Hypoglycemia in unmonitored full-term newborns - a surveillance study

• Published in: Paediatrics & Child Health
• Main Authors: Flavin, Michael P., Osiovich, Horacio, Coughlin, Kevin, Sgro, Michael, Ray, Joel, Hu, Liyuan, Leon, Juan Andres, Gregoire, Keith, Barr, Logan, Gallipoli, Alessia, Grewal, Karen
• Format: Article in Journal/Newspaper
• Language: unknown
• Published: Scholarship@Western 2018
• Subjects: newborn; hypoglycemia; risk factors; screening; Pediatrics; First Nations
• Online Access: https://ir.lib.uwo.ca/paedpub/207; https://doi.org/10.1093/pch/pxy025

Background and objectives Hypoglycemia monitoring is not recommended for most full-term newborns. We wished to determine the incidence, presentation and case characteristics of hypoglycemia in low-risk newborns. Methods With the assistance of the Canadian Paediatric Surveillance Program, we conducted a national study of severe hypoglycemia in apparently low-risk full-term newborns. Paediatricians who reported a case were sent a detailed questionnaire and the data were analyzed. Results: All 93 confirmed cases were singletons, 56% were first-borns and 65% were male. An 8% rate of First Nations cases was twofold the population rate. Maternal hypertension rate was 23%, fourfold the general pregnancy rate. Maternal obesity was double the general pregnancy rate at 23%. Concerning signs or feeding issues were noted in 98% at the time of diagnosis. Median time to diagnosis was 4.1 hours. Mean blood glucose at intravenous (IV) start was 1.4 ± 0.5 hours (SD). Seventy-eight per cent had at least one of four potential stress indicators and were more likely to have early diagnosis (P=0.03). Major signs were present in 20%. Those cases presented later and had lower glucose levels (median=0.8 mmol/L versus 1.6 mmol/L, [PConclusion Hypoglycemia in unmonitored newborns is uncommon but is associated with significant morbidity. We provide a range of clues to help identify these newborns soon after birth. Widespread adoption of norm-based standards to identify small-for-gestational age infants is supported.