxygen in inspired air should be avoided to reduce the enhancement of cerebral vasoconstriction and decreased flow that normally occurs after birth.
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Affiliation(s)
- A M Rudolph
- Department of Pediatrics, University of California, San Francisco, CA, USA
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Primum non nocere: earlier cessation of glucose monitoring is possible. Eur J Pediatr 2018; 177:1239-1245. [PMID: 29845515 PMCID: PMC6061039 DOI: 10.1007/s00431-018-3169-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 04/21/2018] [Accepted: 04/23/2018] [Indexed: 11/09/2022]
Abstract
UNLABELLED Newborns are at relatively high risk for developing hypoglycaemia in the first 24 h after birth. Well-known risk factors are prematurity, small for gestational age (SGA) or large for gestational age (LGA), and maternal pre-existent or gestational diabetes mellitus. Prolonged hypoglycaemia is associated with poor neurodevelopmental outcomes; hence, prevention through proper monitoring and treatment is important. Given the ongoing debate concerning frequency and duration of screening for neonatal hypoglycaemia, therefore, we investigated the frequency and duration of glucose monitoring safe to discover neonatal hypoglycaemia in different risk groups. Data of newborns at risk for hypoglycaemia were retrospectively collected and analysed. Blood glucose concentrations were measured 1, 3, 6, 12, and 24 h after birth. Moderate hypoglycaemia was defined as a blood glucose concentration of < 2.2 mM and severe hypoglycaemia as a concentration of < 1.5 mM. Of 1570 newborns, 762 (48.5%) had at least one episode of hypoglycaemia in the first 24 h after birth; 30.6% of them had severe hypoglycaemia (all in the first 9 h after birth). Only three SGA and two LGA newborns had a first moderate asymptomatic hypoglycaemic episode beyond 12 h after birth. The incidence of hypoglycaemia increased with accumulation of multiple risk factors. CONCLUSION Safety of limiting the monitoring to 12 h still has to be carefully evaluated in the presence of SGA or LGA newborns; however, our results suggest that 12 h is enough for late preterm newborns (> 34 weeks) and maternal diabetes. What is Known: • Newborns are at relatively high risk for developing hypoglycaemia and such hypoglycaemia is associated with adverse neurodevelopmental outcomes. • Proper glucose monitoring and prompt treatment in case of neonatal hypoglycaemia are necessary. What is New: • Glucose monitoring 12 h after birth is proficient for most newborns at risk. • Maternal diabetes leads to the highest risk of early neonatal hypoglycaemia and newborns with more than one risk factor are at increased risk of hypoglycaemia.
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Wirth M, Jellimann J, Jellimann S, Hascoët J. Neonatal diabetes mellitus: improved screening and early management of an underestimated disease. Clin Case Rep 2018; 6:18-22. [PMID: 29375830 PMCID: PMC5771913 DOI: 10.1002/ccr3.1276] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 10/16/2017] [Accepted: 10/23/2017] [Indexed: 12/03/2022] Open
Abstract
Neonatal diabetes mellitus is underdiagnosed in the neonatal period because of the metabolic adaptation capacities of the newborns. However, it is associated with increased risk of short- and long-term morbidity; when transient it may recurs in adulthood. It is important to improve screening and early management with appropriate guidelines.
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Affiliation(s)
- Maëlle Wirth
- Department of NeonatologyUniversity Hospital of Nancy54035NancyFrance
| | | | - Stéphanie Jellimann
- Department of Pediatric EndocrinologyUniversity Hospital of Nancy54500Vandœuvre‐Les‐NancyFrance
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Kallem VR, Pandita A, Gupta G. Hypoglycemia: When to Treat? Clin Med Insights Pediatr 2017; 11:1179556517748913. [PMID: 29276423 PMCID: PMC5734558 DOI: 10.1177/1179556517748913] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 11/26/2017] [Indexed: 11/16/2022] Open
Abstract
Hypoglycemia is the most common metabolic disorder encountered in neonates. The definition of hypoglycemia as well as its clinical significance and management remain controversial. Most cases of neonatal hypoglycemia are transient, respond readily to treatment, and are associated with an excellent prognosis. Persistent hypoglycemia is more likely to be associated with abnormal endocrine conditions, such as hyperinsulinemia, as well as possible neurologic sequelae. Manifestations of hypoglycemia include seizures which can result in noteworthy neuromorbidity in the long haul. Thus, hypoglycemia constitutes a neonatal emergency which requires earnest analytic assessment and prompt treatment. In this review, we have tried to cover the pathophysiology, the screening protocol for high-risk babies, management, long-term neurologic sequelae associated with neonatal hypoglycemia, with evidence-based answers wherever possible, and our own practices.
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Affiliation(s)
| | - Aakash Pandita
- Department of Neonatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Girish Gupta
- Department of Neonatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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Harris DL, Gamble GD, Weston PJ, Harding JE. What Happens to Blood Glucose Concentrations After Oral Treatment for Neonatal Hypoglycemia? J Pediatr 2017; 190:136-141. [PMID: 28709629 DOI: 10.1016/j.jpeds.2017.06.034] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/03/2017] [Accepted: 06/13/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine the change in blood glucose concentration after oral treatment of infants with hypoglycemia in the first 48 hours after birth. STUDY DESIGN We analyzed data from 227 infants with hypoglycemia (blood glucose <46.8 mg/dL, 2.6 mmol/L) born at a tertiary hospital who experienced 295 episodes of hypoglycemia. Blood glucose concentrations were measured (glucose oxidase) within 90 minutes after randomization to dextrose or placebo gel plus feeding with formula, expressed breast milk, or breast feeding. RESULTS The overall mean increase in blood glucose concentration was 11.7 mg/dL (95% CI 10.4-12.8). The increase was greater after buccal dextrose gel than after placebo gel (+3.0 mg/dL; 95% CI 0.7-5.3; P = .01) and greater after infant formula than after other feedings (+3.8 mg/dL; 95% CI 0.8-6.7; P = .01). The increase in blood glucose concentration was not affected by breast feeding (+2.0 mg/dL; 95% CI -0.3 to 44.2; P = .09) or expressed breast milk (-1.4 mg/dL; 95% CI -3.7 to 0.9; P = .25). However, breast feeding was associated with reduced requirement for repeat gel treatment (OR = 0.52; 95% CI 0.28-0.94; P = .03). CONCLUSIONS Treatment of infants with hypoglycemia with dextrose gel or formula is associated with increased blood glucose concentration and breast feeding with reduced need for further treatment. Dextrose gel and breast feeding should be considered for first-line oral treatment of infants with hypoglycemia.
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Affiliation(s)
- Deborah L Harris
- Newborn Intensive Care Unit Waikato District Health Board, Hamilton, New Zealand; Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Greg D Gamble
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Philip J Weston
- Newborn Intensive Care Unit Waikato District Health Board, Hamilton, New Zealand
| | - Jane E Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand.
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McKinlay CJ, Chase JG, Dickson J, Harris DL, Alsweiler JM, Harding JE. Continuous glucose monitoring in neonates: a review. Matern Health Neonatol Perinatol 2017; 3:18. [PMID: 29051825 PMCID: PMC5644070 DOI: 10.1186/s40748-017-0055-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 08/24/2017] [Indexed: 12/17/2022] Open
Abstract
Continuous glucose monitoring (CGM) is well established in the management of diabetes mellitus, but its role in neonatal glycaemic control is less clear. CGM has provided important insights about neonatal glucose metabolism, and there is increasing interest in its clinical use, particularly in preterm neonates and in those in whom glucose control is difficult. Neonatal glucose instability, including hypoglycaemia and hyperglycaemia, has been associated with poorer neurodevelopment, and CGM offers the possibility of adjusting treatment in real time to account for individual metabolic requirements while reducing the number of blood tests required, potentially improving long-term outcomes. However, current devices are optimised for use at relatively high glucose concentrations, and several technical issues need to be resolved before real-time CGM can be recommended for routine neonatal care. These include: 1) limited point accuracy, especially at low or rapidly changing glucose concentrations; 2) calibration methods that are designed for higher glucose concentrations of children and adults, and not for neonates; 3) sensor drift, which is under-recognised; and 4) the need for dynamic and integrated metrics that can be related to long-term neurodevelopmental outcomes. CGM remains an important tool for retrospective investigation of neonatal glycaemia and the effect of different treatments on glucose metabolism. However, at present CGM should be limited to research studies, and should only be introduced into routine clinical care once benefit is demonstrated in randomised trials.
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Affiliation(s)
- Christopher J.D. McKinlay
- Liggins Institute, University of Auckland, Private Bag 92019, Victoria St West, Auckland, 1142 New Zealand
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - J. Geoffrey Chase
- Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | - Jennifer Dickson
- Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | - Deborah L. Harris
- Liggins Institute, University of Auckland, Private Bag 92019, Victoria St West, Auckland, 1142 New Zealand
- Neonatal Intensive Care Unit, Waikato District Health Board, Hamilton, New Zealand
| | - Jane M. Alsweiler
- Liggins Institute, University of Auckland, Private Bag 92019, Victoria St West, Auckland, 1142 New Zealand
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Jane E. Harding
- Liggins Institute, University of Auckland, Private Bag 92019, Victoria St West, Auckland, 1142 New Zealand
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Smolkin T, Ulanovsky I, Carasso P, Makhoul IR. Standards of admission capillary blood glucose levels in cesarean born neonates. World J Pediatr 2017; 13:433-438. [PMID: 28194693 DOI: 10.1007/s12519-017-0016-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 06/17/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neonatal hypoglycemia (NH) and cutoffs remain undefined. Our center screens all cesarean-delivered (CD) neonates for NH. We sought to define standards of admission capillary blood glucose levels (ACBGLs) in CD neonates who were at the lowest risk for hypoglycemia. METHODS Of 4947 neonates, 519 met all 14 inclusion criteria. These highly-selected neonates were apparently the healthiest, least-stressed, earliest to be admitted to nursery and at lowest-risk for hypoglycemia. For each CD, cord blood gases and glucose were determined and each infant was screened for blood glucose at nursery admission. RESULTS Sampling age was 41.6±15.3 minutes, a mean ACBGL of 52.3±10.7 mg/dL, and percentiles as follows: 1st percentile, 29.2; 3rd, 33.6; 5th, 35.0; 10th, 39.0; 25th, 46.0; 50th, 51.0; 75th, 58.0; 90th, 67.0; 95th, 71.0; 97th, 73.0, and 99th, 84.4. ACBGL rose significantly with increasing gestational age (P=0.004), increasing cord blood glucose (P<0.001), decreasing cord blood pH (P<0.001) and decreasing sampling age (P=0.027). CONCLUSIONS Setting uniform ACBGL cutoffs for NH definition is unachievable due to the enormous heterogeneity among newborns. Hence, we provide group-based ACBGL standards in CD neonates. We propose setting ACBGL cutoffs for use in CD neonates: 1) hypoglycemia: ACBGL <5th percentile (<35 mg/dL); and 2) interventional hypoglycemia: ACBGL <1st percentile (<30 mg/dL).
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Affiliation(s)
- Tatiana Smolkin
- Department of Neonatology, Ruth Rappaport Children's Hospital, Haifa Israel, Rambam Health Care Campus, Bat-Galim, Haifa, 31096, Israel
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Irena Ulanovsky
- Department of Neonatology, Ruth Rappaport Children's Hospital, Haifa Israel, Rambam Health Care Campus, Bat-Galim, Haifa, 31096, Israel
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Pnina Carasso
- Department of Neonatology, Ruth Rappaport Children's Hospital, Haifa Israel, Rambam Health Care Campus, Bat-Galim, Haifa, 31096, Israel
| | - Imad R Makhoul
- Department of Neonatology, Ruth Rappaport Children's Hospital, Haifa Israel, Rambam Health Care Campus, Bat-Galim, Haifa, 31096, Israel.
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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Abstract
Despite the high neonatal mortality rate in puppies, pertinent criteria for health evaluation of the newborns are not defined. This study was thus designed to measure and to characterize factors of variation of six health parameters in dog neonates, and to evaluate their value as predictors of neonatal mortality. A total of 347 purebred puppies under identical conditions of housing and management were examined within the first 8h after birth and then at Day 1. The first health evaluation included Apgar score, weight, blood glucose, lactate and β-hydroxybutyrate concentration, rectal temperature and urine specific gravity (SG). The second evaluation at Day 1 included the same parameters, excluding Apgar score and weight. The mortality rate over the first 24h and over 21days of age was recorded. The early predictors of neonatal mortality in the dog were determined with generalized linear mixed models and receiver operating characteristic curves analyses. An Apgar score at or below 6 evaluated within the first 8h after birth was found associated with a higher risk of death during the first 24h. A reduced glucose concentration (≤92mg/dl) at Day 1 was found to be associated with higher mortality between 1 and 21days of age. Low-birth-weight puppies were characterized by both low viability (low Apgar score) and low blood glucose concentration, and thus were found indirectly at higher risk of neonatal mortality. This study promotes two low cost easy-to-use tests for health evaluation in puppies, i.e. Apgar scoring and blood glucose assay. Further investigation is necessary to establish if the strong relationship between blood glucose and neonatal survival reflects high energy requirements or other benefits from colostrum intake.
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Abstract
A consistent definition for neonatal hypoglycemia in the first 48 h of life continues to elude us. Enhanced understanding of metabolic disturbances and genetic disorders that underlie alterations in postnatal glucose homeostasis has added useful information to understanding transitional hypoglycemia. This growth in knowledge still has not led to what we need to know: "How low is too low and for how long?" This article reviews the current state of understanding of neonatal hypoglycemia and how different approaches reach different "expert" opinions.
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40
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Harding JE, Harris DL, Hegarty JE, Alsweiler JM, McKinlay CJD. An emerging evidence base for the management of neonatal hypoglycaemia. Early Hum Dev 2017; 104:51-56. [PMID: 27989586 PMCID: PMC5280577 DOI: 10.1016/j.earlhumdev.2016.12.009] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Neonatal hypoglycaemia is common, and screening and treatment of babies considered at risk is widespread, despite there being little reliable evidence upon which to base management decisions. Although there is now evidence about which babies are at greatest risk, the threshold for diagnosis, best approach to treatment and later outcomes all remain uncertain. Recent studies suggest that treatment with dextrose gel is safe and effective and may help support breast feeding. Thresholds for intervention require a wide margin of safety in light of information that babies with glycaemic instability and with low glucose concentrations may be associated with a higher risk of later higher order cognitive and learning problems. Randomised trials are urgently needed to inform optimal thresholds for intervention and appropriate treatment strategies.
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Affiliation(s)
- Jane E Harding
- Liggins Institute, University of Auckland, 85 Park Ave, Grafton, Auckland 1023, New Zealand.
| | - Deborah L Harris
- Liggins Institute, University of Auckland, 85 Park Ave, Grafton, Auckland 1023, New Zealand; Waikato Hospital, Selwyn Street and Pembroke Street, Hamilton 3204, New Zealand.
| | - Joanne E Hegarty
- Liggins Institute, University of Auckland, 85 Park Ave, Grafton, Auckland 1023, New Zealand; National Women's Health, Auckland City Hospital, 2 Park Rd, Grafton, Auckland 1023, New Zealand.
| | - Jane M Alsweiler
- Liggins Institute, University of Auckland, 85 Park Ave, Grafton, Auckland 1023, New Zealand; National Women's Health, Auckland City Hospital, 2 Park Rd, Grafton, Auckland 1023, New Zealand; Department of Paediatrics: Child and Youth Health, University of Auckland, 2 Park Rd, Grafton, Auckland 1023, New Zealand.
| | - Christopher JD McKinlay
- Liggins Institute, University of Auckland, 85 Park Ave, Grafton, Auckland 1023, New Zealand,Department of Paediatrics: Child and Youth Health, University of Auckland, 2 Park Rd, Grafton, Auckland 1023, New Zealand,Kidz First Neonatal Care, Counties Manukau Health, Private Bag 93311, Otahuhu, Auckland, New Zealand
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41
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Hypoglykämien von Neugeborenen diabetischer Mütter. DIABETOLOGE 2015. [DOI: 10.1007/s11428-015-0045-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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42
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Tozier PK. Colostrum versus formula supplementation for glucose stabilization in newborns of diabetic mothers. J Obstet Gynecol Neonatal Nurs 2015; 42:619-28. [PMID: 25803211 DOI: 10.1111/1552-6909.12260] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The purpose of this article is to describe practice change designed to facilitate breastfeeding while maintaining glucose stabilization in infants born to diabetic mothers. Postpractice change outcomes of newborn blood glucose levels, formula supplementation, and colostrum feeds are specifically addressed. There were no significant differences between glucose values for infants given formula supplementation versus those fed colostrum. Postpractice change, admissions to the neonatal intensive care unit (NICU) for glucose stabilization decreased and exclusive breastfeeding increased.
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43
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Re-evaluating "transitional neonatal hypoglycemia": mechanism and implications for management. J Pediatr 2015; 166:1520-5.e1. [PMID: 25819173 PMCID: PMC4659381 DOI: 10.1016/j.jpeds.2015.02.045] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 01/26/2015] [Accepted: 02/13/2015] [Indexed: 11/20/2022]
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44
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Boardman JP, Hawdon JM. Hypoglycaemia and hypoxic-ischaemic encephalopathy. Dev Med Child Neurol 2015; 57 Suppl 3:29-33. [PMID: 25800489 DOI: 10.1111/dmcn.12729] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2014] [Indexed: 11/29/2022]
Abstract
The transition from fetal to neonatal life requires metabolic adaptation to ensure that energy supply to vital organs and systems is maintained after separation from the placental circulation. Under normal conditions, this is achieved through the mobilization and use of alternative cerebral fuels (fatty acids, ketone bodies, and lactate) when blood glucose concentration falls. Severe hypoxia-ischaemia is associated with impaired metabolic adaptation, and animal and human data suggest that levels of hypoglycaemia that are tolerated under normal conditions can be harmful in association with hypoxia-ischaemia. The optimal target blood glucose level for ensuring adequate energy provision in hypoxic-ischaemic encephalopathy (HIE) remains unknown. However, recent data support guidance to maintain a blood glucose concentration of 2.5 mmol/L or more in neonates with signs of acute neurological dysfunction, which includes those with HIE, and this is higher than the accepted threshold of 2 mmol/L in infants without signs of neurological dysfunction or hyperinsulinism.
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Affiliation(s)
- James P Boardman
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
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45
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Abstract
OBJECTIVES Low blood glucose in neonates predisposes to long term pancreatic damage. We focused on evaluating long term consequences of neonatal hypoglycaemia in pancreatic functions. METHODS Pancreatic function was analysed by measuring DNA/protein synthesis, glucose/ATP uptake in vitro. Gene expression of Pdx1, NeuroD1, Pax4, Bax, caspase 3, Beclin1 were done. Muscarinic receptors were analysed by radio receptor assay. RESULT Overall pancreatic efficiency was reduced in one-month-old rats exposed to neonatal hypoglycaemia as indicated by decreased DNA/protein synthesis and glucose/ATP uptake in vitro. Both Pdx1 and Neuro D1 expression were significantly down-regulated whereas Pax4 was up-regulated. Up-regulated Bax, caspase 3 and beclin1 along with reduced muscarinic receptors accounts for activation of cell death pathways. CONCLUSION The study revealed a drastic reduction in pancreatic functions along with activation of apoptotic factors in one month old rats exposed to neonatal hypoglycaemia.
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Affiliation(s)
- T R Anju
- Molecular Neurobiology and Cell Biology Unit, Centre for Neuroscience, Department of Biotechnology, Cochin University of Science and Technology , Cochin-682022, Kerala , India
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46
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Wight N, Marinelli KA. ABM clinical protocol #1: guidelines for blood glucose monitoring and treatment of hypoglycemia in term and late-preterm neonates, revised 2014. Breastfeed Med 2014; 9:173-9. [PMID: 24823918 PMCID: PMC4026103 DOI: 10.1089/bfm.2014.9986] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
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Affiliation(s)
- Nancy Wight
- 1 San Diego Neonatology, Inc. , San Diego, California
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47
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Maayan-Metzger A, Schushan-Eisen I, Lubin D, Moran O, Kuint J, Mazkereth R. Delivery room breastfeeding for prevention of hypoglycaemia in infants of diabetic mothers. Fetal Pediatr Pathol 2014; 33:23-8. [PMID: 24099464 DOI: 10.3109/15513815.2013.842271] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the effect of duration of early breastfeeding in the delivery room on blood glucose levels among term neonates of diabetic mothers. METHODS Mothers with gestational diabetes were encouraged to breastfeed their infants immediately after birth in the delivery room. The breastfeeding duration was recorded by the midwife. RESULTS The longer duration of breastfeeding subgroup (n = 39) demonstrated a lower rate of hypoglycaemia in the first 8 hours of life (< 40 mg/dl) compared to the shorter duration subgroup (n = 40), but this difference did not reach statistical significance (2.6% vs. 17.5% respectively, p = 0.057). Hypoglycaemia was mainly predicted by lower cord glucose for each decrease of 10 mg/dl (OR 2.11 [CI 1.1-4.03] p = 0.024. CONCLUSION Longer duration of delivery room breastfeeding did not reduce the rate of hypoglycaemia, which was mainly influenced by lower cord blood glucose level.
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Yotebieng M, Chalachala JL, Labbok M, Behets F. Infant feeding practices and determinants of poor breastfeeding behavior in Kinshasa, Democratic Republic of Congo: a descriptive study. Int Breastfeed J 2013; 8:11. [PMID: 24083882 PMCID: PMC3850507 DOI: 10.1186/1746-4358-8-11] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 09/28/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Although breastfeeding is almost universally accepted in the Democratic Republic (DR) of Congo, by the age of 2 to 3 months 65% of children are receiving something other than human milk. We sought to describe the infant feeding practices and determinants of suboptimal breastfeeding behaviors in DR Congo. METHODS Survey questionnaire administered to mothers of infants aged ≤ 6 months and healthcare providers who were recruited consecutively at six selected primary health care facilities in Kinshasa, the capital. RESULTS All 66 mothers interviewed were breastfeeding. Before initiating breastfeeding, 23 gave their infants something other than their milk, including: sugar water (16) or water (2). During the twenty-four hours prior to interview, 26 (39%) infants were exclusively breastfed (EBF), whereas 18 (27%), 12 (18%), and 10 (15%) received water, tea, formula, or porridge, respectively, in addition to human milk. The main reasons for water supplementation included "heat" and cultural beliefs that water is needed for proper digestion of human milk. The main reason for formula supplementation was the impression that the baby was not getting enough milk; and for porridge supplementation, the belief that the child was old enough to start complementary food. Virtually all mothers reported that breastfeeding was discussed during antenatal clinic visit and half reported receiving help regarding breastfeeding from a health provider either after birth or during well-child clinic visit. Despite a median of at least 14 years of experience in these facilities, healthcare workers surveyed had little to no formal training on how to support breastfeeding and inadequate breastfeeding-related knowledge and skills. The facilities lacked any written policy about breastfeeding. CONCLUSION Addressing cultural beliefs, training healthcare providers adequately on breastfeeding support skills, and providing structured breastfeeding support after maternity discharge is needed to promote EBF in the DR Congo.
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Affiliation(s)
- Marcel Yotebieng
- College of Public Health, Division of Epidemiology, The Ohio State University, Columbus, OH, USA
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Miriam Labbok
- Carolina Global Breastfeeding Institute, Department of Maternal and Child Health, The University of North Carolina at Chapel Hill, Chapel Hill NC, USA
| | - Frieda Behets
- College of Public Health, Division of Epidemiology, The Ohio State University, Columbus, OH, USA
- School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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49
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Mejri A, Dorval VG, Nuyt AM, Carceller A. Hypoglycemia in term newborns with a birth weight below the 10th percentile. Paediatr Child Health 2013; 15:271-5. [PMID: 21532790 DOI: 10.1093/pch/15.5.271] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2009] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Current recommendations suggest that routine screening for hypoglycemia should be performed in all term newborns with a birth weight (BW) below the 10th percentile. The impact of updated growth curves on the incidence of hypoglycemia in small-for-gestational-age (SGA) newborns has not been evaluated. OBJECTIVES To evaluate the occurrence and severity of hypoglycemia in term newborns with a BW between the 10th and fifth percentile, and below the fifth percentile, using recently updated growth curves. DESIGN A one-year prospective cohort study. METHODS Inclusion criteria were gestational age of 37 weeks or greater and BW below the 10th percentile. Neonatal hypoglycemia was defined as a blood glucose level of less than 2.6 mmol/L measured after 2 h of life. Blood glucose was measured routinely for all SGA infants during the first 36 h of life. RESULTS A total of 187 SGA infants met the study criteria: 85 infants with a BW between the 10th and fifth percentile, and 102 infants with a BW below the fifth percentile. The characteristics of the study cohort were similar between BW groups. Twenty-six per cent of the infants screened had at least one episode of hypoglycemia: 22% of infants in the 10th to fifth percentile group and 28% in the less than fifth percentile group. Hypoglycemia was symptomatic in four infants, all of whom were below the fifth percentile for BW. The mean (± SD) lowest blood glucose level was 2.1±0.4 mmol/L (range 0.6 mmol/L to 2.5 mmol/L) in the 10th to fifth percentile group and 2.0±0.5 mmol/L (range 0.8 mmol/L to 2.5 mmol/L) in the less than fifth percentile group (P=0.05). CONCLUSION The present study demonstrates a high incidence of hypoglycemia among SGA infants with a BW below the 10th percentile using updated growth curves. There was no difference in the incidence of hypoglycemia among SGA infants with a BW below the fifth percentile versus those with a BW between the 10th and fifth percentile.
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Affiliation(s)
- Abdelwaheb Mejri
- Department of Pediatrics, CHU Sainte-Justine, 3175 Côte Sainte-Catherine, Montreal, Quebec
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50
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Suzuki S, Koga M, Niizeki N, Furuya A, Takahashi H, Matsuo K, Tanahashi Y, Kawata Y, Asai H, Tsuchida E, Nohara F, Okamoto T, Nagaya K, Azuma H. Glycated albumin is lower in infants than in adults and correlated with both age and serum albumin. Pediatr Diabetes 2013; 14:25-30. [PMID: 22816963 DOI: 10.1111/j.1399-5448.2012.00895.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 05/12/2012] [Accepted: 05/31/2012] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Glycated albumin (GA) reflects glycemic control in patients with neonatal diabetes mellitus (NDM). However, GA in NDM patients is apparently low in relation to glycemia. OBJECTIVE To establish the reference intervals for GA in healthy infants. SUBJECTS AND METHODS Fifty-eight healthy, full-term newborn infants were used to define the GA reference values and to investigate its relationship to plasma glucose (PG) and serum albumin. The infants were categorized into three groups according to age: group A, 5 (4-6) median (range) d: n = 18; group B, 33 (30-38) d: n = 19; and group C, 181 (50-352) d: n = 21. We also studied 212 non-diabetic adults [group D, 53 (28-78) yr old] and the 5 NDM patients previously reported for GA comparisons. RESULTS In the infants, GA was strongly positively correlated with logarithmic transformation of age [log (age)] (p = 0.831, p < 0.0001). The GA in groups A, B, C, and D were 7.3 ± 1.0%, 8.6 ± 1.1%, 10.9 ± 0.8%, and 14.0 ± 1.1%, respectively. The GA was more strongly positively correlated with serum albumin (r = 0.768, p < 0.0001) than with PG (r = 0.596, p < 0.0001). When GA levels were compared with the age-dependent reference values, GA in the transient NDM patient was normalized although GA in the four permanent NDM patients decreased but remained high after insulin therapy. CONCLUSIONS This study showed that the reference range for GA in infants is lower than that of adults and increases with age, with which we confirmed that GA in the NDM patients reflected the clinical course. Consequently, GA in NDM patients should be compared with the age-based reference values to assess the accurate glycemic status.
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Affiliation(s)
- Shigeru Suzuki
- Department of Pediatrics, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan.
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