A prospective study: Risk factors and outcomes of hyperglycemia in neonates

Background: Hyperglycemia is a significant risk factor for morbidity and mortality among fragile infants who survive the neonatal period, with its risk inversely related to gestational age, birth weight, and clinical condition.

Objective: This study aimed to identify the risk factors and immediate outcomes associated with hyperglycemia in neonates admitted to the neonatal intensive care units (NICUs) at Ribat University Hospital and Omdurman Maternity Hospital in Khartoum State.

Methods: A prospective, descriptive, total coverage study was conducted from September 1, 2019, to February 28, 2020.

Results: Out of all neonates, 99 exhibited hyperglycemias, with 53.53% being female (female-to-male ratio of 1.1:1). The majority (95.95%) were aged 0-7 days, and 64.64% were preterm. Low birth weight was observed in 69.69% of cases. Most neonates (54.54%) had glucose levels between 150-<200 mg/dL, while 20.2% had levels >300 mg/dL. Hyperglycemia lasted between 24-<72 hours in 57.58% of cases, with a mean duration of 43.2 hours. Significant negative correlations were found with gestational age and birth weight (r = -0.254, P = 0.011; r = -0.387, P = 0.00), while a positive correlation was noted with the patients' age (r = 0.237, P = 0.018) and the use of respiratory support, antibiotics, and aminophylline (r = 0.198, P = 0.05; r = 0.201, P = 0.046; r = 0.397, P = 0.00). Neonatal sepsis was the most common diagnosis (86.86%), followed by respiratory distress syndrome (RDS) (74.74%) and hypoxic-ischemic encephalopathy (HIE) (14.14%), all showing a significant relationship with hyperglycemia (P = 0.018). Hyperglycemia was significantly associated with mortality (28.29%, P = 0.04), with higher rates observed in Omdurman Maternity Hospital (21.21%) compared to Ribat Hospital (7.08%). Most deaths occurred in critically ill patients, with RDS and HIE showing significant associations with mortality (P = 0.037 and P = 0.02, respectively). There was a negative correlation with intervention (r = -0.368, P = 0.00). The majority of cases (71.71%) were classified as transient hyperglycemia.

Conclusions: There was a high incidence of hyperglycemia among low-birth-weight infants (69.69%). Statistically significant relationships were observed between hyperglycemia and various neonatal parameters (gestational age, birth weight), risk factors (HIE, respiratory support, intravenous fluids, antibiotics, and aminophylline), and mortality. Most cases were transient, indicating that insulin intervention was generally unnecessary.