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Objective:To observe the predictive value of serum LP-PLA2, PAPP-A and C-peptide for patients with diabetes (GDM) patients during pregnancy.Methods:From Jan.2018 to Jan. 2022, 400 patients with gestational diabetes mellitus (GDM group) and 400 healthy pregnant women who underwent prenatal examinations (control group) were enrolled. The serum prenatal lipoprotein-associated phospholipase A2 (Lp-PLA2) , pregnancy-associated plasma protein-A (PAPP-A) , C-peptide and neonatal blood glucose levels were compared between the two groups. The correlation of serum Lp-PLA2, PAPP-A and C-peptide with neonatal hypoglycemia in GDM patients was analyzed, and the value of area under receiver operating curve (ROC) for predicting neonatal hypoglycemia was analyzed.Results:The serum levels of Lp-PLA2, PAPP-A and C-peptide in the GDM group were higher than those in the control group (33.57±6.52 nmol/min/ml vs 23.45±4.38 nmol/min/ml, 26.72±4.79 ng/ml vs 23.57±3.08 ng/ml, 27.32±3.97 ng/mL vs 25.15±0.71 ng/mL) ( P<0.05) . The incidence of neonatal hypoglycemia in the GDM group was higher than that in the control group (16.0% vs 4.5%) ( P<0.05) .The serum levels of Lp-PLA2, PAPP-A and C-peptide in GDM patients with neonatal hypoglycemia were higher than those in neonatal normoglycemic patients (35.82±6.42 nmol/min/ml vs 32.29±6.03 nmol/min/ml, 27.72±4.21 ng/ml vs 25.35±3.98 ng/ml, 32.39±4.78 ng/mL vs 22.18±3.94 ng/mL) ( P<0.05) . Logistic regression analysis showed that high levels of serum Lp-PLA2, PAPP-A and C-peptide in the GDM group were independent risk factors for neonatal hypoglycemia. Serum Lp-PLA2, PAPP-A and C-peptide of GDM patients had certain predictive value for the occurrence of neonatal hypoglycemia, among which C-peptide had the greatest predictive value. Conclusion:High levels of serum Lp-PLA2, PAPP-A and C-peptide are independent risk factors for neonatal hypoglycemia in GDM patients, and have certain predictive value, which can provide a reference for clinical prediction of its occurrence.
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Objective To investigate the occurrence of hypoglycemia in neonates in Meizhou People's Hospital from 2017 to 2018. Methods The clinical data of 5 306 neonates born in Meizhou People's Hospital from January 2017 to December 2018 were retrospectively analyzed. According to the diagnosis of neonatal hypoglycemia, the subjects were divided into a normal neonatal group (5 088 cases) and a neonatal hypoglycemia group (218 cases). The incidence of hypoglycemia in neonates was investigated and the risk factors were analyzed using Logistic regression analysis. Results The incidence of hypoglycemia in neonates in the hospital was 4.11% (218/5 306). The incidence rate was 87.61% (191/218) at birth, 10.55% (23/218) at 0.5h to 48h after birth, and 1.83% (4/218) at 48h after birth. There were 75.23% (164/218) of patients without clinical symptoms, and 24.77% (54/218) of cases with clinical symptoms. Logistic regression analysis showed that premature infants, small for gestational age, maternal gestational diabetes/diabetes, and hyperbilirubinemia syndrome were independent risk factors for inducing hypoglycemia in neonates (OR: 9.125, 11.693, 23.266, 35.474, P < 0.05). Conclusion The incidence of hypoglycemia in neonates in Meizhou People's Hospital was at a low level from 2017 to 2018. Most cases occurred at birth and the majority of patients had no clinical symptoms. Premature infants, small for gestational age, maternal gestational diabetes/diabetes, and hyperbilirubinemia were the independent risk factor for inducing hypoglycemia in newborns.
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Examinar a associação entre parto a termo precoce (PTP) e hipoglicemia neonatal em mulheres com hiperglicemia na gestação (HG). 258 mulheres (30,8 ± 6,4 anos) com parto a termo e HG participaram do estudo. A hipoglicemia neonatal foi estabelecida por registro inferior a 45 mg/dl nas primeiras 24 horas de vida. A idade gestacional no parto foi estabelecida por ultrassonografia. A amostra foi dividida em dois grupos: i) mulheres com PTP (n = 163); ii) mulheres com parto a termo não precoce (n = 95). Os testes Qui-quadrado e Exato de Fisher, além da regressão logística, foram utilizados para análise de associação. O nível de significância de 5% foi adotado. Houve associação entre PTP e maior ocorrência de hipoglicemia neonatal (RC = 2,88; IC 95%: 1,196,96). Neonatos de mulheres com HG e PTP apresentaram maior ocorrência de hipoglicemia que seus pares nascidos a termo não precoce, o que sugere um fator de risco do parto a termo precoce em mulheres com gestação complicada por hiperglicemia.
The association between early term delivery (ETD) and neonatal hypoglycemia in women with diabetes in pregnancy (DP) is analyzed. 258 females (30.8 ± 6.4 years) with term delivery and diabetes in pregnancy participated in current study. Neonatal hypoglycemia was ≤ 45mg/dl in the first 24 hours of life. Gestational age at birth was established by ultrasonography. Sample was divided into (i) ETD females (n = 163) and (ii) females with non-early term delivery (n = 95). The Chi-Squared and Fisher's Exact tests and logistic regression were performed for association analysis at 5% significance level. Early term delivery and higher occurrence of neonatal hypoglycemia were associated (OR = 2.88; IC 95%: 1.19 6.96). Neonates born of females with diabetes during pregnancy and early term delivery had a higher incidence of hypoglycemia than their peers born in non-early term deliveries, which suggests a risk factor for early term delivery in females with pregnancy complicated by hyperglycemia.
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Background: As Indian women has increased risk of developing GDM, screening for GDM is essential for early diagnosis and treatment and hence to reduce the adverse neonatal outcomes.Methods: The antenatal women are screened for GDM by administering 50g GCT and the screening test value of >130mg/dl measured at 1 hours were considered screening test positive and subjected to standard 2 hour 75gm OGTT and the neonatal outcome were observed in relation to neonatal birth weight, Apgar, and the occurrence of complications like hypoglycemia, hypocalcemia, hyperbilirubenemia.Results: The average neonatal birth weight in the study population was 3kg. The women with GDM who required diet alone had average neonatal birth weight of 2.9kgs and the GDM women who were on diet and insulin therapy had average neonatal birth weight of 3.4kg. There was increased incidence of hyperbilirubinemia 33.3% .There was only 1 preterm birth.Conclusions: There is association with neonatal Complications like hyperbilirubenemia and hypoglycemia with women who had screening positive for GDM.
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@#Abstract Maternal hyperglycemia during the peripartum period is highly correlated with fetal hyperinsulinemia and consequent neonatal hypoglycemia. Liberal use of intravenous glucose therapy prior to delivery can potentially cause maternal hyperglycemia, therefore, it is prudent to implement all preventive measures. This study aims to determine the occurrence of neonatal hypoglycemia with intravenous glucose therapy prior to delivery in maternal diabetes mellitus. This was a retrospective cohort study of neonates born from diabetic mothers at the University of Santo Tomas Hospital Clinical and Private Divisions from January 1, 2013 to December 15, 2017. Clinical information gathered was divided into maternal and neonatal characteristics. Maternal intravenous fl uid use, rate, and duration were noted; maternal and neonatal blood glucose results were obtained. There were 109 infants of diabetic mothers, of which 105 were delivered as singleton and 4 from twin pregnancies. Neonatal hypoglycemia was present in 14.68%. Comparing the risk factors, there was a higher amount of glucose infused to the mothers whose offspring developed hypoglycemia compared to those without hypoglycemia. Statistically, this did not demonstrate a signifi cant difference. The rate of glucose infusion and frequency of maternal insulin use were similar between the groups. Linear correlation was not evident when the total glucose infused and the rate of intravenous glucose infusion was compared to the neonatal glucose in the fi rst hour of life. Based on this study, routine administration of glucose-containing intravenous fl uid did not infl uence the incidence of neonatal hypoglycemia. It is recommended that further prospective studies be conducted.
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Diabetes, GestationalABSTRACT
Objective to analyze the relation between glycosylated hemoglobin (HbA1c) of pregnant women with gestational diabetes mellitus (GDM) and neonatal blood glucose.Methods HbA1c values of 743 pregnant women with GDM are detected,and according to HbA1c level,they were divided into 3 groups,such as G1 (HbA1c＜5.5％),G2 (5.5％≤HbA1c≤6.5％) and G3 (HbA1c＞6.5％).Newborn babies' blood glucose values of the women in each group are monitored respectively in the 1st hour and at the 4th and 8th hour.Neonatal hypoglycemia and incidence of threshold blood glucose in the three groups are compared by SPSS 17.0 software.Results (1) The incidence of neonatal hypoglycemia in G1 and G2 are both higher than thatin G3 in the 1st hour (P＜0.05).The incidence of neonatal hypoglycemia in G3 is higher than that in G1 and G2 at the 4th and 8th hour (P＜0.05).(2) With time extending,the incidence of neonatal hypoglycemia declines in G1 and G2 (P＜0.05),but there is no obvious decline in G3 (P＞0.05).(3)The incidence of threshold blood glucose in G3 and G2 are higher than that in G1 in the 1st hour,and at the 4th,8th hour(P＜0.05),and there is no obvious statistical difference between G2 and G3 (P＞0.05).(4)With time extending,the incidence of threshold blood glucose declines in G1 (P＜0.05),but it doesn't decline in G3 evidently(P＞0.05).And there was no obvious decline in G2 in the 4 hours after babies were born(P＞0.05).(5)A mother's HbA1c level has a negative correlation with her baby's blood glucose in 1 hour after birth(r=-0.401,P＜0.05).Conclusion The higher HbA1c level of pregnant women with GDM increases,the higher risks of their neonatal hypoglycemia and threshold blood glucose are.
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Objective Neonatal hypoglycemia is a common metabolic disease during neonatal period and a few children with neonatal hypoglycemiamay show a series of neurologic impairment.This study was to explore the neurobehavioral development of preschool children with neonatal hypoglycemia.Methods 37 children with neonatal hypoglycemia in Neonate Department of Anhui Provincal Children's Hospital from March 2009 to May 2013 were investigated by Chinese Preschool-Children Temperament Scale and Conners Symptoms Questionnaire for Parents, together with the information collection of perinatal period, clinical data and family environment.At the same time 50 controls were randomly chosed of the same period.Results The children of hypoglycemia group and control group were mainly with easy temperament and inclined easy temperament.In the nine dimensions of temperament, there was statistical difference in approach-withdraw between two groups (P<0.05).The incidence of behavioral problem in hypoglycemia group is 24%, involving learning problem and psychophysical problem, and there were statistical difference between two groups in this aspect (P<0.05).Conclusion Neonatal hypoglycemia affects the neurobehavioral development of preschool children.Individualized treatment and education intervention should be taken according to the children's temperament and neurobehavioral development.
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Objective To explore the effects of parents'participatory functional training on the prognosis of newborn babies with hypoglycemic brain injury.Methods Functional training was given to 32 parents of newborn babies with hypoglycemic brain injury and then carried out on their babies for three months.The clinical symptoms and clinical efficacy of the babies and parents'satisfaction with nursing care were then observed.Results The clinical symptoms of the babies were improved significantly after training, and the parents had significantly higher satisfaction with nursing care as compared to pretraining (p<0.01).After training, 22 babies showed significant clinical efficacy (68.75%) , 8 babies had the targeted effect (25.00%);and the total effect rate was 93.75%.Conclusion Parents'participatory functional training helps to improve the prognosis of newborn babies with hypoglycemic brain injury and reduce the incidence of neurological sequelae.
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Objective: To estimate validity of two point-of-care glucometers for the diagnosis of neonatal hypoglycemia and to determine the glucometer’s cut-off values for which standard laboratory confirmatory test are no longer needed. Design: Prospective study. Settings: A tertiary care, university hospital in Bangkok, Thailand. Participants: The study included 180 blood specimens from 166 high-risk neonates aged between 1-24 hours. Results: On average, most of the blood glucose read-outs from the Nova StatStrip and SureStep were higher than laboratory plasma glucose throughout the glucose range with mean differences (SD) of 11.2 (8.4) mg/dL and 13.7 (6.8) mg/dL, respectively. Sensitivity of Nova StatStrip and SureStep were 62% and 53.3%, respectively. Specificity and positive predictive value of both glucometers were 100%. Negative predictive values of both glucometers were approximately 85%. The cut-off levels with 100% negative predictive values were 63 mg/dL and 62 mg/dL for Nova StatStrip and SureStep, respectively. Conclusions: None of the glucometers in this study has sufficient validity to replace laboratory testing in diagnosing hypoglycemia. Confirmatory plasma glucose for diagnosis of hypoglycemia is needed when POC readings are between 39 and 63 mg/dL for Nova StatStrip and between 39 and 62 mg/dL for SureStep.
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Neonatal hypoglycemia is a frequent event in the first hours of life of newborns from mothers with diabetes mellitus. We studied a group of diabetic mothers newborns during the first day of life, taking venous blood samples at < 6 h, 6-12 h and 12-24 h of life for glucose analysis (n = 85), defining hypoglycaemia as a glucose level < 35 mg/dL. Calcium serum levels were also determined in the first venous sample in 19 neonates and 7 mEq/L was the criteria for hypocalcemia. The mothers age (mean ± standard deviation) was 30.5 ± 5.5 years (range 16-41 years), 43 (50.6%) of them with gestational diabetes, 40 (47.1%) with type 2 diabetes and 2 (2.4%) with type 1 diabetes. Pregnancies ended by caesarean section in 78 (91.8%) and by partum in seven (8.2%) women. There were 20 (23.5%) preterm newborns. In relation to neonates weight, 27 (31.7%) were macrosomic and 7 (8.2%) were premature, two of them with very low weight. A total of 55 (64.7%) newborns had hypoglycaemia, but only one of them had a convulsive episode, the rest were asymptomatic. In relation to the newborns weight, 18 (66.6%) of the macrosomic, 33 (64.7%) of the normal weight and four (57.1%) of the premature groups had hypoglycaemia. The comparisons between the newborns weight groups showed non significant differences, but the prevalence of neonatal hypoglycaemia was significantly higher in the group of gestational diabetes than in the type 2 diabetes group (p < 0.05). Calcium analysis also disclosed asymptomatic hypocalcemia in five (7.25%) newborns. These results show an elevated prevalence of asymptomatic neonatal hypoglycaemia in the offspring of women with diabetes mellitus in their early hours of life, and stress the importance of systematic glucose monitoring and early treatment in the first hours of life of these neonates.
La hipoglucemia neonatal es un evento frecuente en las primeras horas de vida del recién nacido (RN) de madres que padecen diabetes mellitus (DM). Para conocer su prevalencia estudiamos los hijos de mujeres con DM y embarazo (n = 85) y cuyos nacimientos ocurrieron en el periodo de reclutamiento de cuatro meses. A estos neonatos se les determinaron las concentraciones de glucosa en sangre venosa realizando una toma en las primeras seis horas, la segunda toma entre las seis y las doce horas y una tercera toma entre las 12-24 horas de vida, usando como criterio de hipoglucemia el propuesto por Cornblath para RN con factores de riesgo para hipoglucemia neonatal (glucosa < 35 mg/dL). Además, en 19 de estos niños se determinó la concentración de calcio en suero en la primera muestra de sangre venosa, tomando como criterio de hipocalcemia < 7 mEq/L. La edad de las madres fue de 30.5 + 5.5 años (media ± DE) de 30.5 ± 5.5 años, con una banda de variación de 16-41 años, 43 (50.6%) padecían DM gestacional, 40 (47.1%) DM tipo 2 y dos DM tipo 1 (2.4%). Setenta y ocho embarazos (91.8%) terminaron por cesárea y siete (8.2%) por parto, obteniéndose 85 RN vivos, de los cuales 20 (23.5%) fueron pretérmino y 65 (76.5%) de término. De acuerdo con el peso al nacer, hubo 27 (31.7%) RN macrosómicos y siete (8.2%) prematuros. Un total de 55 (64.7%) neonatos presentaron hipoglucemia, uno de los cuales desarrolló un episodio convulsivo, el resto no tuvo signos clínicos. La hipoglucemia ocurrió en 18 (66.6%) de los macrosómicos, 33 (64.7%) de los neonatos de peso normal y en cuatro (57.1%) de los prematuros. La comparación de la prevalencia de hipoglucemia por grupos de peso neonatal no mostró diferencias significativas entre los tres grupos, pero la comparación de la prevalencia de hipoglucemia con relación a la variante del tipo de diabetes materna mostró una mayor prevalencia en los hijos de mujeres con diabetes gestacional (p < 0.05). Hubo además cinco niños (7.25%) que presentaron hipocalcemia asintomática. Estos resultados muestran la alta prevalencia de hipoglucemia neonatal asintomática y la necesidad de establecer una vigilancia activa de la glucemia durante las primeras horas de vida en los RN de madres que padecen DM.
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Adolescent , Adult , Female , Humans , Infant, Newborn , Pregnancy , Hypoglycemia/etiology , Pregnancy in Diabetics , Blood Glucose/analysis , Calcium/blood , Diabetes, Gestational , Diabetes Mellitus/blood , Diabetes Mellitus/therapy , Gestational Age , Hypoglycemia/diagnosis , Postpartum Period , Pregnancy Outcome , PrevalenceABSTRACT
The morphologic abnormalities of the endocrine pancreas that underlie persistent neonatal hyperinsulinemic hypoglycemia and are included under the heading "nesidioblastosis" appears to be heterogeneous. This characteristic morphologic finding is ductuloinsular complexes showing endocrine cells budding off the ductoepithelium and merging with adjacent endocrine cell clusters. A case of nesidioblastosis associated with hyperinsulinemic hypoglycemia occurred in a 6/365 year-old male neonate. Microscopic finding of near totally resected pancreas revealed irregular sized islets and ductuloinsular complexes, both of which contained hypertrophied B cells with a few mitosis. Because of persistent hypoglycemia after first operation, he received second operation 8 days after. This histologic finding was more severe comparative to that of first operation. According to these findings, the pathogenesis of nesidioblastosis may be congenital or developmental defect of a kind of compensatory mechanism by unknown stimuli to acquire persistent hypoglycemia.