背景:新生儿低血糖很常见,占新生儿重症监护病房(NICU)入院的4.0-5.8%。子宫内尼古丁暴露不足是新生儿低血糖的潜在原因。大鼠模型表明,子宫内尼古丁暴露可能与胰腺β细胞质量的减少有关,导致葡萄糖失调.这项工作的主要目的是研究子宫内尼古丁暴露的新生儿出生后发生低血糖的风险。
方法:我们进行了一项回顾性配对队列研究,该研究增加了一个现有的新生儿数据集,该数据集包括以家庭为基础的子宫内尼古丁暴露(N=335)。对照组的新生儿父母否认家庭吸烟(N=325),出生在6个月的时间内,出生体重在50克尼古丁暴露的新生儿内。审查的数据包括胎龄,生长参数,母亲有糖尿病史,和每单位方案生命的前三个小时内的葡萄糖水平。
结果:660例新生儿被纳入分析。子宫内尼古丁暴露显示94.3%的后验概率(PP)为更大的低血糖风险(RR=1.185,95%CrI=[0.953,1.445])。当新生儿小于胎龄时,表现出94.6%的PP,宫内生长受限,和糖尿病母亲出生的被排除在外(n=482;RR=1.271,95%CrI=[0.946,1.669]).
结论:发现子宫内尼古丁暴露是出生后发生低血糖的潜在危险因素。应探索行动机制,和额外的研究在子宫内尼古丁暴露的风险应该遵循。
BACKGROUND: Hypoglycemia in neonates is common and contributes to 4.0-5.8% of neonatal intensive care unit (NICU) admissions. In utero nicotine exposure is underexplored as a potential contributor to neonatal hypoglycemia. Rat models have shown that in utero nicotine exposure can be associated with a reduction in pancreatic beta cell mass, leading to glucose dysregulation. The primary aim of this work is to study the risk of developing hypoglycemia after birth in a population of in utero nicotine-exposed neonates.
METHODS: We conducted a retrospective matched cohort study that augmented an existing dataset of neonates admitted to a level IV NICU with household-based in utero nicotine exposure (N = 335). Neonates in the control group parents denied household smoking (N = 325), were born within a 6-month timeframe, and were within a birthweight of 50 grams of a nicotine-exposed neonate. Data reviewed included gestational age, growth parameters, maternal history of diabetes, and glucose levels within the first three hours of life per unit protocol.
RESULTS: 660 neonates were included in the analysis. In utero nicotine exposure demonstrated a 94.3% posterior probability (PP) for greater hypoglycemia risk (RR = 1.185, 95% CrI = [0.953, 1.445]). A 94.6% PP was demonstrated when neonates who were small for gestational age, intrauterine growth-restricted, and born to diabetic mothers were excluded (n = 482; RR = 1.271, 95% CrI = [0.946, 1.669]).
CONCLUSIONS: Nicotine exposure in utero was found to be a potential risk factor for developing hypoglycemia after birth. Mechanisms of action should be explored, and additional research on in utero nicotine exposure risks should follow.