Screening of the neonatal glycemia and its pitfalls

Česká verzia

Authors: M. Wita ^1,2; J. Hálek ^1,2
Authors place of work: Novorozenecké oddělení, FN Olomouc ¹; LF Univerzity Palackého, Olomouc ²
Published in the journal: Čes-slov Neonat 2022; 28 (2): 90-95.
Category: Reviews

Summary

There is a natural drop in the level of plasma glucose in the first hours after birth. As a result of metabolic and hormonal adaptation, glycemic values normalize early in most newborns. However, the ability of this physiological adaptation may be impaired in risk groups of newborns. Knowledge of the connection between hypoglycemia in the neonatal period and a possible subsequent permanent neurological deficit has already been published in the past. Perhaps that is why blood glucose measurement is one of the most common laboratory tests performed in neonatal wards. However, there are no uniform recommendations for the screening and therapy of neonatal hypoglycemia worldwide. The interpretation of clinical studies, with regard to the value of glycemia and possible adverse neurological outcome, is very limited. This is primarily due to the great methodological variability of the clinical studies. National guidelines are thus rather created as consensus recommendations of experts. The review article provides basic knowledge regarding the adaptation of glucose metabolism after birth. There are the basic assumptions of screening for hypoglycemia, as well as a wide range of information and factors that can influence the effectiveness of screening and the interpretation relation between level of the glycemia, clinical condition of the baby and possible neurological consequences.

Keywords:

management – screening – hypoglycemia – newborn – adverse outcome

Zdroje

1. Garg M, Devaskat SU. Disorders of carbohydrate metabolism in the neonate. In: Fanaroff and Martin’s Neonatal-perinatal medicine (11th ed). Philadelphia: Elsevier 2019; 1586−1589.

2. Cornblath M, Hawdon JM, Williams AF, Aynsley-Green A, Ward-Platt MP, Schwartz R, et al. Controversies regarding definition of neonatal hypoglycemia: suggested operational thresholds. Pediatrics 2000; 105(5): 1141−1145.

3. 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. J Pediatr 2009; 155(5): 612−617.

4. Adamkin DH, Newborn CoFa. Postnatal glucose homeostasis in late-preterm and term infants. Pediatrics 2011; 127(3): 575−579.

5. Thompson-Branch A, Havránek T. Neonatal hypoglycemia. Pediatr Rev 2017; 38(4): 147−157.

6. Alkalay AL, Sarnat HB, Flores-Sarnat L, Elashoff JD, Farber SJ, Simmons CF. Population meta-analysis of low plasma glucose thresholds in full-term normal newborns. Am J Perinatol 2006; 23(2): 115−119.

7. Harris DL, Weston PJ, Gamble GD, Harding JE. Glucose profiles in healthy term infants in the dirst 5 days: The glucose in well babies (GLOW) study. J Pediatr 2020; 223: 34−41.e4.

8. Adamkin DH. Neonatal hypoglycemia. Semin Fetal Neonatal Med 2017; 22(1): 36−41.

9. Shah R, Harding J, Brown J, McKinlay C. Neonatal glycaemia and neurodevelopmental outcomes: s systematic review and meta-analysis. Neonatology 2019; 115(2): 116−126.

10. Prevention and treatment of hypoglycaemia in neonates with a gestational age from 35 0/7 weeks in maternity wards [online] 2020 [cit. 31. 7. 2022]. Dostupné na: https://www.neonet.ch/application/ files/9716/0915/3976/2020_SSN_hypoglycaemia_e_neu.pdf.

11. Narvey MR, Marks SD. The screening and management of newborns at risk for low blood glucose. Paediatr Child Health 2019; 24(8): 536−554.

12. Harris DL, Weston PJ, Harding JE. Incidence of neonatal hypoglycemia in babies identified as at risk. J Pediatr 2012; 161(5): 787−791.

13. Wackernagel D, Gustafsson A, Edstedt Bonamy AK, Reims A, Ahlsson F, Elfving M, et al. Swedish national guideline for prevention and treatment of neonatal hypoglycaemia in newborn infants with gestational age ≥35 weeks. Acta Paediatr 2020; 109(1): 31−44.

14. Mitanchez D. Société Française de Pédiatrie: Hypoglycémie néonatale en contexte à risque [on line] 2019-07-30 [cit. 31. 7. 2022]. Dostupné z: https://pap-pediatrie.fr/neonatologie/hypoglycemie-neonatale-en-contexte-risque.

15. Rasmussen AH, Wehberg S, Fenger-Groen J, Christesen HT. Retrospective evaluation of a national guideline to prevent neonatal hypoglycemia. Pediatr Neonatol 2017; 58(5): 398−405.

16. Mejri A, Dorval VG, Nuyt AM, Carceller A. Hypoglycemia in term newborns with a birth weight below the 10th percentile. Paediatr Child Health 2010; 15(5): 271−275.

17. Desoye G, Nolan CJ. The fetal glucose steal: an underappreciated phenomenon in diabetic pregnancy. Diabetologia 2016; 59(6): 1089−1094.

18. Voormolen DN, de Wit L, van Rijn BB, DeVries JH, Heringa MP, Franx A, et al. Neonatal hypoglycemia following diet-controlled and insulin-treated gestational diabetes mellitus. Diabetes Care 2018; 41(7): 1385−1390.

19. Van Kempen AA, Romijn JA, Ruiter AF, Ackermans MT, Endert E, Hoekstra JH, et al. Adaptation of glucose production and gluconeogenesis to diminishing glucose infusion in preterm infants at varying gestational ages. Pediatr Res 2003; 53(4): 628−634.

20. Pavelková A. Srovnání screeningových programů pro záchyt hypoglykemie u novorozenců [in press] [cit. 31. 7. 2022]. Diplomová práce. Univerzita Palackého v Olomouci, Fakulta zdravotnických věd, Ústav porodní asistence.

21. Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr 2013; 13: 59.

22. Villar J, Cheikh Ismail L, Victora CG, Ohuma EO, Bertino E, Altman DG, et al. International standards for newborn weight, length, and head circumference by gestational age and sex: the newborn cross-sectional study of the INTERGROWTH-21st Project. Lancet 2014; 384(9946): 857−868.

23. Malý J, Bodnárová I, Wita M. Prevence a management hypoglykemie u rizikových novorozenců (≥ 35+0 GT) [online 2021] [cit. 31. 7. 2022]. Dostupné z: https://www.neonatologie.cz/_files/ ugd/38d635_0b248ef73cec4de89d59a05256470a5a.pdf.

24. Beardsall K. Measurement of glucose levels in the newborn. Early Hum Dev 2010; 86(5): 263−267.

25. McKinlay CJD, Chase JG, Dickson J, Harris DL, Alsweiler JM, Harding JE. Continuous glucose monitoring in neonates: a review. Matern Health Neonatol Perinatol 2017; 3: 18.

26. Chertok IR, Raz I, Shoham I, Haddad H, Wiznitzer A. Effects of early breastfeeding on neonatal glucose levels of term infants born to women with gestational diabetes. J Hum Nutr Diet 2009; 22(2): 166−169.

27. Edwards T, Liu G, Battin M, Harris DL, Hegarty JE, Weston PJ, et al. Oral dextrose gel for the treatment of hypoglycaemia in newborn infants. Cochrane Database Syst Rev 2022; 3: CD011027.