Prolonged hypoglycemia in full-term, small for gestational age newborns

Objectives: To investigate the course of prolonged hypoglycemia in full-term, small for gestational age (SGA) newborns and their neurologic outcomes. Materials and methods: We retrospectively reviewed the medical records of full-term SGA newborns, born in National Cheng Kung University Hospital between November 1, 1991 and December 31, 2001. They were routinely screened for hypoglycemia at the ages of 1, 2, 4, 6, 12, 24, and 48 hours by dextrostix testing. Hypoglycemia was defined as a glucose value lower than 35 mg/dL within 3 hours, lower than 40 mg/dL between 3 and 24 hours, and lower than 45 mg/dL at more than 24 hours of age. Serum cortisol and insulin levels were determined when the duration of hypoglycemia was exceeded 7 days. Data on risk factors and neurologic outcomes were collected and analyzed. Results: Thirty-five full-term SGA newborns developed hypoglycemia after birth. Eight (23%) of them had hypoglycemia for longer than 48 hours and recovered within 7 days of age; 8 (23%) patients had hypoglycemia for longer than 7 days. The majority recovered from hypoglycemia after glucose intake or a parenteral glucose infusion. However, 4 patients eventually required steroid or glucagon therapy. Their serum insulin and cortisol levels were within normal ranges. Five of the 8 patients with prolonged hypoglycemia developed neurologic dysfunction. Conclusions: Prolonged hypoglycemia in full-term SGA newborns is not uncommon. The majority of hypoglycemic episodes were transient. However, those with prolonged hypoglycemia were at risk of developing neurodevelopmental disorders, and thus aggressive management was indicated.