Population Meta-Analysis of Low Plasma Glucose Thresholds in Full-Term Normal Newborns

Arie L. Alkalay; Harvey B. Sarnat; Laura Flores-Sarnat; Janet D. Elashoff; Sergio J. Farber; Charles F. Simmons

doi:10.1055/s-2006-931912

American Journal of Perinatology, Table of Contents

Am J Perinatol 2006; 23(2): 115-120
DOI: 10.1055/s-2006-931912

Population Meta-Analysis of Low Plasma Glucose Thresholds in Full-Term Normal Newborns

Arie L. Alkalay¹ , Harvey B. Sarnat² , Laura Flores-Sarnat² , Janet D. Elashoff³ , Sergio J. Farber⁴ , Charles F. Simmons¹

¹Division of Neonatology, Department of Pediatrics, Ahmanson Pediatric Center, Cedars-Sinai Medical Center, Los Angeles, California
²Division of Neurology, Department of Pediatrics, Alberta Children's Hospital, Calgary, Canada
³Biostatistics Core
⁴Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California

Abstract

ABSTRACT

There is extreme variation in the definition of low plasma glucose levels in newborn infants in the first postnatal days, ranging from < 30 to ≤ 60 mg/dL. The goal of the present study was to define low thresholds (≤ 5th percentile) of plasma glucose concentrations in full-term normal newborns during the first 72 hours of life. Population meta-analysis was performed on published studies of neonatal hypoglycemia ascertained by MedLine search. One-way analysis of variance was computed across the studies for each of the following four postnatal time periods: 1 to 2 (physiological nadir), 3 to 23, 24 to 47, and 48 to 72 hours. The estimated ≤ 5th percentiles of neonatal hypoglycemia during 1 to 2, 3 to 23, 24 to 47, and 48 to 72 hours after birth were ≤ 28, ≤ 40, ≤ 41, and ≤ 48 mg/dL, respectively. Based on this statistical definition, we recommend that low thresholds of plasma glucose levels of 28, 40, and 48 mg/dL be adopted in full-term normal newborns at 1 to 2, 3 to 47, and 48 to 72 hours of life, respectively.

KEYWORDS

Neonatal hypoglycemia - plasma glucose threshold - population meta-analysis

Full Text

References

REFERENCES

1 Cornblath M, Schwartz R, Aynsley-Green A, Aphil M A, Lloyd J K. Hypoglycemia in infancy: the need for a rational definition. A Ciba Foundation Discussion Meeting. Pediatrics. 1990; 85 834-937
2 Sacks D B. Carbohydrates. In: Burtis CA, Ashwood ER Tietz Textbook of Clinical Chemistry. Philadelphia; W.B. Saunders 1996: 928-1001
3 Cornblath M, Reisner S. Blood glucose in the neonate and its clinical significance. N Engl J Med. 1965; 273 278-283
4 Cornblath M, Ichord R. Hypoglycemia in the neonate. Semin Perinatol. 2000; 24 136-149
5 Srinivasan G, Pildes R S, Cattamanchi G, Voora S, Lilien L D. Plasma glucose values in normal neonates: a new look. J Pediatr. 1986; 109 114-117
6 Heck L J, Erenberg A. Serum glucose levels in term neonates during the first 48 hours of life. J Pediatr. 1987; 110 114-117
7 Koh T HHG, Aynssley-Green A, Tarbit M, Eyre J A. Neural dysfunction during hypoglycemia. Arch Dis Child. 1988; 63 1353-1358
8 Pyrds O, Christensen N J, Friis-Hansen B. Increased cerebral blood flow and plasma epinephrine in hypoglycemic, preterm neonates. Pediatrics. 1990; 85 172-176
9 Hawdon J M, Ward Platt M P, Aynsley-Green A. Patterns of metabolic adaptation for preterm and term infants in the first neonatal week. Arch Dis Child. 1992; 67 357-356
10 Swenne I, Ewald U, Gustaffson J, Sandberg E, Ostenson C-G. Inter-relationship between serum concentrations of glucose, glucagon, and insulin during the first two days of healthy newborns. Acta Paediatr. 1994; 83 915-919
11 Cole M D, Peevy K. Hypoglycemia in normal neonates appropriate for gestational age. J Perinatol. 1994; 2 118-194
12 Tanzer F, Yazar N, Yazar H, Icagansioglu D. Blood glucose levels and hypoglycemia in full term neonates during the first 48 hours of life. J Trop Pediatr. 1997; 43 58-60
13 Yamauchi Y. Hypoglycemia in healthy, full term, breast fed neonates during the early days of life: preliminary observation. Acta Paediatr Jpn. 1997; 39(suppl 1) S44-S47
14 Cowett R M, Howard G M, Johnson J, Vohr B. Brain stem auditory evoked potentials in relation to neonatal glucose metabolism. Biol Neonate. 1997; 71 31-36
15 Ryan A S, Wenjun Z, Acosta A. Breastfeeding continues to increase into the new millennium. Pediatrics. 2002; 110 1103-1109
16 Kalhan S, Parimi P. Gluconeogenesis in the fetus and neonate. Semin Perinatol. 2000; 24 94-106
17 Kalhan S, Peter-Wohl S. Hypoglycemia: what is it for the neonate?. Am J Perinatol. 2000; 17 11-18
18 Hawdon J M, Ward Platt M P. Metabolic adaptation in small for gestational age infants. Arch Dis Child. 1993; 68 262-268
19 Pildes R, Forbes A E, O'Connor S M, Cornblath M. The incidence of neonatal hypoglycemia a complete survey. J Pediatr. 1967; 70 76-80
20 Lucas A, Morley R, Cole T J. Adverse neurodevelopmental outcome of moderate neonatal hypoglycemia. BMJ. 1988; 1304-1308
21 Cornblath M, Schwartz R. Outcome of neonatal hypoglycemia. Complete data are needed [letter]. BMJ. 1999; 318 194-195
22 Stanley C A, Baker L. The causes of neonatal hypoglycemia. N Engl J Med. 1999; 340 1200-1201

Arie L AlkalayM.D.

Cedars-Sinai Medical Center, 8700 Beverly Blvd., Room 4310, Los Angeles, CA 90048