Presented at the Neonatal Society 2017 Autumn Meeting.
Course C, Doherty C
Welsh Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, UK
Background: Neonatal hypoglycaemia is a common problem and needs prompt recognition and management to prevent short and long term sequelae, including neurodevelopmental delay. Admissions to our intensive and high-dependency neonatal unit for treatment of hypoglycaemia appear to be increasing over a five year period (3.9% of admissions in 2005 to 5.1% in 2011), despite the same unit guideline for the past twelve years. This study aimed to identify the burden of neonatal hypoglycaemia on care services, identify factors that influence need for admission, and whether changing maternal characteristics may be causative, such as impaired glucose tolerance and maternal obesity.
Methods: A retrospective case note review of admissions to the neonatal unit was performed between 1st January 2011 and 31st December 2013. Cases were identified from the unit’s admissions book, and were eligible for inclusion if the primary reason for admission was hypoglycaemia. Neonatal and antenatal/maternal demographic details were collected, as well as details on time until presentation, adherence to local treatment guideline, investigations undertaken and results and duration of admission.
Results: 102 cases were identified during the study period. Over the three years examined, admissions for neonatal hypoglycaemia increased from 5.1% of all unit admissions to 8.5%. Median gestational age of 37.4 weeks (range=33.4-42.1). Median birthweight of 2710.5g (range=1600-4830). 88% of cases were classified as ‘infants at risk of hypoglycaemia’ by hospital guidelines. 35 mothers (34%) had an OGTT performed, confirming gestational diabetes in 13% by current guidelines. 2-hour glucose median 6.3 (range=3.2-12.7). 7% had mothers with type 1 diabetes and 4% had mothers with type 2 diabetes. No data on maternal BMI was available. 19% had evidence of neonatal sepsis, 27% had a maternal history of preeclampsia and there were no cases with an Apgar score <9 at 10 minutes. 95.1% (97 cases) were appropriate admissions according to unit guidelines. 17% had a hypoglycaemia screen sent, revealing 12 cases (12% of total) of hyperinsulinism (HI), with one of these cases having a history of maternal diabetes (Type 2). Median length of IV fluids required was 48 hours (range=0- 384), with 24 infants (24%) requiring a GIR >8 (Median maximum GIR 5.8, range=0-21.4). Median length of stay was 5 days (range=1-29), but for those with HI median length of stay was 12.5 days (range=5-21).
Conclusion: Despite appropriate use of unit management guidelines, there has been a 67% increase in admissions for hypoglycaemia, suggesting a change in the population. The majority of these cases do not show evidence of hyperinsulinism, but still require a significant amount of intervention. A minority of mothers have a history of diabetes, but other antenatal factors, such as increased maternal impaired glucose tolerance, secondary to increasing maternal BMI, may be programming adverse infant glycaemic control. This highlights the importance of monitoring maternal BMI and weight gain during pregnancy, and further studies are taking place in this area.
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