新生儿低血糖症临床及危险因素分析

目的 探讨新生儿低血糖症的临床表现及相关高危因素.方法 对2009年1月至2010年7月我院新生儿科住院的新生儿低血糖症患儿与同期产科分娩的血糖正常对照组新生儿临床资料进行回顾性分析,对相关危险因素采用单因素及多因素回归分析.结果 新生儿低血糖症267例,占同期住院新生儿的11.5%(267/2325),267例低血糖症中无症状者169例(63.3%),有症状者98例(36.7%),表现为吸吮无力72例(27.0%),震颤60例(22.5%),嗜睡40例(15.0%),尖叫22例(8.2% ),发绀12例 (4.9% ),抽搐10例(3.8% ).Logistic多因素回归分析显示,低体温(OR=13.372)、早产儿(OR=13.451)、低出生体重儿(OR=4.489)、喂养不当(OR=42.378)、孕母糖尿病(OR=6.329)是新生儿发生低血糖的主要危险因素.结论 对有低血糖高危因素的新生儿应常规监测血糖,及时采取措施纠正低血糖,以减少新生儿低血糖的发生.     

Clinical features and EEG monitoring ofneonatal hypoglycemic brain injury

目的 探讨新生儿低血糖脑损伤(HBD)时的脑电图(EEG)改变与临床预后关系,为HBD的诊断及预防提供依据.方法 监测住院新生儿血糖并描记入院后24-72 h的EEG,低血糖新生儿于入院后2周再次EEG检查.分析比较低血糖新生儿与正常血糖新生儿,以及无症状性与症状性低血糖患儿EEG的异常率以及预后.结果 人组100例新生儿,其中低血糖组52例,正常血糖组48例;低血糖组新生儿中症状性低血糖25例,无症状性低血糖27例.EEG异常率低血糖组新生儿73.1%(38/52),正常血糖组12.5%(6/48),两者差异有统计学意义(χ2=37.17,P<0.05).低血糖组新生儿中,症状性低血糖组EEG异常率96%(24/25).无症状性低血糖组51.9%(14/27),两者差异有统计学意义(χ2=10.7,P<0.05).新生儿血糖越低、持续时间越长,则EEG异常越严重.EEG中重度异常新生儿,大多遗留认知障碍、癫癎、脑瘫等后遗症.结论 新生儿HBD与低血糖的严重程度及持续时间密切相关.EEG能客观、直接地反映脑细胞的功能状态及损害程度,有助于早期评估脑损伤的程度及预后.     

新生儿低血糖的相关危险因素分析

目的 探讨住院新生儿的低血糖发生率并分析低血糖发生的相关危险因素.方法 常规监测所有住院新生儿的血糖水平,对高危新生儿和初次检测呈异常血糖水平者每天监测血糖,直至血糖水平恢复正常并稳定.结果 668例住院新生儿中检出低血糖113例,发病率为16.9%.低血糖在早产儿、足月儿和过期产儿的发生率分别为55.6%(19/34)、14.9%(93/625)和11.1%(1/9);在极低出生体质量儿、低出生体质量儿、正常出生体质量儿及巨大儿的发生率分别为77.8%(7/9)、51.1%(23/45)、12.4%(72/581)和33.3%(11/33);在重度窒息儿、轻度窒息儿和无窒息儿的发生率分别为42.9%(9/21)、34.3%(23/67)和14.0%(81/580);低血糖的发生还与母亲分娩时补液与否有关(9/51,58/180).结论 早产、低出生体质量、围产期窒息等新生儿易发生低血糖,应在新生儿早期主动连续监测新生儿尤其是高危儿的血糖水平,母亲分娩时应予以适当补液,同时注重早期喂养,以期及时诊治新生儿低血糖,减少其对新生儿的危害.     

新生儿低血糖78例临床分析

目的　探讨引起新生儿低血糖的危险因素 ,为防治提供理论依据。方法　选取新生儿 812例进行血糖监测。结果　早产儿、低体重儿发病率分别为 2 9.33% ,30 .33% ,高于足月正常儿 7.6 0 % ;剖宫产儿的低血糖发生率 2 0 .6 0 % ,高于经阴道分娩者的 7.6 7% ,新生儿期多种疾病如窒息、硬肿症、败血症等易引起低血糖。结论　对存在低血糖的高危因素者 ,应对其进行血糖监测 ,并针对性采取措施 ,在治疗中避免出现高血糖。     

危重新生儿血糖和胰岛素水平的变化及其临床意义

目的 探讨危重新生儿血糖和血清胰岛素的变化及其临床意义.方法 选择2006年12月-2009年1月在本院住院的危重新生儿60例.男36例,女24例;体质量2 300～4 200 g;胎龄35～41周;日龄1～27 d.采用微量血糖仪测定危重新生儿标本中血糖水平;对于高血糖和低血糖新生儿给予相应治疗;用化学发光免疫法检测危莺患儿血清胰岛素水平.健康对照组30例按上述同样方法测定相应指标.并进行二组比较.结果 危重60例患儿中糖代谢紊乱26例(43%),其中高血糖21例,低血糖5例.危重新生儿血糖、胰岛素水平[(6.37±4.11)mmol/L、(25.73±14.32)mIU/L]较健康足月新生儿[(4.13±1.73)mmol/L、(4.01±1.73)mIU/L]显著升高(t=2.32,4.76 Pa<0.01),经治疗后血糖均恢复正常.结论 危重新生儿可出现糖代谢紊乱及高胰岛素血症,对危重患儿应密切监测血糖变化,尽早发现血糖异常,及时诊断并合理处理.     

新生儿低血糖脑损伤临床特征与脑电图监测

目的探讨新生儿低血糖脑损伤(HBD)时的脑电图(EEG)改变与临床预后关系,为HBD的诊断及预防提供依据。方法监测住院新生儿血糖并描记入院后24～72 h的EEG,低血糖新生儿于入院后2周再次EEG检查。分析比较低血糖新生儿与正常血糖新生儿,以及无症状性与症状性低血糖患儿EEG的异常率以及预后。结果入组100例新生儿,其中低血糖组52例,正常血糖组48例;低血糖组新生儿中症状性低血糖25例,无症状性低血糖27例。EEG异常率低血糖组新生儿73.1%(38/52),正常血糖组12.5%(6/48),两者差异有统计学意义(χ2=37.17,P<0.05)。低血糖组新生儿中,症状性低血糖组EEG异常率96%(24/25),无症状性低血糖组51.9%(14/27),两者差异有统计学意义(χ2=10.7,P<0.05)。新生儿血糖越低、持续时间越长,则EEG异常越严重。EEG中重度异常新生儿,大多遗留认知障碍、癫疒间、脑瘫等后遗症。结论新生儿HBD与低血糖的严重程度及持续时间密切相关。EEG能客观、直接地反映脑细胞的功能状态及损害程度,有助于早期评估脑损伤的程度及预后。     

新生儿低血糖的监测与处理

症状性低血糖治疗不适当会导致神经系统后遗症 ,测定血糖应注意 :1.安静时测定 ;2 .血糖可因采血部位不同而有差别 ;3.测定时间不同 ,血糖值也不相同。介绍新生儿低血糖的临床表现、诊断和治疗 ,治疗症状性低血糖 (输液疗法、糖皮质激素 ,药物如胰高血糖素、二氮嗪等 ) ,及无症状性低血糖等的治疗 ,生后应尽早开始授乳 ,治疗初期应维持较高的血糖 (80～ 10 0ｍｇ/ｄｌ) ,血糖 6 0～ 80ｍｇ/ｄｌ较合适。新生儿低血糖的监测与处理$复旦大学附属第五人民医院儿科!200240@王晓明 $复旦大学附属第五人民医院儿科!200240@成志伟 $上海市第一人民医院儿科!200080@沈时霖     

高危儿血糖紊乱和新生儿行为神经测定的临床研究

目的 探讨高危儿血糖紊乱的发生情况及其与新生儿行为神经测定评分异常的关系.方法 对2005年6月至2007年6月收治的159例高危儿进行血糖监测,对住院7 d以上的54例患儿进行新生儿行为测定评分并进行比较.结果 高危儿易发生血糖紊乱,低血糖的发生率为17.6%,高血糖的发生率为22.0%,混合性血糖紊乱发生率为6.9%.54例高危儿中,20例低血糖患儿评分异常率30%,15例高血糖患儿评分异常率27%,血糖正常的19例患儿中,评分异常率5%.结论 高危儿存在血糖紊乱,而血糖紊乱可造成脑损伤,在治疗过程中应及早检测血糖,有目的 地加以纠正,可以减少神经系统后遗症,改善预后.     

新生儿疟疾的临床特征

目的 探讨新生儿疟疾的临床特征,提高早期诊断和治疗水平.方法 2004年11月-2006年11月在尼日尔马拉迪省中心医院儿科住院的疟疾新生儿63例,经外周血涂片找到疟原虫确诊.对63例患儿的临床特征和实验室检查结果进行分析,观察双氢青蒿素及奎宁马斯的治疗效果.应用SPSS 14.0统计软件处理相关数据,采用x2检验.结果 63例患儿症状和体征均无特异性.发热为最常见的症状(68.25%),其次是进乳减少(52.38%)、活动减少(46.03%)、呕吐(36.51%)及腹泻(30.16%).体征以贫血最多见(57.15%),其次为低血糖(39.68%)和脾大(36.51%).42例进行疟原虫分类,其中恶性疟29例(46.03%),三日疟8例(12.7%),卵形疟5例(7.94%).持续发热5 d、惊厥、昏迷、呼吸窘迫、重度贫血的患儿与无上述并发症者比较,病死率显著增高(x2=12.05,7.65,8.20,11.59,8.56 Pa<0.05).结论 对疑有疟疾的新生儿均应常规血涂片查找疟原虫,以确保早期诊断、治疗.     

妊娠期糖尿病母亲的新生儿出生48小时内血糖的动态变化及低血糖的影响因素

摘要目的：探讨糖尿病母亲婴儿（IDMS）出生后血糖的变化情况,分析IDMS发生低血糖的可能影响因素。方法：回顾性横断面调查,纳入2014年1月1日至12月31日在福建省妇幼保健院（我院)定期产检和分娩、单胎活产的全部妊娠期糖尿病（GDM）产妇,收集产妇和新生儿的一般临床资料、母亲孕产期血糖值和IDMS出生后48 h内各时点的血糖值。血糖值＜2.2 、~2.6 mmol·L-1 为低血糖和临界低血糖。多因素Logistic回归分析IDMS低血糖、临界低血糖的影响因素。结果：共1 083份病志进入本文分析。①GDM产妇年龄(30.2±4.2)岁,(39.1±1.4)孕周,初产妇66.8%,阴道分娩82.4%,孕前BMI＜18.5者4.5%、≥25者9.8%。1 083例IDMS中,早产儿3.8%,男52.5%,Apgar评分均≥8分,出生体重(3 303.7±428.2)g。②IDMS出生0.5 h时平均血糖明显下降,2~48 h呈上升趋势。母亲孕前BMI 18.5~24.9、阴道分娩、足月儿、总产程时间≥7 h、傍晚至夜间分娩、正常体重儿的IDMS出生时和生后某些时点的平均末梢血糖相对较高。③1 083例IDMS中,低血糖7例(0.65%),6例发生在出生时,1例发生在生后48 h;临界低血糖29例(2.68%),26例发生在出生时,生后12、24和48 h各1例。④多因素非条件Logistic回归显示,孕末期静脉血糖水平高是新生儿低血糖、临界低血糖的保护因素。结论：IDMS生后48 h内发生低血糖的时间以出生时最多,但生后48 h都有发生低血糖的可能,应密切监测。GDM孕妇孕末期静脉血糖水平高可能是新生儿低血糖和临界低血糖的保护因素。     

Incidence of hypoglycemia in newborns at risk and an audit of the 2011 American academy of pediatrics guideline for hypoglycemia

Background

Hypoglycemia is low blood glucose level that may negatively affect neurological and developmental prognosis. The American Academy of Pediatrics (AAP), Committee on Fetus and Newborn defined the safe glucose concentrations in the 2011 guideline for newborns at risk for hypoglycemia. This study aimed to investigate the incidence and associated risk factors for hypoglycemia in newborn infants having risk and to assess compliance with the AAP guideline.

Blood sugar levels in twin neonates

Blood sugar determinations were carried out on 50 pairs of twins before the initiation of first feeds. The mean blood sugar values of 36.69±14.03 mg/dl were observed. Blood sugar values had a definite correlation with birth weight and gestational age, significantly higher values were observed in infants weighing 2250 gm had above and having a gestational age of over 37 weeks. The mean sugar values did not differ between the larger and smaller twin in the 2 groups less than 25 percent discordant, nor were the values influenced by birth order or sex of these infants. Significant hypoglycemia (blood sugar <20 mg%) was observed in smaller member of the twin (70%) in 7 infant.     

Brain imaging findings in neonatal hypoglycemia: case report and review of 23 cases

A hypoglycemic infant with secondary occipital brain injury defined by serial computed tomography and magnetic resonance imaging is described. An additional 22 similar cases were previously published in the English language literature. A total of 23 cases (including the present case) were reviewed. Abnormal brain imaging findings are associated with profound hypoglycemia and show involvement of the occipital lobes in 82% of affected newborns. Half of these infants had visual impairment, and their median and range of plasma glucose values, and postnatal age when hypoglycemia was first detected, were 7 mg/dL (range, 2-26 mg/dL) and 48 hours (range, 1-72 hours), respectively.     

新生儿低血糖并发坏死性小肠结肠炎的临床特征分析

目的 探讨新生儿低血糖并发坏死性小肠结肠炎(necrotizing enterocolitis,NEC)患儿的临床特征、结局及其高危风险因素.方法 本研究为回顾性分析,收集2014年1月至2019年12月厦门市妇幼保健院新生儿科住院的低血糖患儿临床资料,依据NEC诊断标准及Bell分级标准(Ⅱ～Ⅲ级)纳入研究组(21例...     

A randomized, controlled study of insulin pump therapy in diabetic preschoolers

OBJECTIVE: To compare glycemic control, safety, and parental satisfaction in preschool-aged diabetic children randomized to treatment either with continuous subcutaneous insulin infusion (CSII) or intensive insulin injection therapy. STUDY DESIGN: This clinical trial enrolled 42 patients <5 years of age who had been diagnosed with diabetes for at least 12 months. Children were randomly assigned to CSII (n = 21) or intensive insulin injection therapy (n = 21). Hemoglobin A1c (HbA1c) level was measured at baseline, 3, and 6 months. Secondary outcomes included severe hypoglycemic events, meter-detected hypoglycemia, blood sugar variability, body mass index (BMI), and satisfaction with therapy. RESULTS: Thirty-seven patients completed 6 months of therapy. There was a significant decrease in HbA1c during the study period for both groups (from 8.9% +/- 0.6% to 8.6% +/- 0.6% at 3- and 6-month visits). At 3 months, children using pumps had a significantly lower HbA1c than the injection group (8.4% vs 8.8%); however, by 6 months the two groups were similar (8.5% vs 8.7%). No differences in pre-meal blood sugar variabilities were seen between groups. Children on pumps had increases in the number of meter-detected episodes of hypoglycemia. Pump therapy was safe and well tolerated. No episodes of ketoacidosis occurred in either group, whereas one hypoglycemic seizure occurred in each group. Parents reported satisfaction with CSII, with 95% of families continuing on CSII beyond the 6-month study period. CONCLUSION: Pump therapy in preschool-aged children was not associated with clinically significant differences in glycemic control as compared with intensive injection therapy. The rationale for initiating CSII in this age group should be based on patient selection and lifestyle preference.     

新生儿糖代谢紊乱的临床研究

目的分析新生儿糖代谢紊乱的相关因素,探讨其预防和治疗措施。方法住院新生儿1783例进行血糖监测。所有息儿监测至2次空腹血糖正常为止。计数资料采用X2检验。结果发生糖代谢紊乱295例,其中低血糖症176例,高血糖症52例,二者兼有67例。血糖异常与胎龄呈显著负相关(P=0.001);与出生体质量呈显著负相关(P<0.01);小于胎龄儿(SGA)易发生糖代谢紊乱;轻度窒息组血糖紊乱以低血糖症为主,重度窒息组血糖紊乱以高血糖症居多(P<0.01);血糖恢复时间与窒息程度呈显著正相关(P<0.01);血糖异常与感染程度星显著正相关(P=0.019);糖尿病母亲婴儿易患低血糖症。结论对高危儿应尽早进行血糖监测,对血糖异常者及时处理,以减少或避免后遗症发生。     

糖尿病母亲婴儿低血糖发生情况及其与脑损伤的关系

目的探讨糖尿病母亲婴儿（IDMS）低血糖的发生情况及其与脑损伤的关系。方法分析86例IDMS低血糖的发生情况、母亲孕期血糖控制与低血糖持续时间的关系。分析其脑损伤发生及严重程度与低血糖持续时间、并其他疾病和症状性低血糖的关系。结果短暂性低血糖75例（87.2%）,反复发作性低血糖11例（12.8%）。母亲孕期血糖反复发作性低血糖发生率控制不满意组为19.4%,满意组为8%。反复发作性低血糖组脑损伤总发生率及重度脑损伤发生率高于短暂性低血糖组,并其他疾病组48.5%和无临床症状组57.4%,均有显著性差异（Pa〈0.05）。结论低血糖的持续时间与母亲妊娠期血糖控制情况及脑损伤发生、严重程度有关;低血糖并其他疾病会加重脑损伤,症状性低血糖时常存在严重脑损伤。     

胰岛素泵治疗儿童1型糖尿病并酮症或酮症酸中毒26例

目的观察胰岛素泵持续皮下注射胰岛素对儿童1型糖尿病并酮症或酮症酸中毒(DK/DKA)的疗效。方法本院内分泌科2003~2005年收治的1型糖尿病并DK/DKA患儿43例,分为治疗组26例和对照组17例。治疗组予胰岛素泵治疗,对照组予小剂量胰岛素持续静脉滴注。比较二组患儿血糖、尿酮体、血pH值变化,住院时间长短。结果1.治疗组血糖下降相对稳定,纠正酸中毒后无反复。2.治疗过程中治疗组未出现低血糖,对照组2例出现。3.住院时间治疗组[(11.92±4.72)d]较对照组[(17.35±4.83)d]治疗组较对照组明显缩短(P<0.001)。结论胰岛素泵持续皮下注射胰岛素治疗儿童1型糖尿病并DK/DKA是安全有效的。     

Prevalence and consequences of nocturnal hypoglycemia among conventionally treated children with diabetes mellitus

To determine the prevalence and predictors of, and the glucose responses after, nocturnal hypoglycemia, we studied 135 pediatric patients with insulin-dependent diabetes mellitus on 388 nights. The frequencies of blood glucose values less than 60, 50, and 40 mg/dl (3.3, 2.8, and 2.2 mmol/L) at 2 AM were 14.4%, 7.0%, and 2.1%, and at 6 AM were 6.7%, 2.6%, and 0.5%, respectively. Longer duration of diabetes, higher daily insulin doses, and lower glycosylated hemoglobin values were all significant but weak predictors of 2 AM hypoglycemia (glucose less than or equal to 60 mg/dl (less than or equal to 3.3 mmol/L). A 10 PM glucose concentration less than or equal to 100 mg/dl (less than or equal to 5.6 mmol/L) was present on 48% of nights with 2 AM glucose values less than or equal to 60 mg/dl (less than or equal to 3.3 mmol/L), but only 24% of nights with 10 PM blood glucose values less than or equal to 100 mg/dl (less than or equal to 5.6 mmol/L) were followed by 2 AM hypoglycemia. After treatment of 70 episodes of 2 AM glucose concentrations less than or equal to 60 mg/dl (less than or equal to 3.3 mmol/L), mean 6 AM glucose concentration was 95 +/- 6 mg/dl (5.7 +/- 0.3 mmol/L) and less than or equal to 100 mg/dl in 68.6%. In only 4.3% of these cases was the 6 AM glucose concentration greater than 200 mg/dl (greater than 11.1 mmol/L). Among patients who experienced 2 AM hypoglycemia, after-breakfast glucose values were not greater on days with 2 AM hypoglycemia than on days without it. These data indicate that 2 AM hypoglycemia is relatively common in patients with insulin-dependent diabetes mellitus, is frequently preceded by a 10 PM glucose value less than or equal to 5.6 mmol/L, and is less well predicted by other factors. Appropriate treatment of 2 AM hypoglycemia seldom results in either before-breakfast or after-breakfast blood glucose values greater than 200 mg/dl (greater than 11.1 mmol/L). Early-morning hypoglycemia is an uncommon cause of otherwise unexplained, prebreakfast hyperglycemia in children with insulin-dependent diabetes mellitus.