Incidence and factors associated with neonatal hypoglycaemia in Chinese newborns delivered via caesarean section: a cross-sectional study

Background Neonatal hypoglycaemia is a common metabolic disorder in newborns and may be more frequent in infants delivered by caesarean section because of altered metabolic adaptation after birth. Evidence specific to Chinese caesarean-delivered newborns remains limited. Objective To determine the incidence of neonatal hypoglycaemia and identify factors associated with its occurrence in Chinese newborns delivered via caesarean section. Design Cross-sectional study. Setting Three regional obstetric care centres in East China. Participants A total of 1232 mother-newborn pairs, including both term and preterm singleton infants delivered via caesarean section. Methods Data were extracted from hospital electronic medical records. Neonatal hypoglycaemia was defined as a blood glucose level below 2.6 mmol/L within 24 hours after birth. Maternal, obstetric and neonatal characteristics were analysed. Bivariable analyses were performed to assess associations between neonatal hypoglycaemia and candidate variables, followed by multivariable logistic regression to identify independent factors. Predictive performance of the final model was evaluated using receiver operating characteristic analysis. Results Neonatal hypoglycaemia occurred in 800 of 1232 newborns, giving an incidence of 64.9% (95% CI 62.3% to 67.6%). In multivariable logistic regression, higher gestational age was independently associated with lower odds of neonatal hypoglycaemia (OR 0.781, 95% CI 0.684 to 0.891; p<0.001). Compared with appropriate-for-gestational-age newborns, large-for-gestational-age newborns had higher odds of hypoglycaemia (OR 2.200, 95% CI 1.477 to 3.276; p<0.001), whereas small-for-gestational-age newborns had lower odds (OR 0.394, 95% CI 0.188 to 0.824; p=0.013). Elective caesarean delivery was also associated with higher odds of hypoglycaemia (OR 1.638, 95% CI 1.248 to 2.150; p<0.001). Compared with parity 1, parity 3 was associated with higher odds of hypoglycaemia (OR 2.274, 95% CI 1.151 to 4.496; p=0.018), whereas parity 2 was not significant (OR 1.224, 95% CI 0.936 to 1.601; p=0.140). For amniotic fluid characteristics, category 1 was not significantly associated with hypoglycaemia (OR 0.624, 95% CI 0.287 to 1.359; p=0.235), whereas categories 2 and 3 were associated with lower odds (OR 0.478, 95% CI 0.291 to 0.786; p=0.004, and OR 0.518, 95% CI 0.296 to 0.909; p=0.022, respectively). The final model showed modest discrimination, with an area under the curve of 0.667 (95% CI 0.633 to 0.697). Conclusions Neonatal hypoglycaemia was common among Chinese newborns delivered via caesarean section, but most episodes were asymptomatic and resolved with routine feeding within 24 hours. Gestational age, fetal growth classification, elective caesarean delivery, parity and amniotic fluid characteristics were associated with hypoglycaemia in the current model. Early glucose monitoring and targeted nutritional support may be particularly important for newborns at increased risk.