Early postnatal glucose patterns and risk factors for hypoglycemia in healthy at-risk neonates: A prospective observational study

Objective: This study aimed to determine the prevalence and early postnatal changes in blood glucose, evaluate whether glucose levels within the first six hours predict later hypoglycemia, and assess biochemical patterns in neonates with low glucose.Methodology: A prospective observational study was conducted over one year at the Neonatal Unit and NICU of a tertiary care hospital, Lucknow, India including 450 at-risk but healthy neonates (infants of diabetic mothers, late preterm, SGA/LGA, or low birth weight).Blood glucose was measured at 2, 6, 12, 24, 48, and 72 hours using a bedside glucometer, with low readings confirmed in the laboratory.Neonates were clinically monitored and managed as per standard protocols.Maternal, perinatal, and neonatal factors were analyzed using SPSS 21.0.Results: Among 450 neonates, low blood glucose (<45 mg/dl) peaked at 6 hours (49.8%) and declined to 1.8% by 72 hours, while plasma glucose was lowest within 4 hours (44.7%).Symptomatic hypoglycemia occurred mainly within 6 hours (55.1%), with jitteriness as the most common symptom (30%).Symptomatic neonates showed significantly lower glucose levels at 6 and 12 hours (p<0.01).Prematurity and early excessive weight loss were significant neonatal risk factors, while obstructed labor and cesarean delivery were notable maternal associations.Over half (58.9%) of hypoglycemic neonates required glucose infusion, and 39.4% showed hyperinsulinemia with impaired ketogenesis.Mortality was 5.8%. Conclusion:Neonatal hypoglycemia is most frequent in the first six hours of life.Early glucose monitoring and prompt intervention are essential to prevent complications and reduce mortality.