What are the barriers preventing the screening and management of neonatal hypoglycaemia in low-resource settings, and how can they be overcome?

Maternal Health, Neonatology and Perinatology

Review

Lauren M Irvine¹  Deborah L Harris² 

[1] School of Nursing, Midwifery, and Health Practice, Faculty of Health, Victoria University of Wellington – Te Herenga Waka, Deborah Harris Level 7, Clinical Services Block, Wellington Regional Hospital, 6021, Newtown, Wellington, New Zealand;School of Nursing, Midwifery, and Health Practice, Faculty of Health, Victoria University of Wellington – Te Herenga Waka, Deborah Harris Level 7, Clinical Services Block, Wellington Regional Hospital, 6021, Newtown, Wellington, New Zealand;Liggins Institute, University of Auckland, Auckland, New Zealand;

关键词: Health equity;    Newborn;    Blood glucose monitoring;    Dextrose gel;    Developing nations;    Neonatal care;   

DOI  :  10.1186/s40748-023-00162-4

 received in 2023-02-20, accepted in 2023-05-23,  发布年份 2023

来源: Springer

【 摘 要 】

Over 25 years ago, the World Health Organization (WHO) acknowledged the importance of effective prevention, detection and treatment of neonatal hypoglycaemia, and declared it to be a global priority. Neonatal hypoglycaemia is common, linked to poor neurosensory outcomes and, if untreated, can cause seizures and death. Neonatal mortality in low and lower-middle income countries constitutes an estimated 89% of overall neonatal deaths. Factors contributing to high mortality rates include malnutrition, infectious diseases, poor maternal wellbeing and resource constraints on both equipment and staff, leading to delayed diagnosis and treatment. The incidence of neonatal hypoglycaemia in low and lower-middle income countries remains unclear, as data are not collected.Data from high-resource settings shows that half of all at-risk babies will develop hypoglycaemia, using accepted clinical thresholds for treatment. Most at-risk babies are screened and treated, with treatment aiming to increase blood glucose concentration and, therefore, available cerebral fuel. The introduction of buccal dextrose gel as a first-line treatment for neonatal hypoglycaemia has changed the care of millions of babies and families in high-resource settings. Dextrose gel has now also been shown to prevent neonatal hypoglycaemia.In low and lower-middle income countries, there are considerable barriers to resources which prevent access to reliable blood glucose screening, diagnosis, and treatment, leading to inequitable health outcomes when compared with developed countries. Babies born in low-resource settings do not have access to basic health care and are more likely to suffer from unrecognised neonatal hypoglycaemia, which contributes to the burden of neurosensory delay and death.

【 授权许可】

CC BY   
© The Author(s) 2023