DOI: 10.18410/jebmh/2015/759
ORIGINAL ARTICLE
HYPOGLYCEMIA AMONGST NEONATES ADMITTED IN NICU IN A
TERTIARY CARE CENTRE KGH
P. Indira1, S. Jyotsna2
HOW TO CITE THIS ARTICLE:
P. Indira, S. Jyotsna. “Hypoglycemia Amongst Neonates Admitted in NICU in A Tertiary Care Centre KGH”.
Journal of Evidence based Medicine and Healthcare; Volume 2, Issue 35, August 31, 2015;
Page: 5465-5471, DOI: 10.18410/jebmh/2015/759
ABSTRACT: Hypoglycemia is a historically one of the most common metabolic problem seen in
both the newborn nursery and NICU but confirming a diagnosis of clinically significant
hypoglycemia requires to be investigated. OBJECTIVES: to study incidence of hypoglycemia in
NICU, various factors associated with hypoglycemia, clinical features of hypoglycemia.
MATERIALS AND METHODS: Study Design: A hospital based prospective study conducted
Neonatal Intensive Care Unit, Department of pediatrics, King George Hospital. For a period of 4
months (Jan 2015-April 2015) were 300 new born babies were included. RESULTS: 1)
Distribution of hypoglycemia in study group are 95% normoglycemic; 5% hypoglycemic. 2)
Among the total babies enrolled % of hypoglycemia in male babies 3% and female babies 2%. 3)
Percentage of hypoglycemia among the birth weight <2500gm is 9.1% when compared to
>2500gms which is 2.2%. CONCLUSIONS: There is statistical significant association between
hypoglycemia and gender i,e p=.04. There is statistically significant association between
hypoglycemia and birth weight of the baby i, e p=.01. Further study recommended as our study
duration was short and number of babies enrolled are also less.
KEYWORDS: Hypoglycemia, Birth weight, Newborn.
INTRODUCTION: Hypoglycemia in a neonate has been defined as blood sugar value <
40mg/dl. Hypoglycemia is encountered in a variety of neonatal conditions including prematurity,
growth retardation and maternal diabetes. Screening for hypoglycemia in certain high-risk
situations is recommended. Supervised breast-feeding may be an initial treatment option in
asymptomatic hypoglycemia. However, symptomatic hypoglycemia should always be treated with
a continuous infusion of parenteral dextrose. Neonates needing dextrose infusion rates above 12
mg/kg/min should be investigated for the cause of hypoglycemia. Hypoglycemia has been linked
to poor neuro-developmental outcome, and hence aggressive screening and treatment is
recommended.1,2 Further descriptions of the neurological sequelae associated with symptomatic
hypoglycemia in the newborn period followed. Concern arouse that hypoglycemia without clinical
signs might also lead to neurodevelopmental sequelae.3,4 In Tanzer F et al study ( in full term
neonates) , lowest blood glucose level was seen in the first 3 hours of life5.
METHODS: Design and Setting: This prospective study has been carried out in Neonatal
Intensive Care Unit, Department of Pediatrics King George Hospital, Vishakhapatnam over a
period of 4 months from January 2015 to April 2015.
Study Population: Total number of babies enrolled were 300.
J of Evidence Based Med & Hlthcare, pISSN- 2349-2562, eISSN- 2349-2570/ Vol. 2/Issue 35/Aug. 31, 2015 Page 5465
DOI: 10.18410/jebmh/2015/759
ORIGINAL ARTICLE
Inclusion Criteria: Inborn babies in King George hospital brought to our NICU.
Exclusion Criteria: All out borns.
Data Collection: Blood glucose estimated by one touch basic glucometer. Immediately within an
hour after birth-repeat after two and four hours of admission. In high risk neonates blood glucose
4-6 hourly for next 48 hours. Blood glucose levels of less than 40mg/dl considered as
hypoglycemia irrespective of gestational age and birth weight.6 Enteral feeding within half an hour
of birth was started (Intravenous glucose only when weight of babies was <1500gms or in sick
neonates).
OBSERVATIONS: Total 300 babies were enrolled in the study, the following observations were
grouped into Group A and B as hypoglycemic (15) and normoglycemics;285 respectively


Group A: Hypoglycemia (< 40 mg/dl) N=15.
Group B: Normoglycemia (> 40mg/dl) N=285.
Following observations are reported in our study.
Figure 1: Total babies enrolled were 300
5% of babies are hypoglycemic and 95% of babies are normoglycemic.
J of Evidence Based Med & Hlthcare, pISSN- 2349-2562, eISSN- 2349-2570/ Vol. 2/Issue 35/Aug. 31, 2015 Page 5466
DOI: 10.18410/jebmh/2015/759
ORIGINAL ARTICLE
Figure 2
p=0.04, there is statistical significant association between hypoglycemia and gender.
Figure 3
p =0.01 there is statistically significant association between hypoglycemia and birth
weight of the baby.7
J of Evidence Based Med & Hlthcare, pISSN- 2349-2562, eISSN- 2349-2570/ Vol. 2/Issue 35/Aug. 31, 2015 Page 5467
DOI: 10.18410/jebmh/2015/759
ORIGINAL ARTICLE
Figure 4
Among the hypoglycemic 73% of the babies shown symptoms of hypoglycemia.
Risk factor
Total babies No. of babies showing
Septicemia
50
4(8%)
Normal babies(hypothermic)
65
2(3%)
Respiratory distress
40
1(2.5%)
Birth asphyxia
35
2(5.7%)
Tabular form showing the risk factors in hypoglycemic
infants: term babies: Total 205 babies
preterm babies
Total
95 babies
Small for gestation
55
1(1.8%)
Respiratory distress
40
0%
Tabular form showing the risk factors in hypoglycemics infants
J of Evidence Based Med & Hlthcare, pISSN- 2349-2562, eISSN- 2349-2570/ Vol. 2/Issue 35/Aug. 31, 2015 Page 5468
DOI: 10.18410/jebmh/2015/759
ORIGINAL ARTICLE
Figure 5
Refusal of feeds was the most common sign among the hypogylcemics.
hypoglycemics
normoglycemics
Preterm
6
89
Term
9
196
Total
15
285
Total
95
205
300
Table 1: Showing the percentage of pre-terms and term babies with hypoglycemia
hypoglycemia within 24hrs 10 babies 3.33%
hypoglycemia >24hrs
5 babies
1.66%
Tabular showing hypoglycemia onset timing
DISCUSSION: Neonatal hypoglycemia is one of the most common problems seen in neonatal
intensive care units. It is accepted that the persistent early and prolonged hypoglycemia results in
brain damage and mental retardation.8
Thus, neonatal intensive care therapy units must identify all neonates with risk of neonatal
hypoglycemia, and to early initiate the treatment, because early recognition offers the best
outcomes.
In the present the accepted definition of hypoglycemia is whole-blood glucose
level<40mg/dl, both in the term neonates and in the premature infants.
J of Evidence Based Med & Hlthcare, pISSN- 2349-2562, eISSN- 2349-2570/ Vol. 2/Issue 35/Aug. 31, 2015 Page 5469
DOI: 10.18410/jebmh/2015/759
ORIGINAL ARTICLE
The risk category of newborns with neonatal hypoglycemia:
 Premature infants.
 Small for gestational age infants.
 Large for gestation age infants.
 Post maturity.
 Twins.
 Infant of diabetic mother.
 Infants born from mothers who receive high glucose infusion before delivery.
 Newborn with neonatal pathology.
OTHERS: Beck with weidemann syndrome, erythro-blastosis, wrong-positioned umbilical artery
catheter.
The results of our study suggest that newborns with low body weight are at greater risk
for hypoglycemia.
The small for gestation age preterm neonates are at greater risk of neonatal
hypoglycemia, because the fuels are directed towards growth, as opposed to glycogen deposits.9
P. K Singhal et.al9 study showed 71.5% case were term birth asphyxia with hypoglycemia
and study showed 11.6% septicemia cases developed hypoglycemia comparison to our study
showed 5.7% and 8% respectively. Our study is comparable to study done by M.A.Bhat et al10 in
SGA babies, 98% of the episodes of hypoglycemia occurred within 24hrs. Acc to Hawdon et al11
study on preterm infants the mean blood glucose concentration was significantly lower on the 1st
day than on the subsequent days.
CONCLUSION: Hypoglycemia is a common preventable and neglected problem in developing
countries. Our study showed that preterm, LGA’s, SGA’s term, birth asphyxia, IGDM/IDM’s
septicemia, hypothermia are at an increased risk of developing hypoglycemia. More than half of
the cases were asymptomatic even though the blood glucose levels showed hypoglycemia. Hence
these categories of neonates deserve an aggressive blood sugar monitoring and management in
order to reduce the early infant mortality and neuro development sequelae in later lofe.
Irrespective of the symptomatic and asymptomatic newborns has to be screened for blood
glucose level within 72 hours which can prevent hypoglycemia in turn can prevent tissue damage.
REFERENCES:
1. Ashish jain, Rajiv Aggarwal M, Jeeva sankar, vinod k paul AIIMS protocols neonatology,
New Delhi page no: 221.
2. Williams AF. Hypoglycemia in newborns: a review. Bull. World Health Organ. 1997; 75: 261290.
3. Meherban Singh Care of the new born, 8th edition pg no 466
4. Christine A gleason, sherin u devaskar Averys diseases of the newborn 9th edition pg no
1322.
5. Kalhan S, Peter-Wohl S. hypoglycemia: what is it for the neonate? Am J Prenatal 2000; 17:
11-4.
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DOI: 10.18410/jebmh/2015/759
ORIGINAL ARTICLE
6. Duvanel CB, et al. long term effects of neonatal hypoglycemia on brain growth and
physchomotor development in small for gestational age preterm infants. J Pediatrics 1990;
134: 492-8]
7. Tanzer F, Yanzar N, Yazar H, et al: Blood glucose levels and hypoglycemia in full term
neonates during the first 48hours of life. J. Trop Pediatr. 1997; Feb; 43(1): 58-60.
8. Leeuw RD, de Vries IJ. Hypoglycemia in small–for-dates new born infants, Pediatrics 1976,
58: 18-22.
9. Singhal P.K,.Singh M, Paul V.K, Deodari A.K, Ghorpade M.G, Malhotra A. Neonatal
Hypoglycemia-Clinical profile and glucose requirements. Indian. Pediatrics 1992; 29: 167-71
10. Bhat MA. Hypoglycemia in small for gestational age babies. Ind. J. Pediatrics. 2000;
67(6):423-427.
11. Hawdon JM. Patterns of metabolic adaption for pre-term infants in the first neonatal week.
Arch. Dis. Chil. 1994; 70: F60-F65.
AUTHORS:
1. P. Indira
2. S. Jyotsna
PARTICULARS OF CONTRIBUTORS:
1. Assistant Professor, Department of
Pediatrics, Andhra Medical College,
Vizag, Andhra Pradesh.
2. Post Graduate, Department of
Pediatrics, Andhra Medical College,
Vizag, Andhra Pradesh.
NAME ADDRESS EMAIL ID OF THE
CORRESPONDING AUTHOR:
Dr. P. Indira,
Plot No. 26,
Palace Compound,
Pedha Waltair, Visakhapatnam-17.
E-mail: indiraguda07@gmail.com
Date
Date
Date
Date
of
of
of
of
Submission: 21/08/2015.
Peer Review: 22/08/2015.
Acceptance: 24/08/2015.
Publishing: 31/08/2015.
J of Evidence Based Med & Hlthcare, pISSN- 2349-2562, eISSN- 2349-2570/ Vol. 2/Issue 35/Aug. 31, 2015 Page 5471