Early Glycaemic Status In Preterm Infants Admitted To Special Care Baby Unit In Omdurman Maternity Hospital

Abstract

This prospective, descriptive, cross-sectional, hospital-based study aimed to describe the glycemic status of the newborn preterm infants who were admitted in the special care baby unit (SCBU) in Omdurman Maternity Hospital during the first 72 hours of life. Other objectives were to document the prevalence of both hypo and hyperglycemic episodes among these infants, as well as to define the clinically associated risk factors. Moreover, the study aimed at detecting the immediate outcome of these preterm infants in regard to their early glycemic status. A total of 82 preterm babies were enrolled in the study during the period from June to August 2005. Consent was obtained, clinical assessment and a 72 hour-progress were documented. Serial determinations of blood glucose were recorded using Accu-Check® Active (Roche) device at 1, 2, 6, 12, 18, 24, 36, 48, 60 and 72 hrs of age. Any abnormal results warranted immediate confirmation by the laboratory where the hexokinase enzyme method was used to measure the random blood glucose. Data was analyzed using the SPSS software computer programme. A total of 734 samples were taken with an average of 8.9 samples per infant. Of these, hypoglycemia was detected in 46.8%, while hyperglycemia was present in 16.6%. Most of these events took place during the first 24 hours, thereafter a steady decline was seen. Among the whole study group, hyperglycemia was more prevalent among the males than in the females, giving a ratio of 1.5:1. The frequency of both conditions was inversely proportionate to the birth weight and the gestational age. Preterm infants who were small for gestation (SGA) were the most vulnerable to hypoglycemia which occurred in 63.6% of them, and to hyperglycemia which occurred in 36.6%. Infants born to consanguineous parents had a high percentage of hypoglycemia 61.1%. Among maternal medical and obstetrical problems, only diabetes mellitus was found to correlate significantly with neonatal hypoglycemia. Similarly, maternal pre-medication with dextrose infusions was statistically associated with neonatal hyperglycemia but not with hypoglycemia. Factors that were found to be associated with hypoglycemia were: delivery by (EMCS), low Apgar score, (RDS), hypothermia, intermittent boluses of dextrose and delayed feeding. Factors associated with hyperglycemia were: delivey by (EMCS), low Apgar score, administration of aminophylline, intermittent dextrose boluses, intraventricular haemorrhage, early sepsis and (DIC). Hypoglycemia was reported along the course of 64.3% of the infants who died . Hyperglycemia was detected in 42.9% of that cohort. Accordingly, hypo and hyperglycemia were both found to be poor prognostic indicators for the survival of preterm infants.