Time to First Blood Glucose Determination and Administration of Intravenous Glucose at Birth in Extremely Low Birth Weight Infants

Background: Extremely low birth weight (ELBW) infants are prone to hypoglycemia unless intravenous glucose is administered within an hour (golden hour) of life. These infants often require resuscitation at birth, but monitoring and intervention for hypoglycemia may be delayed. Objectives: (1) Study the time to first blood glucose determination and IV glucose administration at birth in ELBW infants, (2) determine the incidence of hypoglycemia, \u3c47mg/dl, and severe hypoglycemia, \u3c40mg/dl, at admission, (3) determine risk factors for hypoglycemia, and (4) compare clinical outcomes at discharge between hypoglycemic and euglycemic infants. Methods: 244 ELBW (≤1000g birth weight) infants born during Jan 2017- Feb 2020 at the Regional One Health NICU, Memphis, TN were included in the study. Data collected included maternal and infant clinical, demographic, and outcomes at discharge, along with time to first blood glucose determination and IV glucose administration (bolus and/or IV infusion). Blood glucose was measured using the iStat® method at bedside. Data were analyzed for risk factors for hypoglycemia and severe hypoglycemia. Outcomes at discharge of infants who were hypoglycemic or severely hypoglycemic on first blood glucose determination were compared to euglycemic (≥47mg/dl) infants. Results:Gestational age was 26.2 ±2.4 weeks; birth weight 739 ±161g. The median time (IQR) to first glucose determination was 56 (45-73) min, and the median time for initiation of IV fluids with dextrose or giving bolus dextrose was 88 (60-120) min. Within the golden hour, only 59% of all infants had their first blood glucose determination, and 24% had IV glucose administered, (Figure). 123 infants (50%) had hypoglycemia, and 91(37%) had severe hypoglycemia (\u3c40mg/dL). There was no difference between euglycemic and hypoglycemic infants in time to blood glucose determination or IV glucose infusion. Caesarean delivery, intrauterine growth restriction (IUGR), and maternal β-blocker medications use increased the risk for hypoglycemia and severe hypoglycemia (all p Conclusion(s): Incidence of hypoglycemia on admission is high among ELBW infants, and administration of IV glucose is delayed beyond an hour of life in majority of these infants. All ELBW infants need to be screened for hypoglycemia and provided iv glucose within an hour after birt

Hyperglycemia During the First Three Days of Life Increases the Risk of Retinopathy of Prematurity in Extremely Low Birth Weight Infants

Background: The association between hyperglycemia and ROP has been inconsistent in previous studies. Extremely low birth weight (ELBW) infants are at high risk for ROP. They also experience hypoglycemia initially and hyperglycemia while receiving IV glucose infusion. The effect of initial hypoglycemia on hyperglycemia associated ROP risk is unknown. Objective: To study the effect of initial hypoglycemia and subsequent hyperglycemia during the first three days of life on the incidence of ROP and severe ROP in ELBW (birth weight ≤1000g) infants. Methods: Clinical and demographic data were collected from 227 ELBW infants born during the years 2017-2019 at the Regional One Health NICU, Memphis, TN. All blood glucose determinations done during the first 72 hours were collected from these infants along with maternal and neonatal demographic and clinical information. The infants were divided into four groups based on hypoglycemia at birth and subsequent hyperglycemia during the first 72 hours; group I: all the blood glucose levels were between 47-125mg/dl (euglycemia group); group II: initial hypoglycemia (\u3c47mg/dl) and with treatment became euglycemic; group III: initial hypoglycemia and at least one episode of hyperglycemia (\u3e125mg/dl) later on; group IV: initial euglycemia followed by at least one episode of hyperglycemia. Incidence of ROP and severe ROP (stage III or greater) was compared between the groups after adjusting for gestational age. Results: Clinical and outcomes data are presented in the table. The mean blood sugar levels during each day for the first 72 hours are presented in the figure. ROP incidence was lowest in infants who were euglycemic throughout the first 72 hours of life and no severe ROP was seen in this group. Infants who were hypoglycemic initially without experiencing hyperglycemia later appear to have higher incidence of ROP though it was not statistically different after adjusting for gestational age. Infants who were euglycemic at birth and became hyperglycemic later had increased incidence of ROP even after adjusting for gestational age; they also had the highest incidence of severe ROP. Mortality did not statistically differ between the groups. Comparing combined groups 1 &2 vs. 3 &4 showed no difference in ROP [aOR 1.5 (082-2.84)]. Conclusions: Hyperglycemia during the first three days of life without hypoglycemia at birth increases the risk for ROP. Hypoglycemia at birth appears to confound the risk of hyperglycemia associated ROP in ELBW infants