Abnormal blood glucose concentrations on admission to a rural Kenyan district hospital: prevalence and outcome
Abnormal blood glucose concentrations on admission to a rural Kenyan district hospital: prevalence and outcome
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DOI：
10.1136/adc.88.7.621
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发表时间：
2003-07-01
影响因子：
5.2
通讯作者：
Newton, CRJC
中科院分区：
文献类型：
--
作者：
Osier, FHA;Berkley, JA;Newton, CRJC
目的：确定低血糖的患病率，临床特征和结果入院儿童在肯尼亚农村地区hospital.Methods：3742名儿童（包括280名新生儿）在基利菲区医院，肯尼亚的观察性研究。主要结局指标：低血糖（血糖< 2.2 mmol/l）和高血糖（血糖> 10.0 mmol/l）。严重疾病、营养不良、最后一餐> 12小时前和疟疾玻片阳性与低血糖独立相关。总体而言，低血糖儿童的死亡率为20.2%，而血糖正常儿童的死亡率为3.8%（p < 0.001）。低血糖儿童的死亡率主要由那些患有严重疾病或营养不良的儿童（31.8%）承担，而不是那些既不严重也不营养不良的儿童（9.0%）。新生儿：23.0%的新生儿入院时发生低血糖。不能母乳喂养和体重< 2500 g与低血糖独立相关。死亡率为45.2%，而正常血糖新生儿为19.6%（p < 0.001）。2.7%的儿童存在高血磷血症，与正常血磷血症相比死亡率更高，分别为14.0%和3.8%（p < 0.001）。结论：低血磷血症在肯尼亚农村地区医院的儿童中很常见，与死亡率增加有关。除了严重疾病和喂养不良的特征外，临床体征对低血糖的敏感性和特异性较低。在缺乏诊断设施的地方，建议对重病儿童进行推定治疗。对于其他儿童，继续喂养（必要时通过鼻胃管）应成为标准管理的一部分。
Aims: To determine the prevalence, clinical characteristics, and outcome of hypoglycaemia on admission in children at a rural Kenyan district hospital.Methods: Observational study of 3742 children ( including 280 neonates) in Kilifi District Hospital, Kenya. Main outcome measures: hypoglycaemia ( blood glucose < 2.2 mmol/l) and hyperglycaemia ( blood glucose > 10.0 mmol/l).Results: Nonneonates: the prevalence of hypoglycaemia on admission was 7.3%. Severe illness, malnutrition, last meal > 12 hours ago, and a positive malaria slide were independently associated with hypoglycaemia. Overall, mortality in hypoglycaemic children was 20.2% compared to 3.8% in normoglycaemic children ( p < 0.001). The brunt of mortality in hypoglycaemic children was borne by those who were severely ill or malnourished (31.8%) as opposed to those who were neither severely ill nor malnourished (9.0%). Neonates: 23.0% of neonates were hypoglycaemic on admission. Inability to breast feed and weight < 2500 g were independently associated with hypoglycaemia. Mortality was 45.2% compared to 19.6% in normoglycaemic neonates ( p < 0.001). Hyperglycaemia was present in 2.7% of children and was associated with a higher mortality than normoglycaemia, 14.0% versus 3.8% respectively ( p < 0.001).Conclusions: Hypoglycaemia is common in children admitted to a rural Kenyan district hospital and is associated with an increased mortality. Apart from features of severe illness and poor feeding, clinical signs have a low sensitivity and specificity for hypoglycaemia. Where diagnostic facilities are lacking, presumptive treatment of severely ill children is recommended. For other children, the continuation of feeding ( by nasogastric tube if necessary) should be part of standard management.