Journal Reading English

7/24/2019 Journal Reading English

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Oleh : Raisa Janet Ariestha ( I 111 09 041)

Pembimbing : dr. Sumardi F. Simanunta!" S#.A

J$urnal Reading

%e#aniteraan %lini! Ilmu %esehatan Ana!

Fa!ultas %ed$!teran

&ni'ersitas anung#ura

RS& $!ter Abdul A*is

Sing!a+ang,01-



• e$natal h/#$gl/emia () is $mm$n$nditi$n in2uened in ne+b$rn b/ 3at$rs li!ebirth +eight" gestati$nal age" #erinatal

$m#liati$ns" m$de $3 deli'er/ and 3eedingbeha'i$ur1","

• he stated inidene is estimated at 1 t$ - #er1000 births" but it is signi5antl/ higher in

ertain subgr$u#s" 67 in 8A (large 3$rgestati$nal age) in3ants and ab$ut 1-7 in SA(small 3$r gestati$nal age) in3ants (i.e" th$se+ith intrauterine gr$+th retardati$n),

Intr$duti$n



• /#$gl/emia in ne$nates an bes/m#t$mati $r as/m#t$mati.

•

he m$st $mm$n s/m#t$ms suh as$n'ulsi$n" a#ath/" h/#$t$nia" $ma"re3usal t$ 3eeds" /an$sis" high #itedr/" and h/#$thermia are 'er/

n$ns#ei5 and es#eiall/ in small si!ne$nates" these s/m#t$ms ma/ be easil/missed4"-"

Intr$duti$n



• an be easil/ treated in m$st ases i3 it isre$gni*ed" but untreated h/#$gl/emia an ha'eseri$us $nse;uenes 3$r the in3ant as glu$se is the

ma$r substrate 3$r energ/ in all $rgans and alm$ste<lusi'el/ used 3$r erebral metab$lism=

• /#$gl/emia is !n$+n t$ be ass$iated +ith braind/s3unti$n and neur$m$t$r de'el$#mentalretardati$n in b$th s/m#t$mati and as/m#t$mati

ases6 • ene this stud/ +as #lanned t$ e'aluate inidene"

eti$l$g/" linial 3eatures and $ut$me $3 .

Intr$duti$n



• his #r$s#eti'e stud/ +as $nduted in #ediatrisde#artment in tertiar/ are entre 3r$m Jan ,01, t$

June ,01.

•

All ne$nates b$rn at this h$s#ital either b/ 'aginal $r8S>S deli'er/ during stud/ #eri$d +ere inluded andth$se b$rn $utside +ere e<luded.

• Out $3 6000 ne$nates deli'ered" 400 ne$nates +ereadmitted and sreened 3$r h/#$gl/emia at

0"""1,",4"46 and =, hr $3 li3e irres#eti'e $3gestati$nal age +ith $#erati$nal thresh$ld 3$rh/#$gl/emia $3 bl$$d glu$se le'el ? 40 mg@dl3$rmed the stud/ gr$u#.

aterial and eth$ds



• A detailed antenatal" natal and #$stnatal hist$r/ $3 allases +as ta!en.

• he ris! 3at$rs li!e $nsanguinit/" unregistered@

unb$$!ed #regnanies" diabetes" t$<emia" #rematureru#ture $3 membrane" maternal 3e'er" d/suria"ante#artum hem$rrhage(AP)" m$de $3 deli'er/" t/#e$3 deli'er/" me$nium stained li;u$r +ere re$rded.

• he details $3 ases +ere re$rded in a #redesigned

and #retested #r$3$rma.• lu$meter +as used 3$r measuring the bl$$d glu$se

le'els. lu$meter +as AuB>he! Per3$rma made b/R$he diagn$stis" annheim" erman/.

aterial and eth$ds



• Out $3 6000 ne$nates deli'ered in $urinstitute" 400 ne$nates +ere admitted inS>& and #ediatris +ards" $ut $3 +hih10 ne$nates +ere deteted t$ ha'eh/#$gl/emia.

• he $'erall inidene $3 in #resent

stud/ +as 1.,-@1000 li'e births.

Obser'ati$n and Result



•

able 1 sh$+s" $ut $3 10 ne$nates" (,.,7) l$+ birth +eight (?,-00 gm)ne$nates had h/#$gl/emia and 40(=.=7) ne$nates +ith h/#$gl/emia

+ere +eighing C ,-00 grams. hus theh/#$gl/emia +as $mm$n in l$+ birth+eight ne$nates (?,-00gm) $m#aredt$ ne$nates +eighing C,-00gm.



• able , sh$+s" $ut $3 10 ne$nates" =4(9.67) ne$nates +ere #reterm" 1,ne$nates (11.,7) +ere term and ,0

(16.67) ne$nates +ere #$st term. hush/#$gl/emia +as m$re $mm$n in#reterm ne$nates 3$ll$+ed b/ #$st termand term ne$nates.



• able sh$+s that the m$st $mm$nantenatal ris! 3at$rs ass$iated +ithne$natal h/#$gl/emia +ere diabetes in

16 (7) m$thers" t$<emia in 1, (,47)m$thers" PRO in 6 (17) m$thers" 3e'erin (1,7) m$thers" d/suria in 4 (67)and AP in , (47) m$thers.



• he m$st $mm$n ne$natal ris! 3at$rass$iated +ith h/#$gl/emia +as birthas#h/<ia in 4 (4.97) ne$nates

3$ll$+ed b/ RS in 1(,9.,47) ne$nates"se#tiemia in ,0 (16.67) ne$nates andmeningitis in 9 (6.497) ne$nates assh$+n in table 4.



• able - and sh$+s" $ut $3 10 ne$nates

+ith h/#$gl/emia" -0 (4=.1=7) +eres/m#t$mati and - (-,.67) ne$nates +ereas/m#t$mati and the m$st $mm$ns/m#t$m ass$iated +ith ne$natal

h/#$gl/emia +as letharg/ in , (47)ne$nates 3$ll$+ed b/ itteriness in ,4 (467)ne$nates" res#irat$r/ abn$rmalities in 1(,7) ne$nates" sei*ure in 1- (07)

ne$nates and h/#$t$nia in 6 (17) ne$nates.





• able = sh$+s that the m$st $mm$n auses$3 ne$natal deaths +ere birth as#h/<ia in 9(4=.=7) ne$nates" RS in 4 (,1.0-7)ne$nates" se#tiemia in (1-.=97) ne$nates

and meningitis in (1-.=97) ne$nates.e$natal m$rtalit/ +as 1=.97 in #resentstud/ in ne$nates +ith h/#$gl/emia.



• In #resent stud/" $ut $3 10 ne$nates +ith h/#$gl/emia (,.,7) ne$nates+ere l$+ birth +eight (?,.-!g) and 40 (=.=7) ne$nates +ere ab$'e ,.- !g.

• hus the inidene $3 +as signi5antl/ higher in l$+ birth +eight ne$nates(?,.- !g) than ne$nates +eighing C,.- !g +hih $rrelate +ith stud/ d$ne b/singhal et al (1992)9 and Dhananjaya et al (2011)10 which state that prematurityand low birth weight increase the risk of hypoglycemia in neonates.

• ubchenco et al (19!1)11 in his study reported 20."# incidence of hypoglycemiain low birth weight or premature infants.

• $n our study we obser%ed that out of 10& neonates with hypoglycemia' !(&9.1#) neonates were ha%ing gestational age *"! weeks' !1 (11."2#) neonateswere ha%ing gestational age "!+2 weeks and 20 (1.&#) neonates were ha%inggestational age ,2 weeks.

•-ayiran et al (2010)12 found that there was a signicant decrease in blood glucoseconcentration for preterm' in the rst few hours of life' suggesting that they wereless able to adapt to the cessation of intrauterine nutrition compared to termneonates.

• Dhananjaya et al (2011)10 in his study found that incidence of hypoglycemia was11.9# in preterm' 2.9# in term and "0.!# in post term neonates

isussi$n



• /he small for gestational age () and pre+term neonates are at greater riskof neonatal hypoglycemia' as the fuels are directed towards growth due toinade3uate production of glucose.

• 4igh brain5 body mass ratio' limited deposits of glycogen' reduced fat stores'delayed maturation of glu$ne$genesis and h/#erinsulinism +ill 3urther

aggra'ate h/#$gl/emia1"14.• P$stBterm in3ants are als$ at ris! 3$r h/#$gl/emia beause $3 relati'e#laental insuDien/=.

• In #resent stud/ the m$st $mm$n antenatal ris! 3at$r ass$iated +ith +ere diabetes in 16 (7)" t$<emia $3 #regnan/ in 1, (,47)" PRO in 6(17)" 3e'er in (1,7)" d/suria in 4 (67) and AP in , (47) m$thers.

•

he m$st $mm$n ne$natal ris! 3at$r ass$iated +ith h/#$gl/emia +erebirth as#h/<ia in 4 (4.97)" RS in 1(,9.,47)" se#tiemia in ,0 (16.67)and meningitis in 9 (6.497) ne$nates.

• %it*miller et al (19!)16 in his study reported "0+0# of $D7s babies werehypoglycemic. inghal et al (1992)9 in his study reported 2".# of $D7s

babies were ha%ing hypoglycemia.

isussi$n



• Dhananjaya et al (2011)10 state that incidence of hypoglycemia was 0# in$D7s babies and 0# in babies with to8emia as antenatal risk factor which iscomparable with our study.

• inghal et al (1992)9 reported 2.2# neonates with birth asphy8ia' 1".9#neonates with D' and 11.&# neonates with septicemia had hypoglycemia.

• Dhananjaya et al (2011)10 in his study showed 2&.&# neonates with birthasphy8ia' 16.2# neonates with septicemia' and 16."# neonates with D hadhypoglycemia which correlates with our study.

• $D7s babies ha%e increased secretion of pancreatic insulin because of e8posureto increase maternal glucose concentrations in utero.

• :lacental glucose transport is increased' leading to fetal hyperglycemia' whichin turn stimulates secretion of insulin by the fetal pancreas.

• fter deli%ery' increased blood concentrations no longer are present' but thehyperinsulinemia persists' thus maintaining high insulin5 glucagon ratio postnatally. $n utero' hypo8ia' acidosis and alteration in fetal blood ;owmobili<es hepatic glycogen stores and increases the rate of anaerobic glycolysis'there by accelerating glucose use' hence depleting fetal glycogen stores.

isussi$n



• n increase rate of anaerobic glycolysis in combination with an increaserate of glycogenolysis probably predispose to hypoglycemia1&.

• epticemic neonates are predisposed to de%elop hypoglycemia due toinade3uate calorie intake' increased metabolic rate of gluconeogenesisand the possibility of increased peripheral utili<ation due to enhanced

insulin sensiti%ity9'10'1!.• $n present study out of 10& neonates with hypoglycemia' 60 (!.1!#) weresymptomatic and 6& (62."#) neonates were asymptomatic.

• /he most common symptom associated with =4 was lethargy in "2 (&#)neonates followed by jitteriness in 2 (#) neonates' respiratoryabnormalities in 1& ("2#) neonates' sei<ure in 16 ("0#) neonates andhypotonia in (1&#) neonates.

•

inghal et al (1992) in his study reported 69.# cases of =4 wereasymptomatic.

• /he most common symptom obser%ed was lethargy in 1.# neonates'followed by jitteriness in &!.# neonates' respiratory abn$rmalities in41.97 ne$nates and sei*ure in 0.,7 ne$nates +hih $rrelate +ith $urstud/9.

isussi$n



• asrin et al (200!) in his study found refusal of feeds in 6#neonates' irratibility in "0# neonates' cyanosis in 2.# neonates'tachypnoea in 2.6# neonates' sei<ures in 1&.&# neonates' weakcry in 16.# neonates' apnoeic spells in 9.# neonates and cardiacarrest in 9.1# neonates as major signs of hypoglycemia1.

• >.? 4aworth et al found apnoea' cyanosis' irritability' lethargy'muscular twitching' con%ulsions' poor sucking and disappearance ofgrasp and other re;e8es as the major signs of hypoglycemia1!.

• =eonatal mortality was 1!.9# in present study in neonates withhypoglycemia.

•

/he most common causes of neonatal deaths were birth asphy8ia in9 (!."!#) neonates' D in (21.06#) neonates' septicemia in "(16.!9#) neonates and meningitis in " (16.!9#) neonatesassociated with =4.

isussi$n



• is a $mm$n #r$blem +hih an be #re'ented i3 inter'ine earl/. +as m$st $mm$nl/ ass$iated needed l$+ birth +eight"#rematurit/ and #$stmaturit/. RS and se#sis a$mm$date asm$st $mm$n ne$natal ris! 3at$r and babies $3 diabeti m$therand elam#sia 3$rmed m$st $mm$n antenatal ris! 3at$r 3$r .e$natal m$rtalit/ +as 1=.97 in #resent stud/ in ne$nates +ithh/#$gl/emia. ene ab$'e ateg$ries $3 ne$nates (igh ris!ne$nates) re;uires an aggressi'e bl$$d sugar m$nit$ring andmanagement +hih an redue ne$natal m$rtalit/ andneur$l$gial se;uelae in later li3e. In #resent stud/" m$re than hal3$3 ne$nates +ith h/#$gl/emia +ere as/m#t$mati and the m$st$mm$n s/m#t$m in $bser'ed +as letharg/" itteriness"res#irat$r/ abn$rmalities" h/#$t$nia" and sei*ure. hus high ris!ne$nates sh$uld be sreened 3$r h/#$gl/emia irres#eti'e $3s/m#t$ms +ithin =, hrs $3 li3e.

>$nlusi$n



han!/$u

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