Neonatologist Children's Hospital & Medical Center Nonthaburi, Nonthaburi, Thailand
Background: Neonatal hypoglycemia is a common metabolic complication in newborns at risk, with potential long-term neurological consequences. Early feeding has been proposed as a preventive strategy, but its effectiveness remains uncertain. Objective: To evaluate the effect of early feeding on the incidence of hypoglycemia in at-risk newborns. Design/Methods: We conducted a retrospective cohort study of 960 at-risk newborns to evaluate the effect of early feeding on hypoglycemia. With 80% power and a 5% significance level, this sample size could detect a reduction in hypoglycemia from 50% to 25%. Eligible infants were born at ≥34 weeks’ gestation with one or more risk factors, including mother with diabetes, late preterm birth, small or large for gestational age, or birth weight < 2,500 g or >4,000 g. Infants requiring immediate NICU admission, having contraindications to enteral feeding, or with incomplete data were excluded. Participants were equally divided into early feeding and routine care groups. Early feeding was provided within 30 minutes before the first glucose screening. Hypoglycemia was defined as a point-of-care glucose level < 40 mg/dL. Multivariable logistic regression was used to assess the association. Results: The incidence of hypoglycemia was comparable between the early feeding and routine care groups (10.2% vs. 10.0%, p=0.50). Mean glucose levels at first screening were significantly higher in the early feeding group (63.8 ± 16.3 mg/dL vs. 58.9 ± 16.3 mg/dL, p< 0.01). Multivariable analysis showed that early feeding was not significantly associated with reduced hypoglycemia risk (OR 0.95, 95% CI 0.61–1.48, p=0.82). Independent risk factors for hypoglycemia included gestational age (OR 0.71, 95% CI 0.54–0.94, p=0.02), large for gestational age status (OR 3.08, 95% CI 1.7–5.6, p< 0.01), and mother with diabetes (OR 2.68, 95% CI 1.58–4.55, p< 0.001).
Conclusion(s): Preterm infants, mother with diabetes, and large for gestational age status were significant risk factors. Although early feeding was associated with higher initial glucose levels, it did not significantly reduce the incidence of hypoglycemia in at-risk newborns. Early feeding may still be beneficial as a supportive measure but should be combined with vigilant monitoring in high-risk infants.
Table 2 Baseline characteristics of hypoglycemic and non-hypoglycemic infants Table 2.pdfTable 2 Baseline characteristics of hypoglycemic and non-hypoglycemic infants
Table 3 Risk factors for neonatal hypoglycemia Table 3.pdfTable 3 Risk factors for neonatal hypoglycemia
