TITLE:
Metabolic Emergencies in Newborns in a Subsaharian Neonatology Department: Evaluation of Glucose, Sodium and Potassium Disorders
AUTHORS:
Ndèye Fatou Sow, Amadou Sow, Mame Aita Seck, Yaay Joor Dieng, Djeneba Fafa Cissé, Papa Moctar Faye, Ndèye Ramatoulaye Diagne, Ousmane Ndiaye
KEYWORDS:
Metabolic Disorders, Newborn, Hypoglycemia, Hyperkalaemia, Hyperglyce-mia, Hypernatremia
JOURNAL NAME:
Open Journal of Pediatrics,
Vol.12 No.1,
March
28,
2022
ABSTRACT: Introduction: Metabolic neonatal adaptation is a complex phenomenon and metabolic
disorders can be frequent in immature newborns or in life-threatening
situations. In Low and Middle income countries (LMIC) the difficult access to some diagnostic tests makes the management of
the metabolic emergencies challenging. The main objectives of this study
were to assess the frequency and circumstances of occurrence and to describe
the clinical picture associated with glucose, sodium and potassium disorders in
neonates. Patients and Methods: Our study was a retrospective and
descriptive study conducted in the neonatology unit of National Children
Hospital Albert Royer in Dakar (Senegal) from January 1 to December 31, 2014. Results: The prevalence of the studied metabolic disorders was 46.7%. The most common metabolic
disorder noted was Hyperglycemia followed by Hyponatremia. Thermoregulation
disturbances were found particularly in newborns with serum sodium disorders (hyponatremia
33.5% and hypernatremia 59.7%). Neurological signs were noted in case of blood
sugar abnormalities (hypoglycemia 26.1% and hyperglycemia 29.8%). Half of the
newborns with hyperglycemia (82 cases/50%) had blood sugar levels greater than
or equal to 2 g/l. Hypernatremia was severe (Serum sodium> 180 mmol/l) in 12
neonates (16.7%). The main diagnoses retained were sepsis (159 cases/45.4%),
prematurity (96 cases/27.4%), intrauterine growth retardation (66 cases/18.9%),
malformations (63 cases/18%), perinatal asphyxia (44 cases/12.6%) and
malnutrition (36 cases/10.3%). For most metabolic disorders, the correction was
late and was done beyond 48 hours. On average, the correction time varied
between 3 hours and 6 days. The most frequent complications were cerebral edema
(12 cases), brain death (8 cases) and increased intracranial pressure (3
cases). The most lethal disorders were Hyperkalemia followed by Hyperglycemia. Conclusion: Metabolic disorders especially glucose, sodium and potassium disorders are
common in newborns. They are medical emergencies that can lead to vital
instability and death. Their management is challenging in low-income countries
due to the lack of adapted facilities and means to diagnose them. It is
therefore important to improve the availability of technical methods and means of biological analysis in hospital
laboratories and to monitor closely all newborns for early diagnosis of these
disorders.