#47 Small for gestational age infants at risk for prolonged hypoglycemia

PURPOSE: Hypoglycemia is a common problem in the small for gestational age (SGA) infant. Infants with hypoglycemia beyond the first few days of life may be at increased risk for adverse outcome. This group of infants is not well described. The aim of this study is to determine the incidence and duration of prolonged hypoglycemia in a population of SGA infants and to identify risk factors for the development of prolonged hypoglycemia. METHODS: A retrospective cohort of SGA infants (BW less-than-or-equals, slant10th %tile ) at the Hospital of the University of Pennsylvania. Infants with hypoglycemia (blood glucose less-than-or-equals, slant 40 mg/dl) at greater-or-equal, slanted 72 days of life were identified. A case-control study nested within the cohort was used to define infant and maternal risk factors for the occurrence of prolonged episodes of hypoglycemia. Infants were matched on gestational age. Multivariable analysis was used for risk factor identification. RESULTS: 249 infants met the criteria for inclusion in the study. The incidence of prolonged hypoglycemia was 8%. Eleven cases were born at <36 weeks gestation (27 4/7–34 4/7 weeks) and nine cases at greater-or-equal, slanted36 weeks (36–41 4/7). The median age when episodes ceased was 40 days (range = 7–110) and 11.5 days (4–28), respectively. Multivariable analysis identified severe growth retardation (BW less-than-or-equals, slant3rd %tile vs. 3–10th %tile) and infant thrombocytopenia (platelet count <100K within the first 24 hrs of life) as significant risks factors; OR = 5.8 (95% CI 1.6–21.3) and 5.3 (95% CI 1.2–23.9), respectively. CONCLUSION: We conclude the incidence of prolonged hypoglycemia in this population of SGA infants is clinically significant. Infants with the most severe growth retardation and early thrombocytopenia are at increased risk. Early identification of these infants will optimize monitoring and therapy potentially resulting in fewer episodes of hypoglycemia.