低血糖新生儿的临床特点及病因探讨

Clinical characteristics and etiology of neonatal hypoglycemia

目的 探讨引起新生儿低血糖的高危因素及临床特点。方法 对688例新生儿于入院时常规进行血糖检测,其中65例发生低血糖。分析低血糖患儿的情况,包括早产儿及小于胎龄儿、窒息、感染、黄疸、母亲合并糖尿病、喂养困难、红细胞增多症、母亲合并妊高征等;比较不同胎龄与体重患儿低血糖发生率;分析低血糖患儿的治疗结果。结果 窒息、母亲合并糖尿病、早产儿及小于胎龄儿、喂养困难、母亲合并妊高征等患儿低血糖发生率较高。胎龄<37周患儿的低血糖发生率高于胎龄≥37周患儿,差异有统计学意义(χ^(2)=23.07, P<0.05)。出生体重<2500 g及>4000 g患儿的低血糖发生率高于2500~4000 g患儿,差异有统计学意义(χ^(2)=20.41、22.01, P<0.05)。65例低血糖患儿经及时治疗后,53例患儿12 h内血糖恢复正常,有7例出现高血糖。结论 凡糖尿病母亲婴儿、窒息、早产及小于胎龄儿、巨大儿等高危儿,生后均应严密监测血糖,并尽早开奶,加强喂养。在治疗过程中,早产儿及小于胎龄儿血糖恢复正常后,应减慢葡萄糖的输注速度或降低其浓度,以避免发生高血糖。

Objective To discuss the risk factors and clinical characteristics of neonatal hypoglycemia.Methods Blood glucose test was routinely performed on 688 neonates on admission,of which 65 cases had hypoglycemia.The conditions of children with hypoglycemia,including premature infants and smallfor-gestational-age infants,asphyxia,infection,jaundice,maternal diabetes mellitus,feeding difficulties,polycythemia,and maternal pregnancy-induced hypertension were analyzed.The incidence of hypoglycemia in children with different gestational ages and body weights was compared,and the treatment results of children with hypoglycemia were analyzed.Results The incidence of hypoglycemia was higher in children with asphyxia,maternal diabetes mellitus,premature and small-for-gestational-age infants,feeding difficulties,and maternal pregnancy-induced hypertension.The incidence of hypoglycemia in children with gestational age<37 weeks was higher than that in children with gestational age≥37 weeks,and the difference was statistically significant(χ^(2)=23.07,P<0.05).The incidence of hypoglycemia in children with birth weight<2500 g and>4000 g was higher than that in children with birth weight of 2500-4000 g,and the difference was statistically significant(χ^(2)=20.41,22.01;P<0.05).After timely treatment of 65 children with hypoglycemia,blood glucose returned to normal within 12 h in 53 cases,and hyperglycemia occurred in 7 cases.Conclusion All infants with high risk such as maternal diabetes mellitus,asphyxia,premature and small-for-gestational-age infants,and fetal macrosomia should be closely monitored for blood glucose after birth,and breastfeeding should be started and enhanced as early as possible.During the treatment process,after the blood glucose of premature and small for gestational age infants has returned to normal,the infusion of glucose should be slowed down or its concentration reduced to avoid hyperglycemia.