Risk Belirlenen Bebeklerde Hipoglisemi İnsidansı

Yıl 2020, Cilt: 14 Sayı: 6, 512 - 517, 30.11.2020

Özge Yüce Deniz Anuk-ince

https://doi.org/10.12956/tchd.784141

Öz

Amaç:
Bu retrospektif çalışmanın amacı risk altındaki bebeklerde hipoglisemi insidansını belirlemek ve doğum sonrası 48 saate kadar sonuçlarını değerlendirmekti. Ayrıca hipoglisemi olan ve olmayan bebeklerin demografik özelliklerini karşılaştırmayı amaçladık.

Yöntemler:
Hipoglisemi ICD kodu ile taranan yenidoğanlar risk faktörleri açısından değerlendirildi ve hastalar risk faktörlerine göre gruplandırıldı. Risk altındaki tüm bebekler doğum sonrası 48 saate kadar tarandı. hipoglisemi, bebeğin yaşına bakılmaksızın kan şekeri konsantrasyonunun 47 mg / dl'nin altında olması olarak tanımlandı.

Bulgular:  823 bebekte hipoglisemi ICD kodu ile doğumdan 48 saat sonra kan şekeri konsantrasyonu ölçüldü. Bu bebeklerin 251'inde (% 30,4) hipoglisemi saptandı. 823 bebekten 215'i (% 26) hipoglisemi için en az bir risk faktörüne sahip olduğu için tarandı. Bunların 149'unda (% 69,3) hipoglisemi saptandı. Diyabetik anne bebeği dışında risk altındaki tüm bebeklerde hipoglisemi insidansı artmıştır. Bununla birlikte, risk altındaki bebeklerin tamamına yakını ilk 24 saatte hipoglisemi geliştirmesine rağmen, 7'sinde (% 4,6) postnatal 24-48 saat içinde hipoglisemi tespit ettik. Hipoglisemik olan ve olmayan risk altındaki bebeklerin demografik özelliklerinde istatistiksel olarak anlamlı farklılıklar vardı.

Tartışma:
Hipoglisemi risk altındaki bebeklerde yaygındır. Erken ve zamanında teşhis ve tedavi olmadan, nörolojik ve gelişimsel olumsuz sonuçlara neden olabilir. Bu nedenle, etkisini azaltmak için risk altındaki bebeklerde kan şekeri düzeyinin sürekli olarak izlenmesi gerekir.

Anahtar Kelimeler

hipoglisemi insidansı, risk faktörleri, neonatal hipoglisemi

Hypoglycemia Incidence in Babies Identified as at Risk

Öz

Aim: The aim of this retrospective study was to determine the incidence of hypoglycemia in babies at risk and to examine our follow-up results up to 48 hours postnatally. It is also aimed at comparing the demographic characteristics of babies with and without hypoglycemics.

Methods:
The newborns screened with hypoglycemia ICD code were evaluated in terms of risk factors, and the patients were grouped according to risk factors. All babies at risk were screened up to 48 hours postnatally. hypoglycemia was defined as a blood glucose concentration <47 mg/dl, regardless of the age of the baby.

Results:
Blood glucose concentration first 48 hours after birth was measured in 823 babies with the hypoglycemia ICD code. Hypoglycemia was detected in 251 (30.4%) of these babies. 215 (26%) out of 823 babies were screened for having at least one risk factor for hypoglycemia. Hypoglycemia was detected in 149 (69.3%) of them. Incidence of hypoglycemia increased in all babies at risk except infant of diabetic mother. Even through although almost all of the babies at risk developed hypoglycemia in the first 24 hours, we detected hypoglycemia in 7 of them(4.6%) during postnatal 24-48 hours. There were statistically significant differences in demographic characteristics of babies at risk who did and did not become hypoglycemic.

Conclusions: Hypoglycemia is common in babies at risk. Without early detection and timely diagnosis and treatment can cause negative consequences of neurological and developmental. therefore, continuous monitoring of blood glucose level in babies at risk should be performed to reduce its impact.

Anahtar Kelimeler

hypoglycemia incidence, risk factors, neonatal hypoglycemia

Kaynakça

• 1. Cornblath M, Hawdon JM, Williams AF, Aynsley-Green A, Ward-Platt MP, Schwartz R, Kalhan SC. Controversies regarding definition of neonatal hypoglycemia: suggested operational thresholds. Pediatrics 2000; 105(5), 1141-1145.
• 2. Thornton PS, Stanley CA, De Leon DD, Harris D, Haymond MW, Hussain K, Sperling MA. Pediatric Endocrine Society. Recommendations from the Pediatric Endocrine Society for evaluation and management of persistent hypoglycemia in neonates, infants, and children. J Pediatr 2015; 167(2), 238-245.
• 3. Anchan JC, Carr NR, Ahmad KA. Neonatal hypoglycemia: is there a neurodevelopmental impact in early childhood?. Journal of Perinatology 2019; 39(1), 4-7.
• 4. McKinlay CJ, Alsweiler JM, Anstice NS, Burakevych N, Chakraborty A, Chase JG, Paudel N. Association of neonatal glycemia with neurodevelopmental outcomes at 4.5 years. JAMA pediatrics 2017; 171(10), 972-983.
• 5. Committee on Fetus and Newborn, Adamkin DH. Postnatal glucose homeostasis in late-preterm and term infants. Pediatrics 2011;127:575-9. 6. Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC pediatrics 2013; 13(1), 59.7.
• 7. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2010; 33: S62-9. 
8. Harris DL, Weston PJ, Battin MR, Harding JE. A survey of the management of neonatal hypoglycemia within the Australian and New Zealand Neonatal Network. J Paediatr Child Health 2009; 26:1-8.
• 9. Barbosa M, Bek Helmig R, Hvidman L. Twin pregnancies treated with emergency or ultrasound-indicated cerclage to prevent preterm births. The Journal of Maternal-Fetal & Neonatal Medicine 2019; 1-6.
• 10. Berger T, Das-Kundu S, Pfister R, et al. Betreuung von Neugeborenen !34 0/7 SSW mit erhohtem Hypoglykamierisiko oder Hypoglykamie im Gebarsaal und in der Wochenbettstation. Pediatr Ann. 2007;18: 15–17.
• 11. Harris DL, Weston PJ, Harding JE. Incidence of neonatal hypoglycemia in babies identified as at risk. The Journal of pediatrics 2012; 161(5), 787-791.
• 12. 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;59:368–74.
• 13. Aziz K, Dancey P. Screening guidelines for newborns at risk for low blood glucose. Paediatr Child Health. 2004; 9:723–729.
• 14. Heck LJ, Erenberg A. Serum glucose levels in term neonates during the first 48 hours of life. The Journal of pediatrics 1987; 110(1), 119-122.
• 15. Ogata E. Carbohydrate metabolism. In: Gordon B, Fletscher M, MacDonald M, editors. Neonatology: pathophysiology and management of the newborn. 4th ed. Philadelphia: Lippincott; 1994. p. 78-86.
• 16. Schaefer-Graf UM, Rossi R, Bu ̈hrer C, Siebert G, Kjos SL, Dudenhausen JW, et al. Rate and risk factors of hypoglycemia in large-for-gestational-age newborn infants of nondiabetic mothers. Am J Obstet Gynecol 2002;187:913-7.
• 17. Holtrop PC. The frequency of hypoglycemia in full-term large and small for gestational age newborns. Am J Perinatol 1993; 10:150-4.
• 18. Zhou W, Yu J, Wu Y, Zhang H. Hypoglycemia incidence and risk factors assessment in hospitalized neonates. The Journal of Maternal-Fetal & Neonatal Medicine 2015; 28(4), 422-425.
• 19. Bromiker R, Perry A, Kasirer Y, Einav S, Klinger G, Levy-Khademi F. Early neonatal hypoglycemia: incidence of and risk factors. A cohort study using universal point of care screening. The Journal of Maternal-Fetal & Neonatal Medicine 2019; 32(5), 786-792.
• 20. Begum S, Dey SK, Fatema K. Neonatal glycemic status of infants of diabetic mothers in a tertiary care hospital. Indian journal of endocrinology and metabolism 2018; 22(5), 621.
• 21. Wang ML, Dorer DJ, Fleming MP, Catlin EA. Clinical outcomes of near-term infants. Pediatrics 2004; 114(2), 372-376.
• 22. Celik IH., Demirel G, Canpolat FE, Dilmen U. A common problem for neonatal intensive care units: late preterm infants, a prospective study with term controls in a large perinatal center. The Journal of Maternal-Fetal & Neonatal Medicine 2013; 26(5), 459-462.
• 23. Hay WW, Raju TN, Higgins RD, Kalhan SC, Devaskar SU.Knowledge gaps and research needs for understanding and treating neonatal hypoglycemia: workshop report from Eunice Kennedy Shriver National Institute of Child Health and Human Development. The Journal of pediatrics 2009; 155(5), 612-617.