Hirshberg E, Larsen G, Van Duker H, 2008. Alterations in glucose homeostasis in the pediatric intensive care unit: hyperglycemia and glucose variability are associated with increased mortality and morbidity. Pediatr Crit Care Med 9: 361–366.
Faustino EV, Hirshberg EL, Bogue CW, 2012. Hypoglycemia in critically ill children. J Diabetes Sci Technol 6: 48–57.
Ognibene KL, Vawdrey DK, Biagas KV, 2011. The association of age, illness severity, and glycemic status in a pediatric intensive care unit. Pediatr Crit Care Med 12: e386–e390.
Zijlmans WC, van Kempen AA, Serlie MJ, Kager PA, Sauerwein HP, 2013. Adaptation of glucose metabolism to fasting in young children with infectious diseases: a perspective. J Pediatr Endocrinol Metab 27: 5–13.
Kraft R, Herndon DN, Mlcak RP, Finnerty CC, Cox RA, Williams FN, Jeschke MG, 2014. Bacterial respiratory tract infections are promoted by systemic hyperglycemia after severe burn injury in pediatric patients. Burns 40: 428–435.
Hirata Y, Tomioka H, Sekiya R, Yamashita S, Kaneda T, Kida Y, Nishio C, Kaneko M, Fujii H, Nakamura T, 2013. Association of hyperglycemia on admission and during hospitalization with mortality in diabetic patients admitted for pneumonia. Intern Med 52: 2431–2438.
Osier FH, Berkley JA, Ross A, Sanderson F, Mohammed S, Newton CR, 2003. Abnormal blood glucose concentrations on admission to a rural Kenyan district hospital: prevalence and outcome. Arch Dis Child 88: 621–625.
Sambany E, Pussard E, Rajaonarivo C, Raobijaona H, Barennes H, 2013. Childhood dysglycemia: prevalence and outcome in a referral hospital. PLoS One 8: e65193.
Faustino EV, Apkon M, 2005. Persistent hyperglycemia in critically ill children. J Pediatr 146: 30–34.
Bhutia TD, Lodha R, Kabra SK, 2013. Abnormalities in glucose homeostasis in critically ill children. Pediatr Crit Care Med 14: e16–e25.
World Health Organization, 2013. Pocket Book for Hospital Care of Children: Guidelines for the Management of Common Illness with Limited Resources, 2nd edition. Geneva, Switzerland: World Health Organization.
Nadjm B, Mtove G, Amos B, Hildenwall H, Najjuka A, Mtei F, Todd J, Reyburn H, 2013. Blood glucose as a predictor of mortality in children admitted to the hospital with febrile illness in Tanzania. Am J Trop Med Hyg 89: 232–237.
Nhampossa T, Sigauque B, Machevo S, Macete E, Alonso P, Bassat Q, Menendez C, Fumado V, 2013. Severe malnutrition among children under the age of 5 years admitted to a rural district hospital in southern Mozambique. Public Health Nutr 16: 1565–1574.
Houin S, Rozance PJ, 2014. 50 years ago in the Journal of Pediatrics: the incidence of neonatal hypoglycemia in a nursery for premature infants. J Pediatr 164: 1485.
Harris DL, Weston PJ, Signal M, Chase JG, Harding JE, 2013. Dextrose gel for neonatal hypoglycaemia (the Sugar Babies Study): a randomised, double-blind, placebo-controlled trial. Lancet 382: 2077–2083.
Pisarchik AN, Pochepen ON, Pisarchyk LA, 2012. Increasing blood glucose variability is a precursor of sepsis and mortality in burned patients. PLoS One 7: e46582.
Badawi O, Waite MD, Fuhrman SA, Zuckerman IH, 2012. Association between intensive care unit-acquired dysglycemia and in-hospital mortality. Crit Care Med 40: 3180–3188.
Sigauque B, Roca A, Mandomando I, Morais L, Quinto L, Sacarlal J, Macete E, Nhamposa T, Machevo S, Aide P, Bassat Q, Bardaji A, Nhalungo D, Soriano-Gabarro M, Flannery B, Menendez C, Levine MM, Alonso PL, 2009. Community-acquired bacteremia among children admitted to a rural hospital in Mozambique. Pediatr Infect Dis J 28: 108–113.
Ikeda T, Takahashi T, Sato A, Tanaka H, Igarashi S, Fujita N, Kuwabara T, Kanazawa M, Nishizawa M, Shimohata T, 2013. Predictors of outcome in hypoglycemic encephalopathy. Diabetes Res Clin Pract 101: 159–163.
Fong CY, Harvey AS, 2014. Variable outcome for epilepsy after neonatal hypoglycaemia. Dev Med Child Neurol 56: 1093–1099.
Sacarlal J, Nhacolo AQ, Sigauque B, Nhalungo DA, Abacassamo F, Sacoor CN, Aide P, Machevo S, Nhampossa T, Macete EV, Bassat Q, David C, Bardaji A, Letang E, Saute F, Aponte JJ, Thompson R, Alonso PL, 2009. A 10 year study of the cause of death in children under 15 years in Manhica, Mozambique. BMC Public Health 9: 67.
Gonzalez R, Munguambe K, Aponte J, Bavo C, Nhalungo D, Macete E, Alonso P, Menendez C, Naniche D, 2012. High HIV prevalence in a southern semi-rural area of Mozambique: a community-based survey. HIV Med 13: 581–588.
Sacoor C, Nhacolo A, Nhalungo D, Aponte JJ, Bassat Q, Augusto O, Mandomando I, Sacarlal J, Lauchande N, Sigauque B, Alonso P, Macete E, Munguambe K, Guinovart C, Aide P, Menendez C, Acacio S, Quelhas D, Sevene E, Nhampossa T, 2013. Profile: Manhica Health Research Centre (Manhica HDSS). Int J Epidemiol 42: 1309–1318.
Bassat Q, Guinovart C, Sigauque B, Aide P, Sacarlal J, Nhampossa T, Bardaji A, Nhacolo A, Macete E, Mandomando I, Aponte JJ, Menendez C, Alonso PL, 2008. Malaria in rural Mozambique. Part II: children admitted to hospital. Malar J 7: 37.
Bassat Q, Guinovart C, Sigauque B, Mandomando I, Aide P, Sacarlal J, Nhampossa T, Bardaji A, Morais L, Machevo S, Letang E, Macete E, Aponte JJ, Roca A, Menendez C, Alonso PL, 2009. Severe malaria and concomitant bacteraemia in children admitted to a rural Mozambican hospital. Trop Med Int Health 14: 1011–1019.
Grummer-Strawn LM, Reinold C, Krebs NF, 2010. Use of World Health Organization and CDC growth charts for children aged 0–59 months in the United States. MMWR Recomm Rep 59: 1–15.
Sullivan GM, Feinn R, 2012. Using effect size—or why the P value is not enough. J Grad Med Educ 4: 279–282.
Solomon T, Felix JM, Samuel M, Dengo GA, Saldanha RA, Schapira A, Phillips RE, 1994. Hypoglycaemia in paediatric admissions in Mozambique. Lancet 343: 149–150.
Elusiyan JB, Adejuyigbe EA, Adeodu OO, 2006. Hypoglycaemia in a Nigerian paediatric emergency ward. J Trop Pediatr 52: 96–102.
Graz B, Dicko M, Willcox ML, Lambert B, Falquet J, Forster M, Giani S, Diakite C, Dembele EM, Diallo D, Barennes H, 2008. Sublingual sugar for hypoglycaemia in children with severe malaria: a pilot clinical study. Malar J 7: 242.
Krinsley JS, 2013. Glycemic control in the critically ill—3 domains and diabetic status means one size does not fit all! Crit Care 17: 131.
Rattarasarn C, 1997. Hypoglycemia in sepsis: risk factors and clinical characteristics. J Med Assoc Thai 80: 760–766.
Branco RG, Chavan A, Tasker RC, 2009. Pilot evaluation of continuous subcutaneous glucose monitoring in children with multiple organ dysfunction syndrome. Pediatr Crit Care Med 11: 415–419.
Bridges BC, Preissig CM, Maher KO, Rigby MR, 2010. Continuous glucose monitors prove highly accurate in critically ill children. Crit Care 14: R176.
Thien HV, Kager PA, Sauerwein HP, 2006. Hypoglycemia in falciparum malaria: is fasting an unrecognized and insufficiently emphasized risk factor? Trends Parasitol 22: 410–415.
Yelich MR, Filkins JP, 1980. Mechanism of hyperinsulinemia in endotoxicosis. Am J Physiol 239: E156–E161.
White NJ, Miller KD, Marsh K, Berry CD, Turner RC, Williamson DH, Brown J, 1987. Hypoglycaemia in African children with severe malaria. Lancet 1: 708–711.
White NJ, Warrell DA, Chanthavanich P, Looareesuwan S, Warrell MJ, Krishna S, Williamson DH, Turner RC, 1983. Severe hypoglycemia and hyperinsulinemia in falciparum malaria. N Engl J Med 309: 61–66.
Robinson PJ, Rapoport SI, 1986. Glucose transport and metabolism in the brain. Am J Physiol 250: R127–R136.
Kawo NG, Msengi AE, Swai AB, Chuwa LM, Alberti KG, McLarty DG, Orskov H, 1990. Hypoglycaemia and cerebral malaria. Lancet 336: 1128–1129.
Bandsma RH, Mendel M, Spoelstra MN, Reijngoud DJ, Boer T, Stellaard F, Brabin B, Schellekens R, Senga E, Heikens GT, 2010. Mechanisms behind decreased endogenous glucose production in malnourished children. Pediatr Res 68: 423–428.
Romijn JA, Godfried MH, Wortel C, Sauerwein HP, 1990. Hypoglycemia, hormones and cytokines in fatal meningococcal septicemia. J Endocrinol Invest 13: 743–747.
Dekker E, Hellerstein MK, Romijn JA, Neese RA, Peshu N, Endert E, Marsh K, Sauerwein HP, 1997. Glucose homeostasis in children with falciparum malaria: precursor supply limits gluconeogenesis and glucose production. J Clin Endocrinol Metab 82: 2514–2521.
Willcox ML, Forster M, Dicko MI, Graz B, Mayon-White R, Barennes H, 2009. Blood glucose and prognosis in children with presumed severe malaria: is there a threshold for ‘hypoglycaemia’? Trop Med Int Health 15: 232–240.
Rake AJ, Srinivasan V, Nadkarni V, Kaptan R, Newth CJ, 2010. Glucose variability and survival in critically ill children: allostasis or harm? Pediatr Crit Care Med 11: 707–712.
Wintergerst KA, Buckingham B, Gandrud L, Wong BJ, Kache S, Wilson DM, 2006. Association of hypoglycemia, hyperglycemia, and glucose variability with morbidity and death in the pediatric intensive care unit. Pediatrics 118: 173–179.
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Hypoglycemia is a life-threatening complication of several diseases in childhood. We describe the prevalence and incidence of hypoglycemia among admitted Mozambican children, establishing its associated risk factors. We retrospectively reviewed clinical data of 13 years collected through an ongoing systematic morbidity surveillance in Manhiça District Hospital in rural Mozambique. Logistic regression was used to identify risk factors for hypoglycemia and death. Minimum community-based incidence rates (MCBIRs) for hypoglycemia were calculated using data from the demographic surveillance system. Of 49,089 children < 15 years hospitalized in Manhiça District Hospital, 45,573 (92.8%) had a glycemia assessment on admission. A total of 1,478 children (3.2%) presented hypoglycemia (< 3 mmol/L), of which about two-thirds (972) were with levels < 2.5 mmol/L. Independent risk factors for hypoglycemia on admission and death among hypoglycemic children included prostration, unconsciousness, edema, malnutrition, and bacteremia. Hypoglycemic children were significantly more likely to die (odds ratio [OR] = 7.11; P < 0.001), with an associated case fatality rate (CFR) of 19.3% (245/1,267). Overall MCBIR of hypoglycemia was 1.57 episodes/1,000 child years at risk (CYAR), significantly decreasing throughout the study period. Newborns showed the highest incidences (9.47 episodes/1,000 CYAR, P < 0.001). Hypoglycemia remains a hazardous condition for African children. Symptoms and signs associated to hypoglycemia should trigger the verification of glycemia and the implementation of life-saving corrective measures.
Financial support: The CISM receives financial support from the Spanish Agency for International Cooperation (AECI). Quique Bassat has a fellowship from the program Miguel Servet of the ISCIII (Plan Nacional de I+D+I 2008-2011, grant no.: CP11/00269). Lola Madrid has a fellowship from the program Rio Hortega of the ISCIII (grant no.: CP13/00260).
Authors' addresses: Lola Madrid, Sozinho Acacio, Tacilta Nhampossa, Antonio Sitoe, Sónia Amós Maculuve, Helio Mucavele, and Betuel Sigaúque, Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique, E-mails: lola.madrid@isglobal.org, sozinho.acacio@manhica.net, tacilta.nhampossa@manhica.net, antonio.sitoe@manhica.net, sonia.maculuve@manhica.net, helio.mucavele@manhica.net, and betuel.sigauque@manhica.net. Miguel Lanaspa, Llorenç Quintó, and Quique Bassat, Barcelona Institute for Global Health, Barcelona, Spain, E-mails: miguel.lanaspa@isglobal.org, lquinto@clinic.ub.es, and quique.bassat@isglobal.org.
Hirshberg E, Larsen G, Van Duker H, 2008. Alterations in glucose homeostasis in the pediatric intensive care unit: hyperglycemia and glucose variability are associated with increased mortality and morbidity. Pediatr Crit Care Med 9: 361–366.
Faustino EV, Hirshberg EL, Bogue CW, 2012. Hypoglycemia in critically ill children. J Diabetes Sci Technol 6: 48–57.
Ognibene KL, Vawdrey DK, Biagas KV, 2011. The association of age, illness severity, and glycemic status in a pediatric intensive care unit. Pediatr Crit Care Med 12: e386–e390.
Zijlmans WC, van Kempen AA, Serlie MJ, Kager PA, Sauerwein HP, 2013. Adaptation of glucose metabolism to fasting in young children with infectious diseases: a perspective. J Pediatr Endocrinol Metab 27: 5–13.
Kraft R, Herndon DN, Mlcak RP, Finnerty CC, Cox RA, Williams FN, Jeschke MG, 2014. Bacterial respiratory tract infections are promoted by systemic hyperglycemia after severe burn injury in pediatric patients. Burns 40: 428–435.
Hirata Y, Tomioka H, Sekiya R, Yamashita S, Kaneda T, Kida Y, Nishio C, Kaneko M, Fujii H, Nakamura T, 2013. Association of hyperglycemia on admission and during hospitalization with mortality in diabetic patients admitted for pneumonia. Intern Med 52: 2431–2438.
Osier FH, Berkley JA, Ross A, Sanderson F, Mohammed S, Newton CR, 2003. Abnormal blood glucose concentrations on admission to a rural Kenyan district hospital: prevalence and outcome. Arch Dis Child 88: 621–625.
Sambany E, Pussard E, Rajaonarivo C, Raobijaona H, Barennes H, 2013. Childhood dysglycemia: prevalence and outcome in a referral hospital. PLoS One 8: e65193.
Faustino EV, Apkon M, 2005. Persistent hyperglycemia in critically ill children. J Pediatr 146: 30–34.
Bhutia TD, Lodha R, Kabra SK, 2013. Abnormalities in glucose homeostasis in critically ill children. Pediatr Crit Care Med 14: e16–e25.
World Health Organization, 2013. Pocket Book for Hospital Care of Children: Guidelines for the Management of Common Illness with Limited Resources, 2nd edition. Geneva, Switzerland: World Health Organization.
Nadjm B, Mtove G, Amos B, Hildenwall H, Najjuka A, Mtei F, Todd J, Reyburn H, 2013. Blood glucose as a predictor of mortality in children admitted to the hospital with febrile illness in Tanzania. Am J Trop Med Hyg 89: 232–237.
Nhampossa T, Sigauque B, Machevo S, Macete E, Alonso P, Bassat Q, Menendez C, Fumado V, 2013. Severe malnutrition among children under the age of 5 years admitted to a rural district hospital in southern Mozambique. Public Health Nutr 16: 1565–1574.
Houin S, Rozance PJ, 2014. 50 years ago in the Journal of Pediatrics: the incidence of neonatal hypoglycemia in a nursery for premature infants. J Pediatr 164: 1485.
Harris DL, Weston PJ, Signal M, Chase JG, Harding JE, 2013. Dextrose gel for neonatal hypoglycaemia (the Sugar Babies Study): a randomised, double-blind, placebo-controlled trial. Lancet 382: 2077–2083.
Pisarchik AN, Pochepen ON, Pisarchyk LA, 2012. Increasing blood glucose variability is a precursor of sepsis and mortality in burned patients. PLoS One 7: e46582.
Badawi O, Waite MD, Fuhrman SA, Zuckerman IH, 2012. Association between intensive care unit-acquired dysglycemia and in-hospital mortality. Crit Care Med 40: 3180–3188.
Sigauque B, Roca A, Mandomando I, Morais L, Quinto L, Sacarlal J, Macete E, Nhamposa T, Machevo S, Aide P, Bassat Q, Bardaji A, Nhalungo D, Soriano-Gabarro M, Flannery B, Menendez C, Levine MM, Alonso PL, 2009. Community-acquired bacteremia among children admitted to a rural hospital in Mozambique. Pediatr Infect Dis J 28: 108–113.
Ikeda T, Takahashi T, Sato A, Tanaka H, Igarashi S, Fujita N, Kuwabara T, Kanazawa M, Nishizawa M, Shimohata T, 2013. Predictors of outcome in hypoglycemic encephalopathy. Diabetes Res Clin Pract 101: 159–163.
Fong CY, Harvey AS, 2014. Variable outcome for epilepsy after neonatal hypoglycaemia. Dev Med Child Neurol 56: 1093–1099.
Sacarlal J, Nhacolo AQ, Sigauque B, Nhalungo DA, Abacassamo F, Sacoor CN, Aide P, Machevo S, Nhampossa T, Macete EV, Bassat Q, David C, Bardaji A, Letang E, Saute F, Aponte JJ, Thompson R, Alonso PL, 2009. A 10 year study of the cause of death in children under 15 years in Manhica, Mozambique. BMC Public Health 9: 67.
Gonzalez R, Munguambe K, Aponte J, Bavo C, Nhalungo D, Macete E, Alonso P, Menendez C, Naniche D, 2012. High HIV prevalence in a southern semi-rural area of Mozambique: a community-based survey. HIV Med 13: 581–588.
Sacoor C, Nhacolo A, Nhalungo D, Aponte JJ, Bassat Q, Augusto O, Mandomando I, Sacarlal J, Lauchande N, Sigauque B, Alonso P, Macete E, Munguambe K, Guinovart C, Aide P, Menendez C, Acacio S, Quelhas D, Sevene E, Nhampossa T, 2013. Profile: Manhica Health Research Centre (Manhica HDSS). Int J Epidemiol 42: 1309–1318.
Bassat Q, Guinovart C, Sigauque B, Aide P, Sacarlal J, Nhampossa T, Bardaji A, Nhacolo A, Macete E, Mandomando I, Aponte JJ, Menendez C, Alonso PL, 2008. Malaria in rural Mozambique. Part II: children admitted to hospital. Malar J 7: 37.
Bassat Q, Guinovart C, Sigauque B, Mandomando I, Aide P, Sacarlal J, Nhampossa T, Bardaji A, Morais L, Machevo S, Letang E, Macete E, Aponte JJ, Roca A, Menendez C, Alonso PL, 2009. Severe malaria and concomitant bacteraemia in children admitted to a rural Mozambican hospital. Trop Med Int Health 14: 1011–1019.
Grummer-Strawn LM, Reinold C, Krebs NF, 2010. Use of World Health Organization and CDC growth charts for children aged 0–59 months in the United States. MMWR Recomm Rep 59: 1–15.
Sullivan GM, Feinn R, 2012. Using effect size—or why the P value is not enough. J Grad Med Educ 4: 279–282.
Solomon T, Felix JM, Samuel M, Dengo GA, Saldanha RA, Schapira A, Phillips RE, 1994. Hypoglycaemia in paediatric admissions in Mozambique. Lancet 343: 149–150.
Elusiyan JB, Adejuyigbe EA, Adeodu OO, 2006. Hypoglycaemia in a Nigerian paediatric emergency ward. J Trop Pediatr 52: 96–102.
Graz B, Dicko M, Willcox ML, Lambert B, Falquet J, Forster M, Giani S, Diakite C, Dembele EM, Diallo D, Barennes H, 2008. Sublingual sugar for hypoglycaemia in children with severe malaria: a pilot clinical study. Malar J 7: 242.
Krinsley JS, 2013. Glycemic control in the critically ill—3 domains and diabetic status means one size does not fit all! Crit Care 17: 131.
Rattarasarn C, 1997. Hypoglycemia in sepsis: risk factors and clinical characteristics. J Med Assoc Thai 80: 760–766.
Branco RG, Chavan A, Tasker RC, 2009. Pilot evaluation of continuous subcutaneous glucose monitoring in children with multiple organ dysfunction syndrome. Pediatr Crit Care Med 11: 415–419.
Bridges BC, Preissig CM, Maher KO, Rigby MR, 2010. Continuous glucose monitors prove highly accurate in critically ill children. Crit Care 14: R176.
Thien HV, Kager PA, Sauerwein HP, 2006. Hypoglycemia in falciparum malaria: is fasting an unrecognized and insufficiently emphasized risk factor? Trends Parasitol 22: 410–415.
Yelich MR, Filkins JP, 1980. Mechanism of hyperinsulinemia in endotoxicosis. Am J Physiol 239: E156–E161.
White NJ, Miller KD, Marsh K, Berry CD, Turner RC, Williamson DH, Brown J, 1987. Hypoglycaemia in African children with severe malaria. Lancet 1: 708–711.
White NJ, Warrell DA, Chanthavanich P, Looareesuwan S, Warrell MJ, Krishna S, Williamson DH, Turner RC, 1983. Severe hypoglycemia and hyperinsulinemia in falciparum malaria. N Engl J Med 309: 61–66.
Robinson PJ, Rapoport SI, 1986. Glucose transport and metabolism in the brain. Am J Physiol 250: R127–R136.
Kawo NG, Msengi AE, Swai AB, Chuwa LM, Alberti KG, McLarty DG, Orskov H, 1990. Hypoglycaemia and cerebral malaria. Lancet 336: 1128–1129.
Bandsma RH, Mendel M, Spoelstra MN, Reijngoud DJ, Boer T, Stellaard F, Brabin B, Schellekens R, Senga E, Heikens GT, 2010. Mechanisms behind decreased endogenous glucose production in malnourished children. Pediatr Res 68: 423–428.
Romijn JA, Godfried MH, Wortel C, Sauerwein HP, 1990. Hypoglycemia, hormones and cytokines in fatal meningococcal septicemia. J Endocrinol Invest 13: 743–747.
Dekker E, Hellerstein MK, Romijn JA, Neese RA, Peshu N, Endert E, Marsh K, Sauerwein HP, 1997. Glucose homeostasis in children with falciparum malaria: precursor supply limits gluconeogenesis and glucose production. J Clin Endocrinol Metab 82: 2514–2521.
Willcox ML, Forster M, Dicko MI, Graz B, Mayon-White R, Barennes H, 2009. Blood glucose and prognosis in children with presumed severe malaria: is there a threshold for ‘hypoglycaemia’? Trop Med Int Health 15: 232–240.
Rake AJ, Srinivasan V, Nadkarni V, Kaptan R, Newth CJ, 2010. Glucose variability and survival in critically ill children: allostasis or harm? Pediatr Crit Care Med 11: 707–712.
Wintergerst KA, Buckingham B, Gandrud L, Wong BJ, Kache S, Wilson DM, 2006. Association of hypoglycemia, hyperglycemia, and glucose variability with morbidity and death in the pediatric intensive care unit. Pediatrics 118: 173–179.
Past two years | Past Year | Past 30 Days | |
---|---|---|---|
Abstract Views | 44 | 44 | 9 |
Full Text Views | 309 | 101 | 0 |
PDF Downloads | 124 | 38 | 0 |