Prevalence of hypoglycemia in newborn at Kenyatta National Hospital and the response to glucose supplementation in low birth weight.
Masakha, Mmbone Mary
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Hypoglycaemia in neonates is defined as blood glucose concentration below 1.I mmol/1 for term neonates. A common abnormality in neonates, it is associated, with neurolo,_'ical damage and death when it occurs in the first few days of life. This is more pronounce in rural set-ups without the knowledge, detection and management facilities. When promptly diagnosed and managed, its effects can be prevented or minimized. Studies at Kenyatta National Hospital (KNH) show that 59.8% of all neonates born at the facility have low birth weight (LBW- 2500 gms) and end up in newborn unit. It has also been noted that the LBW neonates mostly suffer hypoglycaemia and hence need for this study. Four populations of neonates and one population of mothers of the neonates were used in the study. The neonates' blood glucose was determined using the precision QID sensor. The neonates were weighed in grams (gms) wing a top loading balance. The mother's height, weight and HIV status were determined during the last trimester of pregnancy. The neonates populations excluded neonates with congenital or physical abnormalities and those from diabetic mothers. The first population of neonates (for blood glucose reference range) had 117 neonates after removal of the outliers and were physically healthy weighing > 2500 gins. The second (Population A) had 348 neonates of all neonates born during the study. Their blood glucose and weight were taken at birth. The third, LBW neonates (Population B) had 336 neonates whose weight and blood glucose were taken at birth. The fourth of 54 neonates (Population C) consisted of LBW with blood glucose <1.7mmol. This group was supplemented with 10% dextrose and feeds per kilogram body weight (i.e. 120 -125 Kcal/Kg/day of the oral feed) and followed for five days. The blood glucose was taken in the morning and afternoon each day and their weight taken on alternate days. The fifth population was the neonates' mothers (Population D). Their nutritional status was taken from the Basal Metabolic Index (BMI) and a questionnaire on their feeding habits and income. The normal blood glucose reference range of neonates in this study at birth was 1.7 to 4.Ommo/l. On the nutritional status of the mothers, 15.8% were obese, 33.3% were over-weight, 30.7% had normal good nutrition, 10.3% had chronic malnutrition, 3.4% had severe malnutrition and 6.3% were malnourished. From the study, 43.6% of the neonates had low birth weight. The prevalence of hypoglycaemia in the neonates at KNH during the study period was 19.5%, while the prevalence of hypoglycaemia in the LBW neonates was 30.4%. The prevalence of HIV in the neonates' mothers during the study period at the same facility was 7.8%, while the prevalence of HIV in the LBW neonates' mothers during the same period was 8.9%. Hypoglycaemia was highest in neonates of teenage mothers, 15-19 years, while no hypoglycaemia was noted in neonates of mothers 40-44 years of age ( P=O.-',1)8). In the LBW neonates hypoglycaemia was high in neonates of mothers 15-19 years and 35-39 years (P=0.188). The lower the birth weight of the neonate, the more the neonate was prone to hypoglycaemia (P=0.004). Hypoglycaemia was higher in the neonates of the most malnourished and HIV positive mothers (P=0.017, P=0.004). In the LBW neonates there was a higher tendency to hypoglycaemia regardless of mothers'nutritional status (P=0.659). Most LBW neonates came from malnourished mothers (P=0.010). In the follow-up group (Population C) the mean blood glucose levels per day increased from 1.3mmol/l on day one to 6.lmmol/1 on day five. In conclusion, there is a high prevalence of hypoglycaemia at 19.5% in neonates and 30.4% in LBW neonates. Poor nutrition in mothers leads to a higher percentage of both LBW neonates and also hypoglycaemia. The study recommends correction of nutritional status of mothers to forestall LBW and hypoglycaemia in neonates. Mandatory screening of blood sugar in neonates is also recommended.