Ramasubbareddy Dhanireddy, MD
Background: Extremely low birth weight (ELBW) infants are prone to hypoglycemia unless intravenous glucose is administered within an hour (golden hour) of life. These infants often require resuscitation at birth, but monitoring and intervention for hypoglycemia may be delayed.
Objectives: (1) Study the time to first blood glucose determination and IV glucose administration at birth in ELBW infants, (2) determine the incidence of hypoglycemia, <47mg/dl, and severe hypoglycemia, <40mg/dl, at admission, (3) determine risk factors for hypoglycemia, and (4) compare clinical outcomes at discharge between hypoglycemic and euglycemic infants.
Methods: 244 ELBW (≤1000g birth weight) infants born during Jan 2017- Feb 2020 at the Regional One Health NICU, Memphis, TN were included in the study. Data collected included maternal and infant clinical, demographic, and outcomes at discharge, along with time to first blood glucose determination and IV glucose administration (bolus and/or IV infusion). Blood glucose was measured using the iStat® method at bedside. Data were analyzed for risk factors for hypoglycemia and severe hypoglycemia. Outcomes at discharge of infants who were hypoglycemic or severely hypoglycemic on first blood glucose determination were compared to euglycemic (≥47mg/dl) infants.
Results:Gestational age was 26.2 ±2.4 weeks; birth weight 739 ±161g. The median time (IQR) to first glucose determination was 56 (45-73) min, and the median time for initiation of IV fluids with dextrose or giving bolus dextrose was 88 (60-120) min. Within the golden hour, only 59% of all infants had their first blood glucose determination, and 24% had IV glucose administered, (Figure). 123 infants (50%) had hypoglycemia, and 91(37%) had severe hypoglycemia (<40mg/dL). There was no difference between euglycemic and hypoglycemic infants in time to blood glucose determination or IV glucose infusion. Caesarean delivery, intrauterine growth restriction (IUGR), and maternal β-blocker medications use increased the risk for hypoglycemia and severe hypoglycemia (all p
Conclusion(s): Incidence of hypoglycemia on admission is high among ELBW infants, and administration of IV glucose is delayed beyond an hour of life in majority of these infants. All ELBW infants need to be screened for hypoglycemia and provided iv glucose within an hour after birth
Esmail, Jihan and Dhanireddy, Ramasubbareddy MD , "Time to First Blood Glucose Determination and Administration of Intravenous Glucose at Birth in Extremely Low Birth Weight Infants" (2021). Longitudinal Scholar's Project. Paper 12. http://dx.doi.org/10.21007/com.lsp.2022.0010.