Does early enteral feeding prevent hypoglycemia in small for gestational age neonates?

摘要

Abstract. OBJECTIVES: To determine the association between early enteral feeding and the incidence of hypoglycemia in SGA neonates.STUDY DESIGN: A retrospective review to evaluate the association of hypoglycemia and early enteral feeding was performed. Eligible patients were born full-term between 1/1/2008-7/1/2011 and classified as SGA (birth weight <10th percentile). We collected the first two serum glucose values, time to enteral feeds and feeding type. The primary outcome was incidence of hypoglycemia, defined as serum glucose values <35 mg/dL (1.9 mmol/L). RESULTS: 203 infants were included in the analysis. 94 patients were fed between the first and second glucose measurement and 109 were not. Although the incidence of hypoglycemia was greater in the group that received early enteral feeds (13% versus 4%; p = 0.02), feeding was not a significant predictor of the second serum glucose in a multivariable regression model (p = 0.078). CONCLUSIONS: This study suggests that early enteral feeding does not predict hypoglycemia in this cohort of SGA neonates. Prevention of early neonatal hypoglycemia has not been well defined. The American Academy of Pediatrics recently established new guidelines for monitoring at-risk neonates which recommend close monitoring of blood glucose values starting in the first hour of life. Despite broad adoption of these recommendations, the impact of early feeding on the prevention of neonatal hypoglycemia in the first several hours of life remains unknown. Symptomatic infants with hypoglycemia warrant prompt intervention because they are known to be at risk of long-term neurodevelopmental problems including poorer performance on the Bayley psy-chomotor developmental assessment scores, decreased head circumference and neuronal injury. In asymptomatic infants, the level of serum glucose below which intervention is required is controversial because the long term complications are not well-described.