Abstract
Background: To determine the incidence of hypoglycemia during the first 48 hours of life among small-for-gestational-age (SGA) neonates and compare its occurrence between term and preterm SGA neonates.
Methods: A prospective observational study was conducted among 100 SGA neonates admitted to a tertiary care neonatal intensive care unit. Blood glucose was measured at 1, 2, 4, 6, 12, 24, and 48 hours of life. Maternal and neonatal characteristics, risk factors, feeding practices, clinical manifestations, and outcomes were recorded. Associations with hypoglycemia were assessed using univariate and multivariable logistic regression.
Results: Of 625 newborns enrolled, 100 (16.0%) were SGA; 66 (66.0%) were term and 34 (34.0%) preterm. Hypoglycemia occurred in 26 (26.0%) neonates and was significantly more frequent in preterm than term SGA neonates (47.1% vs. 15.2%, p<0.001). Among hypoglycemic neonates, 16 (61.5%) were symptomatic. The highest frequency of hypoglycemia occurred at 2 hours of life. Delayed initiation of enteral feeding was significantly associated with hypoglycemia. Blood glucose levels differed significantly between neonates weighing <1.8 kg and those weighing ≥1.8 kg at 2 and 4 hours. Univariate analysis identified low birth weight, prematurity, anthropometric measures, caesarean delivery, and 1-minute Apgar score as significant factors. On multivariable analysis, head circumference, chest circumference, 1-minute Apgar score, and caesarean delivery remained significantly associated with hypoglycemia. Two neonates with concomitant sepsis died.
Conclusion: Hypoglycemia was common among SGA neonates, particularly those born preterm. Early glucose monitoring, especially during the first 4 hours, together with timely enteral feeding, may facilitate early detection and prevention of neonatal hypoglycemia.