Analysis Of Risk Factors Related To Neonatal Hypoglycemia And Clinical Characteristics

Aims:To study the clinical features and complications of neonatal hypoglycemia.To investigate the related risk factors for effective prevention and intervention measures.To analyze the relationship between blood glucose level,hypoglycemia duration and brain injury.To study the imaging manifestations of hypoglycemic encephalopathy.To provide a reference for reducing the incidence of neonatal hypoglycemia and hypoglycemic encephalopathy.Materials and Methods:There were 117 cases of newborns who were diagnosed hypoglycemia in neonatology department(exclude NICU)of The Children's Hospital of Zhejiang University School during January 1,2016 to December 31,2017.117 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 period and reviewed the basic information,maternal and newborns' related information,auxiliary examination(cranial MRI,etc.).Then,we statistically analyzed the relative risk factors which might cause neonatal hypoglycemia,such as newborns' gestational age,gender,birth weight of newborns,twins,maternal pregnancy complications(gestational diabetes mellitus,gestational hypertension,amniotic fluid pollution,intrauterine distress,hypothyroidism),delivery mode(cesarean section)and so on.To analyze the relationship between the lowest blood glucose level,hypoglycemia duration and brain injury,and to collect and summarize the imaging features of hypoglycemic encephalopathy.Data were performed by using T test,Chi-Square test and Logistic regression analyses.The non-normal distribution is described by the median(M),using the rank sum test.P<0.05 was considered statistically significant.Results:(1)The proportion of hypoglycemia of newborns in our hospital during 2016 to 2017 was 0.69%(117/16971),of which 23.93%(28/117)were preterm infants and 76.07%(89/117)were term infant,and premature infants:term infants,approximately 1:3.The proportion of baby boys was 67.52%(79/117),and the proportion of baby girls was 32.48%(38/117),baby boys:baby girls,approximately 2:1.At the time of admission,the proportion of children with age of 3 days or less was the highest,89 cases(76.07%).(2)The neonate's general condition and clinical characteristics:the case group and control group respectively,gestational age(37.5±1.8w ? 38.2±2.2w,t=-2.907,P=0.019),birth weight(2923.72±807.90g and 3192.78±454.36g,t=-3.140,P=0.000),premature infants[28(23.93%)and 13(11.1 1%),?2=13.798,P=0.000),low birth weight[37(31.62%)and 5(4.27%),?2= 26.647,P = 0·000),macrosomia[14(11.97%)and 1(0.85%),?2=12.038,P=0.001)and SGA[30(25.64%)and 2(1.71%),?2= 28.381,P=0.000),LGA[11(9.40%)and 1(0.85%),?2=8.343,P = 0.004],the case group was higher than the control group,which had statistically significant differences(P<0.05).Twins between the two groups had no statistically significant difference(P>0.05).(3)Clinical features and complications of hypoglycemia in newborns:61 cases(45.54%)newborns with hypoglycemia were symptomatic hypoglycemia.The clinical characteristics of neonatal hypoglycemia and complications:in the group of 117 cases,22 cases(18.8%)appeared cyanosis,14 cases(11.97%)had poor response,10 cases(8.55%)in shortness of breath,8 cases(6.84%)had convulsion.Common complications of neonatal hypoglycemia have congenital heart disease(61 cases,52.14%),neonatal hyperbilirubinemia(27 cases,23.08%),neonatal sepsis(21 cases,17.95%),neonatal erythremia(15 cases,12.82%),etc.There were 81 cases(69.23%)took the head MRI examination,among which,15 patients(55.56%)with hypoglycemic brain injury showed typical hypoglycemic encephalopathy.There were 10 cases(66.67%,10/15)involved in the bilateral occipital lobes and corpus callosum simultaneously.(4)27 cases(23.08%)had brain injury,the lowest blood glucose level of hypoglycemic newborns with brain injury and no brain injury was(1.30±0.54 mmol/L and 1.67±0.51 mmol/L,t=3.271,P=0.694),there was no statistically significant difference(P>0.05);duration of hypoglycaemia<12h of the incidence of newborns with brain injury is 9/71(12.68%),the incidence of-72h is 8/24(33.33%),the incidence of>72h was 10/22(45.45%),the difference was statistically significant(?2=11.955,P=11.955),81 patients(69.23%,81/117)in neonatal hypoglycemia newborns took head MRI,15 cases of hypoglycemic brain injury whose cranial MRI imaging findings were typical hypoglycemic encephalopathy,including 10 cases(66.67%,10/15)were involving top bilateral occipital lobe brain white matter and the corpus callosum at the same time.(5)The mothers' general condition and clinical characteristic:the case group and control group rate of cesarean section[70(59.83%)and 49(41.88%),?2=7.541,P = 0.006),gestational diabetes mellitus(GDlM)[26(22.22%)and 3(2.56%),?2=20.822,P=0.000)],gestational hypertension disease[19(16.23%)and 2(1.71%),?2=15.119,P=0.000)],amniotic fluid pollution[19(16.23%)and 2(1.71%),x2=15.119,P=0.000)],intrauterine distress[12(10.26%)and 2(1.71%),?2=7.597,P=0.006)],hypothyroidism[8(6.84%)and 1(0.85%),?2=5.662,P=0.017),the case group were higher than the control group,the difference was statistically significant(P<0.05).Gravidity and parity between the two groups had no statistically significant differences(P>0.05).(6)By single factor and multiple factors analysis:low birth weight(OR=9.588;95%CI=3.152-29.164),macrosomia(OR=14.610;95%CI=1.689-126.354),gestational diabetes mellitus(GDM)(OR=7.231;95%CI=1.867-28.008),gestational hypertension disease(OR=7.456;95%CI=1.461-38.065),amniotic fluid contamination(OR=9.162;95%CI=1.845-45.493),hypothyroidism(OR=13.281;95%CI=1.480-119.198)were the risk factors of neonatal hypoglycemia.Conclusion:(1)Neonatal hypoglycemia is not uncommon in our neonatology department,baby boys are more than baby girls,the proportion of children with age of 3 days or less was the highest.Most hypoglycemia newborns are symptomatic hypoglycemia,main performance include cyanosis,poor response,shortness of breath or breathing difficulties,convulsions,moaning,muscular hypertonia or hypomyotonia,sleepiness,hypothermia,etc.Asymptomatic hypoglycemia neonates also requires attention.(2)The neonatal brain injury was common,the relationship between blood glucose level and the incidence of hypoglycemic brain injury is not significant,which is related to the hypoglycemia duration,the longer duration of hypoglycemia,the higher incidence of brain injury.The cranial MRI examination in newborns with hypoglycemia was of great significance for early diagnosis and evaluation of prognosis.(3)Low birth weight,macrosomia,gestational diabetes mellitus(GDM),gestational hypertension disease,amniotic fluid contamination and hypothyroidism were the risk factors for neonatal hypoglycemia.Pay close attention to blood sugar levels of newborns(especially for the newborns with high risk factors),the neonatal hypoglycemia should be early discoveried,early diagnosed,early treated,correct blood sugar as soon as possible to avoid sequelae.