| Objective: To investigate the obstetric risk factors of neonatal hypoglycemia.To guide more effective prevention and intervention.To provide clinical guidance for reducing the incidence of neonatal hypoglycemia.Materials and Methods: There were 92 cases of newborns who were tested within thirty minutes after birth and diagnosed hypoglycemia in the First Affiliated Hospital of Dalian Medical University during September 1,2014 to December 31,2015.92 cases of newborns who were tested blood glucose in normal range as control group were randomly selected from our hospital during the same period.Firstly,we calculated the incidence of neonatal hypoglycemia during this time.Then,we statistically analyzed the relative risk factors which might cause neonatal hypoglycemia,such as maternal age,the pre-pregnancy BMI,pregnancy complications(pregnancy with diabetes,hypertensive disorders complicating pregnancy,premature rupture of membranes,intrauterine infection and intrauterine distress),delivery mode(cesarean section),delivery gestational age,gestational age,birth weight of newborns,gender,the incidence of premature babies,macrosomia,low birth weight infants,LGA(large for gestational age),SGA(small for gestational age),twins and so on.In addition,we analyzed clinical manifestations of hypoglycemia and situation of newborns into the NICU.Date were performed by using T test,Chi-Square test and logistic regression analyses.Results:(1)The incidence of neonatal hypoglycemia was 5.3% during this time,the incidence of hypoglycemia in preterm infants was 10.5%,the incidence of hypoglycemia in term infants was 4.8%.(2)The general condition and clinical characteristics of newborns: Birth weight,gender,the incidence of macrosomia,SGA,LGA between the two groups had no statistically significant differences(P>0.05).In the case group,neonatal gestational age(38.1±1.8weeks ? 39.3±1.4weeks,t=-5.081,P=0.000),the blood glucose concentration(1.9 ±0.3mmol/l ? 3.9±0.9mmol/l,t=-19.907,P=0.000),were all less than the control group,which were statistically significant differences(P<0.05).For the incidence of premature infants[19.6%(18/92)? 4.3%(4/92),?2=8.725,P=0.003],low birth weight infants [14.1%(13/92)? 3.3%(3/92),?2=5.545,P=0.019],twins(8.7%? 0,P=0.007),the case group were higher than control group,which were statistically significant differences(P<0.05).(3)The clinical manifestations of neonatal hypoglycemia: 83 cases(90.2%)in the case group had no symptoms.Only 9 cases had clinical manifestations(9.8%),but not typical.There were the 6.5% infants with perioral and(or)systemic cyanosis,the 3.3% with poor response,the 2.2% infants with moaning,the 2.2% with tachypnea,the 1.1% with dyspnea.(4)Newborns into the NICU: 14 cases of newborns were into the NICU(15.2%),and 12 cases were diagnosed as neonatal hypoglycemia.There had 6 cases of concurrent pathological jaundice(one of them had polycythemia,another one had neonatal hypoxic ischemia encephalopathy).In addition,another one case was persistent hypoglycemia,accompanied by neonatal hypoxic ischemia encephalopathy.Because his parents gave up treatment,he finally died.(5)The general condition and clinical data of mothers: age,gravidity,parity,the situation of premature rupture of membranes,intrauterine infection,intrauterine distress between the two groups had no statistically significant differences(P>0.05).In case group,the delivery pregnancy weeks(38.1±1.8weeks ? 39.3±1.4weeks,P=0.000),the rate of pre-pregnancy overweight or obesity[45.7%(42/92)? 12.0%(11/92),?2=25.468,P=0.000],pregnancy with diabetes mellitus[40.2%(37/92)? 12.0%(11/92),?2=19.054,P=0.000],gestational hypertension disease[32.6%(30/92)? 6.5%(6/92),?2=19.892,P=0.000],the rate of cesarean section [94.6%(87/92)? 52.2%(48/92),?2=42.307,P=0.000],the rate of elective cesarean[63.2%(55/92)? 41.7%(20/92),?2=5.819,P=0.016],the case group were higher than control group,which were statistically significant differences(P<0.05).(6)By single factor and multiple factors analysis: pre-pregnancy overweight or obesity(OR=3.355;95%CI=1.416-7.950),pregnancy with diabetes mellitus(OR=3.368;95%CI=1.369-8.286),cesarean section(OR=9.174;95%CI=3.142-26.787),premature infants(OR=4.981;95%CI=1.187-20.898)were the risk factors of neonatal hypoglycemia.Conclusions:(1)Most of the neonatal hypoglycemia has no symptoms,A minority of them has untypical symptoms,so we should pay attention to this.(2)Pre-pregnancy overweight or obesity,pregnancy with diabetes mellitus,cesarean section,premature infants are the obstetric risk factors of neonatal hypoglycemia.(3)Controlling pregestational weight,strengthening the standard management of diseases such as diabetes and hypertension disease during pregnancy,decreasing obstetric complications,reducing the cesarean delivery rate,shortening the preoperative fasting time and giving preoperative rehydration,are all playing a positive role in reducing and preventing the incidence of neonatal hypoglycemia. |
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