Analysis of blood glucose changes and nursing countermeasures in 24 hours after birth of the neonates delivered by mothers with gestation diabetes

doi:10.3761/j.issn.0254-1769.2020.10.008

Abstract

Abstract:

Objective To explore the trend and associated influencing factors of blood glucose in 24 hours after birth of the neonates delivered by gestation diabetes mellitus（GDM） mothers. Methods Mothers with a single birth and diagnosed with GDM during the pregnancy were enrolled from December 2017 to September 2018 in a tertiary women’s hospital in Hangzhou. Baseline data of the parturient women and neonates and blood glucose of the neonates at 3 h,6 h,12 h and 24 h after birth were collected. Results A total of 884 cases of GDM neonates were enrolled. Hypoglycemia occurred in 4 cases at 3 h and 6 h after birth respectively and no hypoglycemia occurred at 12 h and 24 h after birth. Besides,30 cases（3.39%）,19 cases（2.17%）,7 cases（0.81%）,7 cases（0.81%） of critical hypoglycemia（excluding repetitive critical hypoglycemia） occurred at 3 h,6 h,12 h and 24 h after birth,respectively. The incidence of critical hypoglycemia at 3 h was statistically associated with the mode of delivery（OR=3.834）,lactation volume （OR=7.006） and neonatal gender （OR=4.014）（P<0.05）. Lactation deficiency was the major risk factor of critical hypoglycemia at each time point（P<0.05）. Conclusion The incidence of hypoglycemia and critical hypoglycemia of rooming-in GDM neonates decreased gradually within 24 hours after birth. The blood glucose in GDM neonates at different time points was affected by multiple factors. Delivery mode,lactation volume,and gender were independent factors affecting critical hypoglycemia in GDM neonates at 3 h after birth. The implication for clinical practice was that hierarchical and targeted management should be conducted in caring rooming-in GDM neonates.

Key words: Gestational Diabetes Mellitus, Blood Glucose, Rooming-In, Neonatal Nursing Care

摘要：

目的探讨妊娠期糖尿病（gestation diabetes mellitus,GDM）产妇分娩的新生儿出生后24 h内母婴同室期间血糖变化规律及影响因素,并提出护理对策。方法回顾性收集2017年12月—2018年9月入住杭州市某三级甲等妇产科医院的884对GDM产妇的一般资料及分娩新生儿的一般资料和出生后3 h、6 h、12 h、24 h的血糖值,并对其影响因素进行相关性分析。结果新生儿出生后3 h、6 h发生低血糖各4例（0.45%）,12 h、24 h无低血糖发生;3 h、6 h、12 h、24 h发生临界低血糖（不包含重复发生者）各30例（3.39%）、19例（2.17%）、7例（0.81%）和7例（0.81%）。产妇分娩方式（OR=3.834）、泌乳量（OR=7.006）及新生儿性别（OR=4.014）是新生儿出生后3 h发生临界低血糖的影响因素（P<0.05）;产妇泌乳量是各时点发生临界低血糖的影响因素（P<0.05）。结论 GDM产妇分娩的新生儿出生后24 h低血糖、临界低血糖的发生率随时间的延长逐渐降低。多种因素影响新生儿各时间点血糖的变化,择期剖宫产、母乳不足和男性新生儿是新生儿出生后3 h发生临界低血糖的独立影响因素。在临床护理工作中,对GDM产妇分娩的新生儿出生后24 h内母婴同室期间应进行分层、针对性的血糖观察和管理。

关键词: 妊娠期糖尿病, 血糖, 母婴同室, 新生儿护理

FAN Tingting,FENG Suwen,JIN Ying,CHEN Danqing. Analysis of blood glucose changes and nursing countermeasures in 24 hours after birth of the neonates delivered by mothers with gestation diabetes[J]. Chinese Journal of Nursing, 2020, 55(10): 1490-1496.

范婷婷,冯素文,金颖,陈丹青. 妊娠期糖尿病产妇分娩的新生儿出生后24小时内血糖变化规律与护理对策[J]. 中华护理杂志, 2020, 55(10): 1490-1496.

Figures/Tables 2

References 25

[1]	Committee on Fetus and Newborn, Adamkin DH. Postnatal glucose homeostasis in late-preterm and term infants[J]. Pediatrics, 2011,127(3):575-579. DOI URL
[2]	Thornton PS, Stanley CA, De Leon DD, et al. Recommendations from the pediatric endocrine society for evaluation and management of persistent hypoglycemia in neonates,infants,and children[J]. J Pediatr, 2015,167(2):238-245. DOI URL PMID
[3]	Puchalski ML, Russell TL, Karlsen KA. Neonatal hypoglycemia:is there a sweet spot?[J]. Crit Care Nurs Clin North Am, 2018,30(4):467-480. DOI URL PMID
[4]	黄欣欣, 江秀敏, 林艳, 等. 妊娠期糖尿病母亲的新生儿出生48小时内血糖的动态变化及低血糖的影响因素[J]. 中国循证儿科杂志, 2017,12(5):342-346.
	Huang XX, Jiang XM, Lin Y, et al. Dynamic changes of blood glucose in newborns with gestational diabetes mellitus within 48 hours after birth and the influencing factors of hypoglycemia[J]. Chin J Evid Based Pediatr, 2017,12(5):342-346.
[5]	陈妮娜, 马红梅. 自然分娩和剖宫产足月新生儿生后早期血糖变化[J]. 临床和实验医学杂志, 2017,16(6):596-599.
	Chen NN, Ma HM. Blood glucose in early period of full-term neonates in natural labor and cesarean section of delivery[J]. J Clin Exper Med, 2017,16(6):596-599.
[6]	王昌燕. 糖尿病母亲的新生儿早期血糖变化及低血糖的影响因素[J]. 中国妇幼健康研究, 2019,30(3):329-333.
	Wang CY. Early changes of blood glucose in infants of diabetic mothers after birth and influencing factors of hypoglycemia[J]. Chin J Woman Child Health Res, 2019,30(3):329-333.
[7]	中华医学会妇产科学分会产科学组, 围产医学分会妊娠合并糖尿病协作组. 妊娠合并糖尿病诊治指南[J]. 中华妇产科杂志, 2014,49(8):561-569.
	Obstetrics Group of Chinese Medical Association Obstetrics and Gynecology Society, Perinatal Medicine Society,Gestational Diabetes Cooperation Group. Guidelines for the Diagnosis and Treatment of Gestational Diabetes[J]. Chin J Obstet Gynecol, 2014,49(8):561-569.
[8]	WHO. Safe Motherhood:Thermal protection of the newborn:a practical guide[S]. Geneva, 1997.
[9]	邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学[M]. 4版. 北京: 人民卫生出版社, 2011: 47-222.
	Shao XM, Ye HM, Qiu XS. Practical of Neonatology[M]. 4th ed. Beijing: People’s Medical Publishing House, 2011: 47-222.
[10]	Aziz K, Dancey P, Society CP, et al. Screening guidelines for newborns at risk for low blood glucose[J]. Paediatr Child Heal, 2004,9(10):723-729.
[11]	徐景华. 不同喂养方式对糖尿病母亲新生儿血糖和体质量及胆红素的影响[J]. 中华实用诊断与治疗杂志, 2016,30(11):1141-1142.
	Xu JH. Effects of different feeding methods on blood glucose,body mass and bilirubin in newborns of diabetic mothers[J]. J Chin Pract Diagn Therapy, 2016,30(11):1141-1142.
[12]	符佩华, 田铭霞. 两种不同分娩方式对足月新生儿早期血糖的影响[J]. 中国妇幼健康研究, 2016,27(3):346-347.
	Fu PH, Tian MX. Effects of two delivery ways on early blood glucose of full-term newborn infants[J]. Chin J Woman Child Health Re, 2016,27(3):346-347.
[13]	王敏, 张璐, 石芳鑫. 新生儿低血糖的产科相关因素分析[J]. 中华妇幼临床医学杂志（电子版）, 2017,13(3):303-309.
	Wang M, Zhang L, Shi FX. Analysis of obstetric related factors of neonatal hypoglycemia[J]. Chin J Obstet Gynecol Pediatr（Electron Ed）, 2017,13(3):303-309.
[14]	Carolan M. Diabetes nurse educators’ experiences of providing care for women,with gestational diabetes mellitus,from disadvantaged backgrounds[J]. J Clin Nurs, 2014,23(9/10):1374-1384. DOI URL
[15]	金萍. 剖宫产术前不同禁食禁饮方案对妊娠期糖尿病患者母婴结局的影响[J]. 临床护理杂志, 2018,17(3):26-27.
	Jin P. Effects of different fasting and ban drinking regimens on maternal and infant outcomes in patients with gestational diabetes before cesarean section[J]. J Clin Nurs, 2018,17(3):26-27.
[16]	许佳, 赵敏. 缩短禁食禁饮时间对妊娠期糖尿病剖宫产产妇分娩结局的影响[J]. 护理学杂志, 2019,34(5):29-31.
	Xu J, Zhao M. Effect of shortened fasting time before caesarean section on delivery outcomes of women with gestational diabetes mellitus[J]. J Nurs Sci, 2019,34(5):29-31.
[17]	陈昌辉, 李茂军, 吴青, 等. 美国儿科学会胎儿和新生儿委员会《新生儿低血糖症筛查和后续管理指南(2011年版)》解读[J]. 实用医院临床杂志, 2011,8(6):70-72.
	Chen CH, Li MJ, Wu Q, et al. Interpretation of Practical Guide and Algorithm for the Screening and Subsequent Management of Neonatal Hypoglycemia formulated by the American Academy of Pediatrics Committee on Fetus and Newborn[J]. Pract J Clin Med, 2011,8(6):70-72.
[18]	Harding JE, Harris DL, Hegarty JE, et al. An emerging evidence base for the management of neonatal hypoglycaemia[J]. Early Hum Dev, 2017,104:51-56. DOI URL PMID
[19]	章孟星, 周英凤, 钟婕, 等. 妊娠期糖尿病临床护理实践指南的整合研究[J]. 中华护理杂志, 2019,54(1):104-113.
	Zhang MX, Zhou YF, Zhong J, et al. The adaptation of clinical nursing practice guideline for gestational diabetes mellitus[J]. Chin J Nurs, 2019,54(1):104-113.
[20]	Tundidor D, García-Patterson A, María MA, et al. Perinatal maternal and neonatal outcomes in women with gestational diabetes mellitus according to fetal sex[J]. Gend Med, 2012,9(6):411-417. DOI URL PMID
[21]	Wilkin TJ, Voss LD, Metcalf BS, et al. Metabolic risk in early childhood:the Early Bird Study[J]. Int J Obes Relat Metab Disord, 2004,28(Suppl 3):S64-S69. DOI URL
[22]	Tundidor D, García-Patterson A, María MA, et al. Perinatal maternal and neonatal outcomes in women with gestational diabetes mellitus according to fetal sex[J]. Gend Med, 2012,9(6):411-417. DOI URL PMID
[23]	张燕, 杜明钰, 王明芳, 等. 新生儿性别对妊娠期糖尿病人群妊娠结局的影响[J]. 实用妇产科杂志, 2019,35(5):385-389.
	Zhang Y Du MY Wang MF, et al. The Relationship between fetal genders and maternal-fetal pregnancy outcomes in gestational diabetes mellitus[J]. J Pract Obstetrics Gynecol, 2019,35(5):385-389.
[24]	梁福兵. 新生儿总胆红素水平对血糖和血脂代谢的影响[J]. 中国急救医学, 2017,37(z2):31-32.
	Liang FB. Effect of total bilirubin level on blood glucose and lipid metabolism in neonates[J]. Chin J Crit Care Med, 2017,37(z2):31-32.
[25]	蔡春连, 熊丽娜, 王燕, 等. 体位更换对新生儿高胆红素血症光疗效果的meta分析[J]. 中华护理杂志, 2015,50(12):1432-1437.
	Cai CL, Xiong LN, Wang Y, et al. Effects of the position changing phototherapy on newborn infant with hyperbilirubinemia:a meta-analysis[J]. Chin J Nurs, 2015,50(12):1432-1437.