Prevention of hypoglycemia: a controlled evaluation of sugar fortified milk feeding in small-for-gestational age infants.

The study population included 110 term healthy small-for-gestational age (SGA) infants having a blood sugar of > 30 mg/dl at the age of < 30 minutes. They were randomized into two groups; (a) Group I (study group) received sugar-fortified milk formula and (b) Group II (control group) received standard milk formula. A minimum of 80 ml/kg/24 hour of milk was given. The first feeding was given within 45 minutes of birth and subsequently at 2 hours of age and then every 2 hourly till the age of 24 hours. The blood sugar (initial within 30 minutes of birth) was monitored at the age of 2, 4, 12 and 24 hours by dextrostix. The babies on fortified feeds received significantly (p < 0.001) higher amount of carbohydrate (8.1 mg/kg/min) as compared to those on standard milk (5.1 mg/kg/min). The incidence of hypoglycemia was reduced significantly (p < 0.01) by the sugar-fortified feeds. The mean blood sugar level in babies receiving fortified feeds was significantly higher at all the ages as compared to those receiving standard feeds. Nearly all the babies who subsequently developed hypoglycemia had a preceding blood sugar value of less than 60 mg/dl. The study highlights that sugar-fortified milk feeds are useful in preventing hypoglycemia in SGA infants and should be routinely recommended along with breast feeding in developing countries especially when facilities for monitoring of blood sugar are unsatisfactory or not available.

A controlled study of sugar-fortified milk feeding for prevention of neonatal hypoglycaemia.

Healthy term, large for gestational age (LGA) infants (130) with blood sugar greater than 30 mg/dl at the age of less than 30 min were randomized into two groups. Group I (study group) babies received sugar-fortified milk formula while group II (control group) received standard milk formula. Milk was fed at a minimum of 80 ml/kg/24 h. The first feed was given within 45 min of birth and subsequently at 2 h of age and then 2 hourly till the age of 24 h. The blood sugar (initial within 30 min of birth) was monitored by dextrostix at the age of 2, 4, 12 and 24 h. The babies on fortified feeds received significantly (P less than 0.001) higher amount of carbohydrate (8.2 mg/kg/min) as compared to those on standard milk (5.2 mg/kg/min). The incidence of hypoglycaemia was reduced significantly (P less than 0.05) by the sugar fortified feeds. The mean blood sugar level in babies receiving fortified feeds was significantly (P less than 0.001) higher at all ages as compared to those receiving standard feeds. Nearly all the babies who subsequently developed hypoglycaemia had an earlier blood sugar level of less than 60 mg/dl. The study shows that sugar-fortified milk feeds are useful in preventing hypoglycaemia in LGA infants and should be routinely recommended in the special care neonatal units of developing countries especially when facilities for monitoring blood sugar are unsatisfactory or unavailable.

Neurodevelopmental outcome of asymptomatic & symptomatic babies with neonatal hypoglycaemia.

A total of 107 babies with hypoglycaemia were studied over a period of 15 months. Symptomatic hypoglycaemia was found in 43 while it was asymptomatic in the others. Asymptomatic hypoglycaemia occurred at a relatively earlier post-natal age (4.5 +/- 2.2 h), as compared to symptomatic hypoglycemia (18.5 +/- 5.4 h, P less than 0.001). The mean blood glucose in hypoglycaemic babies with seizures was found to be significantly lower (P less than 0.001) when compared to those with other features as well as asymptomatic ones. Hypoglycaemia lasted for a significantly longer duration in symptomatic babies as compared to those without symptoms (P less than 0.001). On neurodevelopment follow up the mental developmental index (MDI) and the psychomotor developmental index (PDI) of symptomatic babies with seizures were significantly lower (P less than 0.001) as compared to those with other features of hypoglycaemia as well as asymptomatic babies. The neurodevelopmental status of babies with symptoms other than seizures was also significantly poorer (P less than 0.001), when compared to asymptomatic hypoglycaemic babies. The duration of hypoglycaemia was directly related to the MDI (r = -0.74, y = 102.5 - 0.69x) and PDI (r = -0.81, y = 105.6 - 0.86x). This study indicates that there is a need to identify babies vulnerable to symptomatic hypoglycaemia more precisely.