Prevalence of neonatal hyperglycaemia in neonates admitted to the new born unit at Kenyatta National Hospital

Abstract

Hyperglycaemia in neonates is a significant risk factor for increased morbidity and mortality. Most of the neonates are under significant physiological stress in addition to their co-morbidities, increasing the likelihood of developing hyperglycaemia. Incidence of neonatal hyperglycaemia has been quoted as 13.5%(11), increasing with decreasing birth weight and gestational age, ranging from about 2% in infants who weigh more than 2,000 g to 45% in those who weigh less than 1,000 9 and up to 80% in extremely low birth weight (ELBW) infants. Factors that have been associated with increased risk of development of hyperglycaemia in neonates include dextrose infusions, prematurity, neonatal sepsis, parenteral nutrition and drugs for example theophylline and phenytoin. Objective: To determine the prevalence of hyperglycaemia and identify associated risk factors for development of hyperglycaemia in neonates admitted in the New Born Unit, Kenyatta National Hospital. Methodology: Neonates admitted into the unit during the study period were recruited into the study. Neonates with gross congenital malformations were excluded. Parental consent was obtained prior to recruitment. Information regarding birth weight, gestational age, co-morbidities including neonatal sepsis, asphyxia and hyper-bilirubinaemia was obtained. Plasma glucose measurements were taken every 8 hours for the first 3 days of life then twice daily for the next 2 days. Samples were obtained by heel prick. following aseptic measures and analysed using the Hemocueﾮ glucose analyser. Any glucose measure >8.3mmol/1 was considered a hyperglycaemic value. Results: We enrolled 93 neonates, 42 neonates (46.2%) were noted to have an episode or episodes of hyperglycaemia. The mean gestational age of the neonates was 34 weeks ﾱ 5 SO and 54 of the neonates weighed 2.Skg and more. The use of intravenous dextrose infusions was significantly associated with the development of hyperglycaemia (confidence interval 95%, p= 0.02 OR= 3.28) with 63% of the babies on IV dextrose infusions developing an episode/episodes of hyperglycaemia. None of the neonates on enteral feeds developed hyperglycaemia. The prevalence of hyperglycaemia was highest on the first 3 days of life (25 out of 43 hyperglycaemic neona.tes - 58.1 %) Hyperglycaemia was noted to increase with decreasing birth weight, 62.5% of neonates less than 1000g developed hyperglycaemia. Hyperglycaemia was found to be an independent predictor of mortality among the neonates within the first 5 days of life (OR= 4.80; 95% CI = 1.98 - 11.63, p<0.001). A high prevalence of hyperglycaemia was found in this study, with intravenous dextrose infusions contributing significantly to its development. The risk of development of hyperglycaemia increased with decreasing birth weight. The findings of this study prompt the need to carefully administer dextrose infusions at rates that mimic normal physiologic output and to routinely monitor plasma glucose levels in neonates.