新生儿低血糖的临床特征、预后及其危险因素分析

Clinical features and prognosis of neonatal hypoglycemia and analysis of risk factors

目的评估新生儿低血糖的临床特征、预后转归情况及危险因素。方法回顾性分析2019年1月至2022年1月合肥市第三人民医院收治的58例低血糖患儿(低血糖组),并采用系统抽样法随机抽取同期住院且血糖监测正常的58例新生儿作为对照组,分析低血糖组的临床特征、预后、转归情况,评估影响新生儿低血糖发生的危险因素。统计学方法采用χ^(2)检验、Fisher确切概率法,多因素Logistic回归分析。结果临床症状以无明显症状居多[48.3%(28/58)],其次为面色发绀[19.0%(11/58)]、呻吟[15.5%(9/58)];合并症以新生儿肺炎居多[84.5%(49/58)],其次为高胆红素血症[25.9%(15/58)]、缺血缺氧性心肌损害[17.2%(10/58)]。58例新生儿低血糖患儿中有11例[19.0%(11/58)]发生低血糖脑损伤,治疗1~2周后复查病情好转,其中8例随访1年,均未遗留后遗症;其他无脑损伤的47例新生儿低血糖患儿治疗后病情好转出院,无后遗症。单因素分析结果显示,低血糖组早产儿比例[25.9%(15/58)与10.3%(6/58),χ^(2)=4.710,P=0.030]、日龄<1 d[69.1%(40/58)与46.6%(27/58),χ^(2)=7.696,P=0.021]高于对照组;剖宫产率[65.5%(38/58)与20.7%(12/58),χ^(2)=23.762,P<0.001]、未开奶率[60.3%(35/58)与10.3%(6/58),χ^(2)=33.474,P<0.001]、孕母妊娠期高血压疾病[19.0%(11/58)与3.5%(2/58),χ^(2)=7.017,P=0.008]及妊娠期糖尿病发生率[43.1%(25/58)与8.6%(5/58),χ^(2)=17.985,P<0.001]均高于对照组。回归分析显示,早产儿(OR=1.719,95%CI:1.005~3.961)、日龄<1 d(OR=2.044,95%CI:1.096~4.327)、剖宫产(OR=3.016,95%CI:1.745~5.216)、未开奶(OR=2.672,95%CI:1.472~4.851)、妊娠期高血压疾病(OR=2.450,95%CI:1.248~4.809)、妊娠期糖尿病(OR=3.080,95%CI:1.774~5.347)均为新生儿低血糖的危险因素(P值均<0.05)。结论早产儿、日龄<1 d、剖宫产、未开奶、妊娠期高血压疾病、妊娠期糖尿病是新生儿低血糖的危险因素,临床应注意筛查及鉴别,并及时对症治疗。

Objective To evaluate the clinical features and prognosis of neonatal hypoglycemia,and perform analysis on its risk factors.Method A retrospective analysis was performed on 58 children with neonatal hypoglycemia(hypoglycemia group)in the Third People's Hospital of Hefei from January 2019 to January 2022.58 neonates who were hospitalized during the same time period and had normal blood glucose monitoring were randomly selected as control group by systematic sampling.The clinical symptoms and prognosis of hypoglycemia group were analyzed.The risk factors for occurrence of neonatal hypoglycemia were evaluated.Statistical methods performed byχ^(2)test,Fisher exact probability method and multivariate Logistic regression analysis.Result Most of the clinical symptoms were asymptomatic[48.3%(28/58)],followed by cyanosis[19.0%(11/58)]and moaning[15.5%(9/58)].Neonatal pneumonia was the most common comorbidity[84.5%(49/58)],followed by hyperbilirubinemia[25.9%(15/58)]and ischemic hypoxic myocardial injury[17.2%(10/58)].Among the 58 children with neonatal hypoglycemia,there were 11 cases[19.0%(11/58)]of hypoglycemic brain injury,and their condition improved after 1 to 2 weeks of treatment,and 8 cases of them were followed up for 1 year without any sequelae.The other 47 cases with neonatal hypoglycemia but without brain injury were cured and discharged after treatment without sequelae.Univariate analysis showed that the proportion of preterm infants in the hypoglycemic group[25.9%(15/58)vs 10.3%(6/58),χ^(2)=4.710,P=0.030]and the age<1 d[(69.1%(40/58)vs 46.6%(27/58),χ^(2)=7.696,P=0.021)were higher than those in the control group;the rate of cesarean section[65.5%(38/58)vs 20.7%(12/58),χ^(2)=23.762,P<0.001],the rate of unopened milk[60.3%(35/58)vs 10.3%(6/58),χ^(2)=33.474,P<0.001],the incidence of gestational hypertension[19.0%(11/58)vs 3.5%(2/58),χ^(2)=7.017,P=0.008],and the incidence of gestational diabetes mellitus[43.1%(25/58)vs 8.6%(5/58),χ^(2)=17.985,P<0.001]were higher than those in the control group.Regression analysis showed that premature infants(OR=1.719,95%CI:1.005-3.961),age<1 day(OR=2.044,95%CI:1.096-4.327),cesarean section(OR=3.016,95%CI:1.745-5.216),nonlactation(OR=2.672,95%CI:1.472-4.851),gestational hypertension(OR=2.450,95%CI:1.248-4.809)and gestational diabetes mellitus(OR=3.080,95%CI:1.774-5.347)were risk factors for neonatal hypoglycemia(all P<0.05).Conclusion Premature infants,age<1 day,cesarean section,non-lactation,gestational hypertensive disease and gestational diabetes mellitus are many risk factors for neonatal hypoglycemia.It is necessary to pay clinical attention to screening and identification and timely perform symptomatic treatment.