新生儿低血糖患病率与潜在病因的研究

Prevalence and potential etiology of neonatal hypoglycemia

目的探讨新生儿低血糖患病率及其相关危险因素。方法随机抽取2016年1月至2018年6月在舟山医院出生的新生儿604名,在产后2天内两次检测新生儿随机血糖(间隔24h),评估新生儿低血糖的发生率,并筛选危险因素。结果活产新生儿低血糖患病率为4.2%,分娩后第1天有84名新生儿出现低血糖,占总病例65.6%;宫内生长受限、早产(依据临床评分)、妊娠期高血压(复杂型)、妊娠期糖尿病、剖宫产、新生儿窒息、初次哺乳间隔>2h、低体温、羊水过少、产时滴注葡萄糖与新生儿低血糖相关(χ^2值分别为 14.360、6.541、8.167、8.167、22.435、11.091、8.061、46.936、26.482、19.527,均 P<0.05);羊水过少预测新生儿低血糖的重要性最强(权重=0.3165),初次哺乳间隔>2h预测新生儿低血糖的重要性相对弱(权重=0.0077),依据临床评分的孕龄(权重=0.0614)、宫内生长受限(权重=0.0164)、新生儿窒息(权重=0.0401)、低体温(权重=0.0834)、复杂型妊娠期高血压(权重=0.1054)、妊娠期糖尿病(权重=0.1066)对于预测新生儿低血糖发生也有重要价值。结论新生儿低血糖发生率较高,羊水过少、复杂型妊娠期高血压和妊娠期糖尿病是新生儿低血糖的主要独立危险因素。

Objective To explore the prevalence and risk factors of hypoglycemia in neonates. Methods From January 2016 to June 2018, 604 neonates born in Zhoushan Hospital were randomly selected. The blood sugar of newborns was measured twice within 2 days after delivery with an interval of 24 hours. The incidence of neonatal hypoglycemia was assessed and the risk factors of hypoglycemia were screened. Results The prevalence of hypoglycemia in live births was 4.2%. On the first day after delivery, 84 neonates complained of hypoglycemia, accounting for 65.6% of total cases. Intrauterine growth restriction, premature delivery(according to clinical score), pregnancy hypertension(complex type), gestational diabetes mellitus, caesarean section, neonatal asphyxia, first breast-feeding interval >2 hours, hypothermia, oligohydramnios, intrapartum glucose infusion were associated with neonatal hypoglycemia(χ~2 value was 14.360, 6.541, 8.167, 8.167, 22.435, 11.091, 8.061, 46.936, 26.482 and 19.527, respectively, all P<0.05). Oligohydramnios(weight=0.3165) had the most importance in predicting neonatal hypoglycemia, followed by first breast-feeding interval>2 hours(weight=0.0077). Gestational age(weight=0.0614), intrauterine growth restriction(weight=0.0164), neonatal asphyxia(weight=0.0401), hypothermia(weight=0.0834), complex gestational hypertension(weight=0.1054), and gestational diabetes mellitus(weight=0.1066) were associated with neonatal hypoglycemia. Conclusion The incidence of neonatal hypoglycemia is relatively high. Oligohydramnion, complicated gestational hypertension and gestational diabetes mellitus are main independent risk factors for neonatal hypoglycemia.