Prevalence and factors associated with abnormal glycemic status among term neonates admitted to special care unit Kawempe National Referral Hospital

Abstract

Background: Abnormal glycemic status is a metabolic disorder characterized by hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar). Both hypoglycemia and hyperglycemia are common in neonatal illnesses and are potentially modifiable risk factors associated with unfavorable outcomes. In Uganda, data on abnormal glycemic status among term neonates is scarce. The study aimed at determining the prevalence and factors associated with abnormal glycemic status among term neonates presenting to the Special Care Unit (SCU) of Kawempe National Referral Hospital. Objective: To determine the prevalence and factors associated with abnormal glycemic status among term neonates presenting to SCU at Kawempe National Referral Hospital (KNRH). Methods: This was a facility based cross sectional study that enrolled 386 term neonates presenting to SCU Kawempe National Referral Hospital. Appearance, pulse, grimace, activity, and respiration (APGAR), sanart score and random blood sugar (RBS) were determined within the first one hour of admission to SCU. The study team was stationed at the triage center of the SCU. As stabilization of the baby was done, eligibility was assessed by the study team. Where written informed consent couldn’t be obtained at that moment, verbal consent was sought to participate in the study and later written informed consent was sought from the caretakers. Research assistants (of nurse cadre) then picked a finger prick sample to measure blood glucose concentration as well as 1ml EDTA blood sample for the CBC and 1ml serum separating tube sample for the CRP test. A questionnaire was administered to determine the sociodemographic characteristics of maternal and antenatal/ child factors as soon as the patient was stabilized. Blood glucose was measured using Accu Chek Performa glucometer from ROCHE laboratories. Participants with plasma glucose levels less than 40 mg/dl (2.2 mmol/L) were classified as hypoglycemic whereas those with levels greater than 150 mg/dl (8.3 mmol/L) were classified as being hyperglycemic. Information on factors associated with abnormal glycemic status was obtained using a structured questionnaire. Data was entered in EPIDATA version 3.1. Factors associated with hypoglycemia/hyperglycemia were independently assessed using multinomial logistic regression in STATA version 16. Odds ratios (OR) with their 95% confidence intervals were reported. A P-value ˂0.05 was considered statistically significant. xiii Results: The median age of the neonates was 3 hours and 45 minutes (IQR – 1 hour & 18 minutes to 11 hours) with majority of them being male, 62.4% (241/386). Majority of the deliveries also took place at Kawempe National Referral Hospital, 61.4% (237/386) and 3.0% (11/373) were twin births. Less than half of the neonates 42.9% (151/352) scored 7 to 10 APGAR at 1 minute, but many 79.0% (282/357) had a score between 7 to 10 at 5 minutes. About a third of deliveries 36.3% (140/386) were by Caesarean section. The prevalence of abnormal glycemic status in the current study was 12.4% (48/386), (95% CI 9.31 – 16.15). The prevalence of hypoglycaemia among the neonates was 7.5% (29/386), (95%CI 5.09 – 10.61) while the prevalence of hyperglycaemia was 4.9% (19/386), (95%CI 2.99 – 7.58). Delivery by caesarean section was associated with reduced odds of hypoglycaemia compared to vaginal delivery (aOR = 0.26, 95%CI 0.09 – 0.79, P value = 0.017). Mother’s positive HIV status (aOR = 5.15, 95%CI 1.06 – 25.12, P value = 0.043), HIE (aOR = 3.95, 95%CI 1.21 – 12.90, P value = 0.023) and raised CRP (aOR = 3.98, 95%CI 1.43 – 11.06, P value = 0.008) were associated with hyperglycaemia. Conclusions and recommendations: The prevalence of abnormal glycemic status among term neonates at the SCU was 12.4%; 7.5% were hypoglycemic and 4.9% were hyperglycemic. Caesarean section delivery was associated with reduced odds of hypoglycaemia while a positive HIV status, HIE and high CRP values were associated with hyperglycaemia. Attending healthcare workers should screen for glycemic status in all neonates born through vaginal delivery and those with HIE, high CRP values, those whose mothers are HIV positive and those with unknown HIV status