Neonatal hypoglycaemia in Nepal 2. Availability of alternative fuels.
نویسندگان
چکیده
AIMS To study early neonatal metabolic adaptation in a hospital population of neonates in Nepal. METHODS A cross sectional study was made of 578 neonates, 0 to 48 hours after birth, in the main maternity hospital in Kathmandu. The following clinical and nutritional variables were assessed: concentrations and age profiles of blood glucose, hydroxybutyrate, lactate, pyruvate, free fatty acids (FFA) and glycerol; associations between alternative fuel levels and hypoglycaemia; and regression of possible risk factors for ketone availability. RESULTS Risk factors for impaired metabolic adaptation were common, especially low birthweight (32%), feeding delays, and cold stress. Blood glucose and ketones rose with age, but important age effects were also found for risk factors like hypothermia, thyroid hormone activities, and feeding practices. Alternative fuel concentrations, except FFA, were significantly reduced in infants with moderate hypoglycaemia during the first 48 hours after birth. Unlike earlier studies, small for gestational age (SGA) infants had significantly higher hydroxybutyrate:glucose ratios which suggested counter regulatory ketogenesis. Hypoglycaemic infants were not hyperinsulinaemic. Regression analysis showed risk factors for impaired counter regulation which included male and large infants, hypothermia, and poorer infant thyroid function. SGA infants and those whose mothers had received no antenatal care had increased counter regulation. CONCLUSIONS Alternative fuels are important in the metabolic assessment of neonates, and they might provide effective cerebral metabolism even during moderate hypoglycaemia. Hypoglycaemic infants generally had lower concentrations of alternative fuels through either reduced availability or increased consumption. SGA and post term infants increased counter regulatory ketogenesis with early neonatal hypoglycaemia, but hypothermia, male gender, and low infant T4 were associated with impaired counter regulation after birth.
منابع مشابه
Neonatal hypoglycaemia in Nepal 1. Prevalence and risk factors.
AIMS To measure the prevalence of hypoglycaemia among newborn infants in Nepal, where classic risk factors prevail, and to evaluate their importance. METHODS A cross sectional study was done of 578 term newborn infants aged 0 to 48 hours on the postnatal wards of a government maternity hospital in Kathmandu, with unmatched case-control analysis of risk factors for moderate hypoglycaemia (less...
متن کاملDeath within the first 24 hours of admission among newborn infants aged less than 24 hours in a Nigerian Special Care Baby Unit: Role of significant hypothermia and hypoglycaemia
Background: Neonatal deaths mostly occur within the first one week and first 24 hours of life from a variety of conditions. Objective: To examine the role of significant hypothermia and hypoglycaemia, in addition to some other factors, in neonatal mortality occurring within the first 24 hours of admission.Methods: A prospective study of newborn infants hospitalized within the first 24 hours of ...
متن کاملComparison of two cotside methods for the detection of hypoglycaemia among neonates in Nepal.
AIMS To compare two cotside methods of blood glucose measurement (HemoCue and Reflolux II) against a standard laboratory method for the detection of neonatal hypoglycaemia in a developing country maternity hospital where hypoglycaemia is common. METHODS 94 newborn infants and 75 of their mothers had blood glucose assessed on the same venous sample using three different methods in the Special ...
متن کاملHypoglycaemia and neonatal brain injury
The transition from fetal to neonatal life requires metabolic adaptation to ensure energy supply to vital organs and systems after separation from the placental circulation. Under normal conditions this is achieved through the mobilisation and use of alternative cerebral fuels (fatty acids, ketone bodies and lactate) when blood glucose concentration falls. The level of blood glucose (BG) concen...
متن کاملPreventive treatment of neonatal hypoglycaemia in infants of insulin dependent diabetic mothers.
Neonatal hypoglycaemia (blood glucose smaller than 20 mg/100 ml) occurred in the first 6 hours of life in 25 of 34 infants born to diabetic mothers receiving insulin. Despite severe hypoglycaemia (blood glucose smaller than 10 mg/100 ml) in 17, clinical features of hypoglycaemia were absent in all but 2. Hypoglycaemia was not related either to the level of plasma insulin in cord blood, determin...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
عنوان ژورنال:
- Archives of disease in childhood. Fetal and neonatal edition
دوره 82 1 شماره
صفحات -
تاریخ انتشار 2000