Journal of Family Medicine and Primary Care · 2 authors, 2 centres
This summary was generated by AI from a single paper. It has not been reviewed by a clinician and is not clinical advice. Verify against the source before acting on it.
This cross-sectional study of 190 high-risk newborns in rural Kerala found a 15.3% incidence of neonatal hypoglycemia, with peak occurrence in the first hour of life. Key risk factors included prematurity, large-for-gestational-age status, and maternal medical conditions such as hypertension and diabetes. Exclusive breastfeeding was associated with a markedly lower hypoglycemia rate (10.5%) compared to formula feeding (33.3%), supporting BFHI-aligned early feeding practices.
**Background:** Neonatal hypoglycemia is a common and treatable metabolic emergency that can lead to serious neurological sequelae if unrecognized. The operational threshold for intervention is blood glucose <45 mg/dL per WHO. High-risk groups include infants of diabetic mothers, preterm, small-for-gestational-age (SGA), and large-for-gestational-age (LGA) babies. This study aimed to determine the frequency and risk factors for hypoglycemia in these at-risk newborns in a baby-friendly hospital in rural Kerala that adheres to BFHI (Baby-Friendly Hospital Initiative) guidelines.
**Methods:** This single-center, hospital-based cross-sectional study was conducted from October 2018 to September 2019. A total of 190 consecutively born high-risk neonates were enrolled. Inclusion criteria: newborns of mothers with gestational diabetes mellitus (GDM) or overt diabetes, LGA, SGA, and preterm babies whose parents provided consent. Exclusion criteria: babies with congenital anomalies, asphyxia, respiratory distress, or sepsis. Data were collected via interviewer-administered proforma and from antenatal and postnatal records. Blood glucose was measured at 1, 4, 8, 12, 24, 48, and 72 hours of life. Hypoglycemia was defined as blood glucose <45 mg/dL. Data were analyzed using SPSS; qualitative data expressed as percentages, quantitative data as mean±SD. Associations were tested using the Chi-squared test.
**Key Results:** Among 190 babies, 22.1% were preterm and 77.9% were term; 70% were appropriate-for-gestational-age (AGA), 26.8% SGA, and 3.2% LGA. Males comprised 54.2% of the sample. 47.9% of mothers had GDM and 5.3% had overt diabetes. The overall incidence of hypoglycemia was 15.3%. Symptomatic hypoglycemia occurred in 10.5% of all babies; the most common symptoms were jitteriness (35%) and poor activity (30%). Asymptomatic hypoglycemia was noted in 4.2% (9 babies). Peak incidence was at 1 hour of life, and no hypoglycemia was detected after 48 hours. Incidence was 19% in preterm vs. 14.2% in term babies; 50% in LGA babies vs. 9.8% in SGA and 15.8% in AGA babies. Hypoglycemia was significantly higher in babies born to mothers with medical illnesses (hypertension: 53.3%, hypothyroidism: 40%; P<0.001). Mode of delivery was also significant: 28.6% of vaginally delivered babies had hypoglycemia vs. 10.6% of cesarean-born babies (P=0.003). Feeding pattern showed a strong association: exclusive breastfeeding had a 10.5% hypoglycemia rate vs. 25.5% in mixed feeding and 33.3% in formula-fed babies (P=0.01). No mortality was observed.
**Clinical Implications:** This study confirms that neonatal hypoglycemia remains a significant concern in high-risk populations even in a BFHI-adherent setting, with a 15.3% incidence. The finding that 50% of LGA babies experienced at least one hypoglycemic episode underscores the need for vigilant monitoring in this subgroup. The strong protective association of exclusive breastfeeding (10.5% vs. 33.3% with formula) reinforces the importance of early and sustained breastfeeding support. The peak incidence in the first hour of life mandates that the first glucose check be performed within that window. The study also highlights that primiparous mothers are not at higher risk when adequate lactation counselling is provided. These findings support training community health workers (ASHAs) in breastfeeding support and glucose monitoring, and establishing breastfeeding support groups in all hospitals to prevent hypoglycemia and its long-term neurological consequences.