Neonatal hypoglycaemia in Nepal 2. Availability of alternative fuels
Anthony M de L Costelloa, Deb K Palb, Dharma S Manandharc, Sujan Rajbhandaric, John M Landd, Navin Pateld
a Centre for
International Child Health, Institute of Child
Health, University College, London, b Neurosciences
Unit, University College, London, c MIRA Project,
Prasuti Griha Maternity Hospital,
Kathmandu, Nepal, d Clinical Biochemistry,
National Hospital for Neurology,
Queen Square, London
Correspondence to: Dr Anthony M de L Costello, Institute of Child Health, 30 Guilford St, London WC1N 1EH Email a.costello{at}ich.ucl.ac.uk.
Accepted 1 August 1999
AIMS
To study
early neonatal metabolic adaptation in a hospital population of
neonates in Nepal.
METHODSA cross
sectional study was made of 578 neonates, 0 to 48 hours after birth, in
the main maternity hospital in Kathmandu. The following clinical and
nutritional variables were assessed: concentrations and age profiles of
blood glucose, hydroxybutyrate, lactate, pyruvate, free fatty acids
(FFA) and glycerol; associations between alternative fuel levels and
hypoglycaemia; and regression of possible risk factors for ketone availability.
RESULTSRisk
factors for impaired metabolic adaptation were common, especially low
birthweight (32%), feeding delays, and cold stress. Blood glucose and
ketones rose with age, but important age effects were also found for
risk factors like hypothermia, thyroid hormone activities, and feeding
practices. Alternative fuel concentrations, except FFA, were
significantly reduced in infants with moderate hypoglycaemia during the
first 48 hours after birth. Unlike earlier studies, small for
gestational age (SGA) infants had significantly higher
hydroxybutyrate:glucose ratios which suggested counter regulatory
ketogenesis. Hypoglycaemic infants were not hyperinsulinaemic. Regression analysis showed risk factors for impaired counter regulation which included male and large infants, hypothermia, and poorer infant
thyroid function. SGA infants and those whose mothers had received no
antenatal care had increased counter regulation.
CONCLUSIONSAlternative
fuels are important in the metabolic assessment of neonates, and they
might provide effective cerebral metabolism even during moderate
hypoglycaemia. Hypoglycaemic infants generally had lower concentrations
of alternative fuels through either reduced availability or increased
consumption. SGA and post term infants increased counter regulatory
ketogenesis with early neonatal hypoglycaemia, but hypothermia, male
gender, and low infant T4 were associated with impaired counter
regulation after birth.
Keywords: hypoglycaemia; Nepal; nutrition
© 2000 by Archives of Disease in Childhood
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