Clinical impact of neonatal hypoglycemia screening in the well-baby care.
Ontology highlight
ABSTRACT: Objectives
To determine the proportion of well-appearing newborns screened for hypoglycemia, yield of specific screening criteria, and impact of screening on breastfeeding.Study design
The retrospective study of well-appearing at-risk infants born ≥36 weeks' gestation with blood glucose (BG) measurements obtained ≤72 h of age.Results
Of 10,533 eligible well newborns, 48.7% were screened for hypoglycemia. Among tested infants, BG < 50 mg/dL occurred in 43% and 4.6% required intensive care for hypoglycemia. BG < 50 mg/dL was associated with lower rates of exclusive breastfeeding (22% vs 65%, p < 0.001). Infants screened due to late-preterm birth were most frequently identified as hypoglycemic. The fewest abnormal values occurred among appropriate weight, late-term infants of nondiabetic mothers.Conclusion
Hypoglycemia risk criteria result in screening a large proportion of otherwise well newborns and negatively impact rates of exclusive breastfeeding. The risks and benefits of hypoglycemia screening recommendations should be urgently addressed.
SUBMITTER: Mukhopadhyay S
PROVIDER: S-EPMC7442584 | biostudies-literature | 2020 Sep
REPOSITORIES: biostudies-literature
Publications
Clinical impact of neonatal hypoglycemia screening in the well-baby care.
Mukhopadhyay Sagori S Wade Kelly C KC Dhudasia Miren B MB Skerritt Lauren L Chou Joseph H JH Dukhovny Dmitry D Puopolo Karen M KM
Journal of perinatology : official journal of the California Perinatal Association 20200309 9
<h4>Objectives</h4>To determine the proportion of well-appearing newborns screened for hypoglycemia, yield of specific screening criteria, and impact of screening on breastfeeding.<h4>Study design</h4>The retrospective study of well-appearing at-risk infants born ≥36 weeks' gestation with blood glucose (BG) measurements obtained ≤72 h of age.<h4>Results</h4>Of 10,533 eligible well newborns, 48.7% were screened for hypoglycemia. Among tested infants, BG < 50 mg/dL occurred in 43% and 4.6% require ...[more]
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Project description:ImportanceNeonatal hypoglycemia is common, occurring in up to 50% of infants at risk for hypoglycemia (infant of diabetic mother [IDM], small for gestational age [SGA], large for gestational age [LGA], and preterm) and is associated with long-term neurodevelopmental impairment. Guidelines recommend screening infants at risk of hypoglycemia. The proportion of infants who require screening for neonatal hypoglycemia is unknown.ObjectiveTo determine the proportion of infants eligible for neonatal hypoglycemia screening using criteria from the highest-scoring critically appraised clinical guideline.Design, setting, and participantsThis systematic review of the literature was conducted to identify clinical practice guidelines for neonatal hypoglycemia and took place at a tertiary maternity hospital in Auckland, New Zealand. Eligible guidelines were critically appraised using the Appraisal of Guidelines for Research and Evaluation II tool. Using screening criteria extracted from the highest-scoring guideline, the proportion of infants eligible for neonatal hypoglycemia screening was determined in a retrospective observational cohort study of infants born January 1, 2004, to December 31, 2018. Data were analyzed by logistic regression. Infant participants were included if gestational age was 35 weeks or more, birth weight was 2000 g or more, and they were not admitted to a neonatal intensive care unit less than 1 hour after birth. The data were analyzed from November 2022 through February 2023. A total of 101 372 infants met the inclusion criteria.ExposureRisk factors for neonatal hypoglycemia.Main outcomeProportion of infants eligible for neonatal hypoglycemia screening.ResultsThe study team screened 2366 abstracts and 18 guidelines met inclusion criteria for appraisal. There was variability in the assessed quality of guidelines and a lack of consensus between screening criteria. The highest-scoring guideline defined screening criteria as: IDM, preterm (less than 37 weeks' gestation), SGA (less than 10th percentile), birth weight of less than 2500 g or more than 4500 g, LGA (more than 90th percentile), or gestational age more than 42 weeks. A total of 101 372 infants met criteria for inclusion in the cohort study; median (IQR) gestational age was 39 (38-40) weeks and 51% were male. The overall proportion of infants eligible for screening was 26.3%. There was an increase in the proportion of eligible infants from 25.6% to 28.5% over 15 years, which was not statistically significant after adjustment for maternal age, body mass index, ethnicity, and multiple pregnancy (odds ratio, 0.99; 95% CI, 0.93-1.03; change in proportion per year).ConclusionA systematic review found that practice guidelines providing recommendations for clinical care of neonatal hypoglycemia were of variable quality with is a lack of consensus regarding definitions for infants at risk for hypoglycemia. In the cohort study, one-quarter of infants were eligible for hypoglycemia screening. Further research is required to identify which infants may benefit from neonatal hypoglycemia screening.
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Project description:BackgroundPoint of care (POC) glucose meters are routinely used as a screening tool for hypoglycemia in a neonatal setting. Glucose meters however, lack the same accuracy as laboratory instruments for glucose measurement. In this study we investigated potential reasons for this inaccuracy and established a cut off value for confirmatory testing.MethodsIn this prospective study, all patients in the neonatal intensive care unit who had a plasma glucose test ordered were eligible to participate. Demographic information, sample collection information (nine variables) and a recent hematocrit value were recorded for each sample. Glucose measurements were taken at the bedside on the glucose meter (RN PCx) as well as in the laboratory on both the glucose meter (LAB PCx) and the laboratory analyzer (PG). Data were analyzed by simple and mixed-effects regression analysis and by analysis of a receiver operator characteristics (ROC) curve.ResultsThere were 475 samples analyzed from 132 patients. RN PCx values were higher than PG values (mean = 4.9%), while LAB PCx results were lower (mean = -5.2%) than PG values. Only 31% of the difference between RN PCx--PG and 46% of the difference for LAB PCx--PG could be accounted for by the variables tested. The largest proportion of variance between PCx and PG measurements was explained by hematocrit (about 30%) with a greater effect seen at glucose concentrations < or =4.0 mmol/L (< or =72 mg/dL)(48% and 40% for RN PCx and LAB PCx, respectively). The ROC analysis showed that for detection of all cases of hypoglycemia (PG < 2.6 mmol/L)(PG < 47 mg/dL) the PCx screening cut off value would need to be set at 3.8 mmol/L (68 mg/dL) requiring 20% of all samples to have confirmatory analysis by the laboratory method.ConclusionThe large difference between glucose results obtained by PCx glucose meter compared to the laboratory analyzer can be explained in part by hematocrit and low glucose concentration. These results emphasize that the glucose meter is useful only as a screening device for neonatal hypoglycemia and that a screening cut off value must be established.
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2014-08-31 | E-MTAB-2883 | biostudies-arrayexpress
Project description:Objective: To evaluate the clinical impact of chromosomal microarray (CMA) on the management of paediatric patients in Hong Kong Methods: We performed NimbleGen 135k oligonucleotide array on 327 children with intellectual disability (ID)/ developmental delay (DD), autism spectrum disorders (ASD), and/or multiple congenital anomalies (MCAs) in a university-affiliated paediatric unit from January 2011 to May 2013. The medical records of patients were reviewed in September 2013, focusing on the pathogenic/likely pathogenic CMA findings and their “clinical actionability” based on established criteria. Results: Thirty-seven patients were reported to have pathogenic/likely pathogenic results, while 40 had findings of unknown significance. This gives a detection rate of 11% for clinically significant (pathogenic/likely pathogenic) findings. The significant findings have prompted clinical actions in 28 out of 37 patients (75.7%), while the findings with unknown significance have led to further management recommendation in only 1 patient (p<0.001). Nineteen out of the 28 management recommendations are “evidence-based” on either practice guidelines endorsed by a professional society (n=9, Level 1) or peer-reviewed publications making medical management recommendation (n=10, Level 2). CMA results impact medical management by precipitating referral to a specialist (n=24); diagnostic testing (n=24), surveillance of complications (n=19), interventional procedure (n=7), medication (n=15) or lifestyle modification (n=12).
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