| dc.description.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.
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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 | en_US |
