Effect of glycaemic status in neonatal sepsis-A prospective observational study

Abstract

Introduction: Neonatal hypoglycemia is a common and readily treatable risk factor for neurologic impairment in children. Although associations between prolonged symptomatic neonatal hypoglycemia and brain injury are well established, the effect of milder hypoglycemia on neurologic development is uncertain. Objective: To determine the glycemic status among patients with neonatal sepsis and to evaluate their association with the mortality.  Methods: It was a prospective observational study conducted at Department of Pediatrics, Rajshahi Medical College Hospital, Rajshahi, Bangladesh from July 2021 to June 2022. Total 52 patients clinically diagnosed as neonatal sepsis were studied, a detailed history and thorough physical examination was done in each patient on admission. History included age of newborn, sex, gestational age, h/o prolonged rupture of membrane (PROM), intrapartum fever or fever 3 days before delivery, per vaginal foul smelling discharge, prolonged labor and features of sepsis. Physical examination included respiratory rate, heart rate, temperature, chest indrawing, grunting, cyanosis, convulsion, breath sound, added sound, weight, jaundice, bleeding manifestation, status of fontanelles, umbilicus and capillary refill time. Blood glucose level and mortality of neonates having hypoglycemia and hyperglycemia were analyzed. Results: Out of 52 patients clinically diagnosed as neonatal sepsis were studied. The mean age was found 10.2±8.4 days with range from 1 to 28 days and more than half (51.6%) patients belonged to age ≤7 days. More than two third (68.7%) patients were male and 31.3% were female. 42(80.77%) patients were found CRP positive and 10(19.23%) were negative CRP. 34.62% patients were blood culture positive and 65.38% patients were culture negative. Majority (71.43%) of CRP positive patients were found normoglycemic, 11.90% were found hypoglycemic and only 16.67% were found hyperglycemic. Among 18 culture positive patients 11(61.11%) were normoglycaemic, 3(16.67%) were hypoglycemic and 4(22.22%) were hyperglycemic. 57.1% of hyperglycemic and 40% of hypoglycemic patients were died whereas only 13.3% of normoglycemic patients were died. Out of 10 expired patients, 2 patients Hypoglycemia, 4 patients Normoglycemia and 4 patients Hyperglycemia. Mortality was high in Hypoglycemia patient (40.0%) in comparison with normoglycaemic patient (13.33%) and the difference was not statistically significant (p>0.05) between two groups. Mortality was also high in hyperglycaemic patient (57.14%) in comparison with normoglycaemic patient (13.33%) and the difference was statistically significant (p<0.05) between two groups. Conclusion: Alteration of glycemic status occurred in septic newborn. Our study showed mortality is higher among the septic newborn with hyperglycemia. The incidence of hypoglycemia was high as compared to hyperglycemia. Neonatal hypoglycemia and hyperglycemia was a significant factor in the overall mortality in neonatal sepsis.