PC1111: Severe Pre-prandial Hypoglycemia in Newborns Who Are at Highest Risk

Background: The brain in a newborn utilizes up to 90% of the total glucose produced in the body, making it highly dependent upon glucose. Alternate fuels such as ketones are produced in very low quantities in the first few hours of life and are unlikely to provide neuroprotection during early hypoglycemia (GLOW study J Pediatr 2021). Hypoglycemia at birth has been associated with long-term brain damage, making it important to detect and treat this problem promptly. Currently, the AAP recommends feeding newborns within 1 hour and screening blood glucose (BG) 30 minutes after this initial feeding. This will practically result in the first BG level to be checked around 1-2 hours of life. Based on a quality improvement initiative at our institution, the practice of screening at-risk newborns includes checking an initial pre-prandial point-of-care (POC) BG level within 1 hour of birth.

Methods: Pre-prandial POC BG levels were performed on all asymptomatic newborns who were at-risk of developing hypoglycemia (defined as late prematurity at 35 0/7-36 6/7 weeks gestation, small for gestational age (SGA), large for gestational age (LGA), and infant of a diabetic mother (IDM)) within 1 hour of birth. Individual chart review was performed on all at-risk newborns who were born in 2020 and 2021 for data extraction. The incidence of severe (BG ≤ 25 mg/dl) and critical (BG ≤ 10 mg/dl) hypoglycemia was calculated in the different at-risk groups.

Results: Of the total 9,919 births in the study period, 1684 (17%) infants had risk factors for neonatal hypoglycemia, prompting screening within 1 hour of life. The incidence of severe hypoglycemia (BG ≤ 25 mg/dl) was 3% (50/1684); however, 0.5% (9/1684) of these at-risk infants had undetectable BG levels (BG ≤ 10 mg/dl), warranting immediate intervention. Among those who were considered at-risk, late premature newborns had the highest risk of developing severe hypoglycemia (BG ≤ 25 mg/dl) (Table 1), and those with more than 1 risk factor had the highest risk of developing critical hypoglycemia (BG ≤ 10 mg/dl) (Table 2).

Conclusion: Severe or even critical hypoglycemia can occur within 1 hour of life among asymptomatic neonates who are at-risk of hypoglycemia, especially in newborns who are considered late premature and those with multiple risk factors. While glucose nadir is physiologic and helps to promote gluconeogenesis, some studies have shown that it is unlikely to provide adequate neuroprotection during early hypoglycemia, which may ultimately result in neonatal hypoglycemic brain injury. As a result, appropriate measures should be taken to detect and treat severe and critical hypoglycemia by performing earlier screening within 1 hour of life in newborns who are at-risk for developing hypoglycemia to prevent any neurologic sequelae from prolonged hypoglycemia.