Browsing by Author "Lewis, Leslie"
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Publication Birth Weight Pattern and Immediate Morbidities in 452 Neonates Born to Diabetic Mothers: A Tertiary Centre Perspective(Nepal Paediatric Society (JNPS), 2023) Bhat. Y, Ramesh; Reddy, Narasimha; Lewis, LeslieAbstract: Introduction: Neonates born to diabetic mothers continue to remain as highrisk neonates despite advanced care of gestational diabetes mellitus (GDM). Morbidities including macrosomia remain a significant problem. We aimed to study the birth weight pattern, incidence of hypoglycemia and immediate morbidities in neonates born to diabetic mothers. Methods: Neonates born to diabetic mothers were prospectively studied over 18 months. The birth weight pattern, hypoglycemia, biochemical abnormalities, hyperbilirubinemia and other systemic morbidities were studied. Results: Among 4654 live births, 516 (11%) neonates were born to diabetic mothers. After excluding 64, 452 neonates were further studied. Overall, 76.1% had normal birth weight. Large for gestational age (LGA) was found in 46 (10.2%). Small for gestational age (SGA) was found in 2.9%. Among 320 neonates born to GDM mothers on diet, 8 (2.5%) were SGA and 32 (10%) were LGA. Among 78 neonates born to GDM mothers on oral hypoglycemic agents, 2 (2.6%) were SGA and 12 (15.4%) were LGA. In 54 neonates born to GDM mothers on insulin, 3 (5.6%) were SGA and 2 (3.7%) were LGA. Overall, 21.7% had one or other morbidity. The overall incidence of hypoglycemia was 15.9%. Hyperbilirubinemia (34.5%) and congenital heart defects (31.8%) were the common morbidities. The other immediate morbidities included respiratory morbidities (9.7%), sepsis (3.8%), polycythemia (2%), birth injuries (1.7%) and perinatal asphyxia (0.9%). Conclusion: About 10% of neonates born to diabetic mothers have macrosomia. Macrosomia was found more in neonates born to GDM mothers who were on oral glycemic agents than those on insulin. Glucose monitoring is needed in neonates of GDM mothers to detect hypoglycemia earlyPublication Blood Glucose Levels and Characteristics of Hypoglycemia in Low Birth Weight Neonates(Nepal Paediatric Society (JNPS), 2021) Y, Ramesh Bhat; George, Juanitha; Lewis, Leslie; Purkayastha, JayashreeAbstract: Introduction: Low birth weight (LBW) neonates comprising of preterm and small for gestational age (SGA) are at risk of hypoglycemia. Hypoglycemia as such in LBW neonates is not well characterized. We aimed to study the blood glucose levels of these neonates and characterise the hypoglycemia. Methods: Blood glucose levels in singleton neonates with birth weight between 1500 gm and 2499 gm were studied prospectively. Glucose levels were assessed at six hour intervals in the first 48 hours of life and extended if indicated. Glucose level ≤ 45 mg/dL in the first 24 hours and < 50 mg/dL thereafter was considered hypoglycaemia. Results: A total of 320 among 3822 neonates satisfied inclusion criteria; 104 had at least one low glucose reading with an incidence of hypoglycaemia of 32.5%. Preterm neonates constituted 158 (49.4%) and SGA 76 (23.8%). Mean blood glucose values were lowest in the first hour of life (60.1 ± 17.2 mg/dL). Incidence of hypoglycemia was highest within one hour of life followed by day two of life (16.3% and 11.6% respectively). About 86 (82.6%) neonates were asymptomatic. Overall, 75% of neonates had a single episode of hypoglycemia and 25% had a recurrence. Hypoglycaemia was noted in 31.8% of neonates born to diabetic mothers, mostly in the first hour (57.1%). Other risk factors for hypoglycemia included intrapartum fluids, birth weight < 2000 g and polycythemia. Conclusions: About a third of LBW neonates had hypoglycemia; mostly on the first hour and day one of life. Asymptomatic nature of hypoglycaemia in the large majority and recurrent hypoglycemia in 25% cases warrants glucose monitoring in this subgroup.