Frequency and Risk Factors for Early Hypoglycemia in Full-term LGA Infants: A Retrospective Study

Frequency and Risk Factors for Early Hypoglycemia in Full-term LGA Infants: A Retrospective Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Frequency and Risk Factors for Early Hypoglycemia in Full-term LGA Infants: A Retrospective Study Chia-Yu Wang, Lin-Yen Wang, Chung-Han Ho, Lin-Yu Wang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7545928/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose : The purpose of this study was to investigate the incidence of early hypoglycemia in full-term large-for-gestational-age (LGA) neonates within the first four hours of life, to identify associated neonatal and maternal risk factors, and to characterize the corresponding blood glucose patterns. Methods: We conducted a retrospective, single-center study reviewing medical records of full-term LGA neonates (birth weight >90th percentile) born from January 1, 2012, to December 31, 2021, and admitted to a well-baby nursery at a tertiary medical center in Southern Taiwan. Blood glucose was measured at 0.5, 1-, 2-, and 4-hours post-birth. Hypoglycemia was defined as blood glucose ≤40 mg/dL. Neonatal and maternal characteristics were compared between hypoglycemic and non-hypoglycemic groups. Results: Of 697 LGA neonates, 253 (36.3%) experienced hypoglycemia, with 98.42% of cases occurring within 1 hour (mean glucose: 40.26±8.16 mg/dL). Among 253 hypoglycemic neonates, 103 (40.7%) required intravenous glucose infusion for persistent hypoglycemia despite repeated early feeding. Multivariate logistic regression analysis identified respiratory distress (OR=2.24, 95% CI: 1.48–3.41), female sex (OR=2.05, 95% CI: 1.32–3.17), and maternal gestational diabetes mellitus (GDM) (OR=1.61, 95% CI: 1.12–2.32) were independent risk factors. Conclusion: Early hypoglycemia is prevalent in LGA neonates, particularly those with female sex, respiratory distress, or maternal GDM. Routine glucose screening within the first hour and early feeding are crucial in preventing severe hypoglycemic episodes. large-for-gestational-age neonatal hypoglycemia gestational diabetes mellitus blood glucose screening risk factors Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Hypoglycemia is the most common metabolic disorder occurring in the neonatal period, and blood glucose concentrations change rapidly in the hours after birth ( 1 ). The abrupt cessation of continuous maternal glucose supply after birth can lead to transient hypoglycemia in newborns. Blood glucose levels typically reach their lowest point as low as 30 mg/dL within 30 to 90 minutes post-birth and then gradually normalize ( 2 ). Undiagnosed or prolonged hypoglycemia can lead to brain injury and adverse neurodevelopmental outcomes ( 3 , 4 ). Large-for gestational-age (LGA) infants, defined as having a birth weight above the 90th percentile for gestational age( 5 ), are at increased risk of hypoglycemia due to fetal hyperinsulinism, often triggered by maternal hyperglycemia during pregnancy. ( 6 , 7 ). This hyperinsulinism drives excessive intrauterine growth by increasing fetal fat and protein stores( 6 – 8 ). LGA births are often associated with maternal diabetes; however, hypoglycemia also occurs in 15–19% of LGA infants born to non-diabetic mothers ( 9 – 11 ). In 2011, the American Academy of Pediatrics (AAP) recommended routine glucose monitoring for at-risk neonates, targeting levels above 40 mg/dL (2.22 mmol/L) from birth to 4 hours and above 45 mg/dL (2.5 mmol/L) from 4 to 24 hours, using repeated oral feeding or intravenous glucose administration ( 12 ). Screening at-risk infants and managing low blood glucose levels in the immediate postnatal period are critical aspects of neonatal care. However, current screening guidelines rely more on expert opinion due to limited evidence ( 13 – 15 ). In Taiwan, evidence on early hypoglycemia among full-term LGA infants remains limited. Therefore, this study aims to determine the incidence, identify neonatal and maternal risk factors, and characterize blood glucose patterns of early hypoglycemia in full-term LGA infants admitted to a well-baby nursery in Southern Taiwan, with the goal of informing local screening and management protocols. Materials and Methods We conducted a retrospective, single-center study through a structured review of medical records of term LGA neonates born between January 1, 2012, and December 31, 2021, and admitted to the well-baby nursery of a tertiary medical center in Southern Taiwan. The nursery admits newborns with a gestational age over 35 weeks who appear healthy after birth, and, as part of routine policy, all newborns undergo a four-hour observation period, with fasting glucose monitored in those at high risk. Blood glucose levels were measured at 0.5, 1, 2, and 4 hours of life in neonates at risk of hypoglycemia, in accordance with the 2011 AAP recommendations ( 12 ). Eligible participants were term LGA neonates, defined as birth weight above the 90th percentile for gestational age based on the Lubchenco Growth Curve ( 15 ), with term gestation defined as 37 weeks to 41 weeks and 6 days. Infants with chromosomal anomalies, major congenital malformations, congenital infections, or without blood glucose testing within the first four hours of life were excluded. 1. Blood Glucose Testing Capillary blood samples were collected via heel pricks, and glucose concentrations were measured using the Fora MD Control POCT S10 glucometer (model TD-4258; TaiDoc Technology Corporation, New Taipei City, Taiwan). The glucometer was calibrated monthly for accuracy. Glucose values below 40 mg/dL were confirmed using an automated biochemical analyzer (TBA-c16000; Toshiba Medical Systems Corporation, Tokyo, Japan). Blood glucose screening was performed at 0.5, 1, 2, and 4 hours before feeding. Hypoglycemia was defined as blood glucose levels below 40 mg/dL from birth to four hours of life, or below 45 mg/dL from four to 24 hours, according to AAP recommendations ( 12 ). Symptoms of hypoglycemia included tremors, jitteriness, irritability, seizures, lethargy, poor feeding, and apnea. Neonates with initial blood glucose levels below 40 mg/dL received immediate feeding, followed by reevaluation after 30 minutes. Persistent hypoglycemia was managed with intravenous (IV) glucose infusion. Neonates with repeated low glucose levels or symptoms were transferred to the neonatal ward. Hypoglycemia episodes were defined as one or more consecutive readings below 40 mg/dL. 2. Definition of study parameters Respiratory distress was defined as tachypnea (respiratory rate > 60 breaths/min) with signs such as grunting, retractions, nasal flaring, or cyanosis. Pregnancy-induced hypertension (PIH) was a systolic blood pressure ≥ 140 mmHg or diastolic ≥ 90 mmHg, and preeclampsia was PIH with proteinuria after 20 weeks’ gestation. Gestational diabetes mellitus (GDM) was diagnosed via an abnormal oral glucose tolerance test (OGTT) under Taiwanese prenatal care protocols, using thresholds of fasting glucose ≥ 92 mg/dL and < 126 mg/dL, 1-hour ≥ 180 mg/dL, or 2-hour ≥ 153 mg/dL and < 200 mg/dL. Meconium-stained amniotic fluid was defined as the presence of meconium before delivery, and premature rupture of membranes (PROM) as rupture before labor onset. Clinical sepsis followed standard neonatal sepsis criteria. 3. Statistical Analysis Data are presented as means ± standard deviation for continuous variables and as frequencies with percentages for categorical variables. Comparisons between hypoglycemic and non-hypoglycemic neonates were performed using Pearson’s chi-square test or Fisher’s exact test for categorical variables and the Mann-Whitney U test for continuous variables. Blood glucose levels at various post-birth time points were visualized using box plots. To identify risk factors for early hypoglycemia in LGA neonates, logistic regression with Firth’s penalized likelihood approach was employed to account for rare events. Both full and reduced logistic regression models were developed. The full model included all potential confounders to provide the most accurate estimation of independent associations, while the reduced model included variables with a univariate p-value < 0.1 in the multivariable logistic regression. Results are reported as odds ratio (OR) with 95% confidence interval (CI). All statistical analyses were performed using SAS statistical software (version 9.4; SAS Institute, Inc., Cary, NC, USA), with p-value < 0.05 considered statistically significant. Results 1. Clinical Characteristics of LGA Infants and Maternal Demographics in Hypoglycemia and Non-Hypoglycemia Groups In our study, 798 newborns were identified as LGA, defined by a birth weight above the 90th percentile for gestational age. Blood glucose concentration was measured for all infants after birth. Our analysis excluded 42 newborns due to incomplete medical records, 5 with chromosome anomalies, 11 with congenital malformations, and 17 with congenital infections. LGA newborns born before 37 weeks of gestation were excluded, resulting in a final cohort of 697 newborns that met the inclusion criteria. Among these 697 LGA neonates, 253 (36.29%) experienced at least one hypoglycemic episode and were categorized into the "hypoglycemia group," while the remaining 444 neonates without hypoglycemia episodes comprised the "non-hypoglycemia group."(Fig. 1 ) Among neonates with hypoglycemia (n = 253), 129 (50.99%) were male and 124 (49.01%) were female. Compared with the non-hypoglycemic group, these neonates had lower gestational age and 5-minute Apgar scores, as well as higher rates of clinical sepsis, respiratory distress, and lethargy. No significant differences were observed in sex, delivery mode, birth weight, head and chest circumference, body length, 1-minute Apgar score, or hypothermia (Table 1 ). Regarding maternal characteristics, both groups were comparable in age, weight, Body Mass Index (BMI), height, preeclampsia, prior history of LGA, meconium-stained amniotic fluid, PROM, maternal diabetes mellitus, and hypertension. However, mothers of the hypoglycemic group had significantly higher rates of multiparity and GDM (Table 2 ). Table 1 Clinical characteristics of LGA infants in hypoglycemic and non-hypoglycemic groups Hypoglycemia (n = 253,36.3%) Non-hypoglycemia (n = 444,63.7%) p-value Sex, n (%) 0.0605 Male 129(50.99) 259(58.33) Female 124(49.01) 185(41.67) Mode of delivery, n (%) 0.1183 Vaginal delivery 98(38.74) 199(44.82) Cesarean section 155(61.26) 245(55.18) Birth weight (g), Mean ± SD 3896.97 ± 269.11 3885.02 ± 204.62 0.7875 Gestational age(weeks), Mean ± SD 38.58 ± 1.15 38.93 ± 1.12 < 0.0001 Macrosomia, n (%) 0.4592 =4000 g 65(25.69) 103(23.20) Week of delivery, n (%) 0.0731 =40 weeks 39(15.42) 93(20.95) Head circumference, Mean ± SD 35.42 ± 1.18 35.53 ± 1.57 0.8693 Chest circumference, Mean ± SD 35.06 ± 1.42 34.99 ± 1.50 0.4396 Body height, Mean ± SD 52.89 ± 1.93 52.78 ± 2.91 0.3001 Apgar score (1 min), Mean ± SD 7.91 ± 0.42 7.94 ± 0.31 0.7512 Apgar score (5 min), Mean ± SD 8.94 ± 0.58 9.00 ± 0.13 0.0224 Clinical sepsis 27(10.67) 20(4.50) 0.0018 Respiratory distress 81(32.02) 63(14.19) < 0.0001 Birth trauma 9(3.56) 12(2.70) 0.5256 Hypothermia 57(22.53) 95(21.40) 0.7275 lethargy 12(4.74) 7(1.58) 0.0136 Blood glucose level, Mean ± SD 0.5 hour 46.17 ± 8.46 65.67 ± 13.52 < 0.0001 1 hour 40.26 ± 8.16 62.82 ± 13.11 < 0.0001 2 hour 61.15 ± 18.47 72.98 ± 12.65 < 0.0001 4 hour 72.39 ± 16.68 75.23 ± 13.40 0.6324 Severe hypoglycemia (< 25 mg/dL), n (%) 2(0.79) 0(0.00) 0.1314 a. Categorical variables analysis by Chi-square test or Fisher's exact test, continuous variables analysis by Mann-Whitney U test. b. Values are presented as mean ± standard deviation or number (%) c. LGA: large for gestational age. Table 2 Maternal demographic characteristics in hypoglycemic and non-hypoglycemic groups of LGA neonates. Hypoglycemia (n = 253, 36.3%) Non-hypoglycemia (n = 444, 63.7%) p-value Maternal age, Mean ± SD 33.00 ± 4.48 33.01 ± 4.37 0.8931 Maternal age 0.0869 =35 years 106(41.90) 157(35.36) Maternal weight (kg), Mean ± SD 77.31 ± 13.13 75.81 ± 12.64 0.1051 Maternal height (cm), Mean ± SD 161.35 ± 5.43 161.19 ± 7.24 0.9270 BMI 29.72 ± 4.96 29.52 ± 10.80 0.0759 BMI group 0.1567 18.5–24.9 41(16.21) 71(15.99) 25.0-29.9 103(40.71) 216(48.65) 30–34 75(29.64) 114(25.68) >=35 34(13.44) 43(9.68) Parity, Mean ± SD 1.85 ± 0.76 1.76 ± 0.86 0.0221 Previous history with LGA 41(16.21) 64(14.41) 0.5250 Gestational diabetes mellitus 91(35.97) 100(22.52) 0.0001 Preeclampsia 17(6.72) 16(3.60) 0.0625 Meconium-stained amniotic fluid 8(3.16) 16(3.60) 0.7585 Premature rupture of membrane 81(32.02) 126(28.38) 0.3122 Maternal diabetes mellitus 24(9.49) 27(6.08) 0.0969 Maternal hypertension 19(7.51) 34(7.66) 0.9436 a. Categorical variables analysis by Chi-square test or Fisher's exact test, continuous variables analysis by Mann-Whitney U test. b. Values are presented as mean ± standard deviation or number (%) 2. Incidence of Hypoglycemia at Different Hours of Life and Incidence of Hypoglycemia Requiring IV Glucose Treatment The overall incidence of hypoglycemia among LGA neonates was 34.99%. Most cases occurred within the first hour of life: 39.13% (n = 99) at 0.5 hours and 59.29% (n = 150) at 1 hour, while only 1.58% (n = 4) occurred at 2 hours, indicating that 98.41% of hypoglycemic episodes developed within the first hour (Fig. 2 ). Among the 253 hypoglycemic neonates, 103 (40.71%) required intravenous glucose infusion due to persistent hypoglycemia despite repeated early feeding (Supplement Digital Content 1, Fig. 2 ). Of these, 55 neonates presented with symptoms such as jitteriness, lethargy, and tachypnea, though no seizures were reported. The majority of IV glucose treatments were initiated at 0.5 hours (53.40%, n = 55) and 1 hour (47.00%, n = 47), with only one neonate (0.97%) requiring intervention at 2 hours (Fig. 2 ). 3. Clinical Characteristics of LGA Infants and Maternal Demographics in Hypoglycemic Infants with and without IV Glucose Infusion Among hypoglycemic neonates, 56 males and 47 females required IV glucose infusion. No significant differences were observed between infusion and non-infusion groups in sex, gestational age, birth weight, anthropometric measures, or mode of delivery. However, neonates receiving IV glucose had lower 1- and 5-minute Apgar scores and higher rates of respiratory distress and clinical sepsis (Table 3 ). Regarding maternal factors, no differences were found in height, meconium-stained amniotic fluid, diabetes mellitus, or hypertension. In contrast, mothers of neonates requiring IV glucose were significantly older, heavier, and had higher BMI, multiparity rates, and increased incidences of GDM and PROM (Supplement Digital Content 2). Table 3 Clinical characteristics of hypoglycemic LGA neonates with and without intravenous (IV) glucose infusion. Hypoglycemic LGA p-value With IV glucose (n = 103, 40.7%) Without IV glucose (n = 150, 59.3%) Sex, n (%) 0.3727 Male 56(54.37) 73(48.67) Female 47(45.63) 77(51.33) Mode of delivery, n (%) 0.8137 Vaginal delivery 39(37.86) 59(39.33) Cesarean section 64(62.14) 91(60.67) Birth weight (g), Mean ± SD 3920.42 ± 323.33 3880.87 ± 224.22 0.6901 Gestational age (weeks), Mean ± SD 38.52 ± 1.16 38.61 ± 1.14 0.4875 Macrosomia, n (%) 0.0555 =4000 gm 33(32.04) 32(21.33) Week of delivery, n (%) =40 weeks 13(12.62) 26(17.33) Head circumference (cm), Mean ± SD 35.59 ± 1.21 35.31 ± 1.16 0.0446 Chest circumference (cm), Mean ± SD 35.25 ± 1.61 34.93 ± 1.25 0.0550 Body height (cm), Mean ± SD 52.77 ± 1.91 52.97 ± 1.95 0.5542 Apgar score (1 min), Mean ± SD 7.82 ± 0.62 7.98 ± 0.142 0.0028 Apgar score (5 min), Mean ± SD 8.85 ± 0.91 9.00 ± 0.00 0.0012 Clinical sepsis 21(20.39) 6(4.00) < 0.0001 Hyperbilirubinemia 55(53.40) 17(11.33) < 0.0001 Respiratory distress 54(52.43) 27(18.00) < 0.0001 Birth trauma 4(3.88) 5(3.33) 1.0000 Hypothermia 17(16.50) 40(26.67) 0.0573 Lethargy 7(6.80) 5(3.33) 0.2366 Blood glucose level, Mean ± SD 0.5 hour 43.69 ± 7.12 47.87 ± 8.90 < 0.0001 1 hour 37.25 ± 6.98 42.33 ± 8.29 < 0.0001 2 hour 49.50 ± 19.30 69.16 ± 12.80 < 0.0001 4 hour 72.70 ± 17.37 72.18 ± 16.24 0.6324 a. Categorical variables analysis by Chi-square test or Fisher's exact test, continuous variables analysis by Mann-Whitney U test. b. Values are presented as mean ± standard deviation or number (%) c. LGA: large for gestational age 4. Blood Glucose Levels 4.A. Mean Blood Glucose Levels in Hypoglycemia vs. Non-Hypoglycemia Groups In the hypoglycemia group, mean glucose levels were 46.17 ± 8.46 mg/dL at 0.5 hours, 40.26 ± 8.16 mg/dL at 1 hour, 61.15 ± 18.47 mg/dL at 2 hours, and 72.39 ± 16.68 mg/dL at 4 hours (Table 1 ). The lowest observed mean glucose occurred at 1 hour (40.26 ± 8.16 mg/dL), with two neonates recording below 25 mg/dL. Compared with the non-hypoglycemia group, mean glucose was significantly lower at all time points: 0.5 hours (46.17 vs. 65.67 mg/dL, p < 0.0001), 1 hour (40.26 vs. 62.82 mg/dL, p < 0.0001), 2 hours (61.15 vs. 72.98 mg/dL, p < 0.0001), and 4 hours (72.39 vs. 75.23 mg/dL, p = 0.0213) (Supplement Digital Content 3). 4.B. Mean Blood Glucose Levels in Hypoglycemic LGA Infants with and without IV Glucose Infusion Of the 253 hypoglycemic neonates, 103 (40.7%) required IV glucose. Their mean glucose levels were 43.69 ± 7.12 mg/dL at 0.5 hours, 37.25 ± 6.98 mg/dL at 1 hour, 49.50 ± 19.30 mg/dL at 2 hours, and 72.70 ± 17.37 mg/dL at 4 hours (Table 3 ). The lowest value occurred at 1 hour (37.25 ± 6.98 mg/dL), with two infants below 25 mg/dL. Compared with those not requiring IV infusion, the IV group had significantly lower glucose at 0.5 hours (43.69 vs. 47.87 mg/dL, p < 0.0001), 1 hour (37.25 vs. 42.33 mg/dL, p < 0.0001), and 2 hours (49.50 vs. 69.16 mg/dL, p < 0.0001), but levels were comparable at 4 hours (72.70 vs. 72.18 mg/dL, p = 0.6324) (Supplement Digital Content 4). 5. Risk factors for early hypoglycemia Combined Effects of Neonatal and Maternal Factors on Hypoglycemia in LGA Neonates Table 4 summarizes the multivariable analysis of neonatal and maternal risk factors for hypoglycemia in LGA neonates, adjusting for potential confounders. Respiratory distress (OR = 2.28, 95% CI: 1.48–3.51, p = 0.0002) was a strong independent predictor, more than twofold increased risk. Female sex was also significantly associated with hypoglycemia (OR = 1.47, 95% CI: 1.05–2.07, p = 0.0258). Although clinical sepsis and lethargy showed significance in univariate analyses, these associations were no longer evident after multivariable adjustment. Other neonatal factors, including cesarean section, macrosomia, Apgar scores, delivery ≥ 40 weeks, hypothermia, and birth trauma, showed no association. Table 4 Maternal demographic characteristics in hypoglycemic LGA neonates with and without intravenous (IV) glucose infusion. Hypoglycemic LGA p-value With IV glucose (n = 103, 40.7%) Without IV glucose (n = 150, 59.3%) Maternal age, Mean ± SD 32.21 ± 4.79 33.54 ± 4.18 0.0318 Maternal age 0.1105 =35 year 37(35.92) 69(46.00) Maternal weight (kg), Mean ± SD 80.06 ± 14.18 75.42 ± 12.04 0.0060 Maternal height (cm), Mean ± SD 161.92 ± 5.98 160.96 ± 5.00 0.1238 BMI, Mean ± SD 30.55 ± 5.20 29.15 ± 4.72 0.0247 BMI group 0.1055 18.5–24.9 15(14.56) 26(17.33) 25.0-29.9 35(33.98) 68(45.33) 30–34 34(33.01) 41(27.33) >=35 19(18.45) 15(10.00) Parity, Mean ± SD 1.70 ± 0.74 1.95 ± 0.75 0.0035 Previous history with LGA 13(12.62) 28(18.67) 0.1998 Gestational diabetes mellitus 45(43.69) 46(30.67) 0.0340 Preeclampsia 11(10.68) 6(4.00) 0.0371 Meconium-stained amniotic fluid 3(2.91) 5(3.33) 1.0000 Premature rupture of membrane 41(39.81) 40(26.67) 0.0277 Maternal diabetes mellitus 14(13.59) 10(6.67) 0.0648 Maternal hypertension 8(7.77) 11(7.33) 0.8977 a. Categorical variables analysis by Chi-square test or Fisher's exact test, continuous variables analysis by Mann-Whitney U test. b. Values are presented as mean ± standard deviation or number (%) c. LGA: large for gestational age. Table 5 Logistic regression with Firth’s approach assessing combined neonatal and maternal risk factors for hypoglycemia in LGA neonates. Univariate OR (95%CI) p-value Reduced model * (95%CI) p-value full model (95%CI) p-value Neonatal factor Sex Male Ref Ref Ref Female 1.35(0.99,1.83) 0.0613 2.05(1.32,3.17) 0.0150 1.47(1.05,2.07) 0.0258 Mode of delivery Vaginal delivery Ref Ref Cesarean section 1.28(0.94,1.76) 01205 1.24(0.85,1.80) 0.2717 Macrosomia =4000 g 1.15(0.80,1.64) 0.4539 1.16(0.74,1.82) 0.5232 Week of delivery =40 weeks 0.69(0.46,1.04) 0.0788 0.91(0.59,1.41) 0.6670 0.98(0.62,1.55) 0.9340 Head circumference (cm) 0.95(0.85,1.07) 0.4162 0.94(0.82,1.08) 0.3876 Chest circumference (cm) 1.03(0.93,1.15) 0.5443 1.02(0.90,1.16) 0.7577 Apgar score (1 min) 0.80(0.53,1.23) 0.3159 1.23(0.75,2.02) 0.4143 Apgar score (5 min) 0.33(0.10,1.08) 0.0677 0.87(0.52,1.46) 0.6044 0.85(0.47,1.55) 0.5999 Clinical sepsis 2.51(1.38,4.58) 0.0026 1.37(0.70,2.67) 0.3605 1.40(0.71,2.76) 0.3391 Hyperbilirubinemia 2.92(1.97,4.34) < 0.0001 2.05(1.32,3.17) 0.0013 2.09(1.33,3.28) 0.0015 Respiratory distress 2.84(1.95,4.13) < 0.0001 2.24(1.48,3.41) 0.0002 2.28(1.48,3.51) 0.0002 Birth trauma 1.34(0.56,3.23) 0.5086 1.18(0.44,3.18) 0.7379 Hypothermia 1.07(0.74,1.55) 0.7181 1.21(0.81,1.83) 0.3525 Lethargy 3.02(1.18,7.75) 0.0215 1.10(0.38,3.13) 0.8652 1.05(0.35,3.09) 0.9365 Maternal factor Maternal age 1.00(0.97,1.04) 0.9756 Maternal age =35 1.32(0.96,1.81) 0.0873 0.83(0.59,1.16) 0.2666 1.13(0.79,1.60) 0.5038 Maternal weight (kg) 1.01(0.99,1.02) 0.1394 Maternal height (cm) 1.00(0.98,1.03) 0.8063 BMI 1.00(0.99,1.02) 0.7728 BMI group 18.5–24.9 Ref Ref 25.0-29.9 0.82(0.53,1.29) 0.3982 0.82(0.50,1.32) 0.4080 30–34 1.14(0.70,1.84) 0.6041 0.93(0.55,1.56) 0.7780 >=35 1.37(0.76,2.47) 0.3012 0.86(0.43,1.69) 0.6546 Parity 1.14(0.95,1.37) 0.1741 1.20(0.97,1.49) 0.0992 Previous history with LGA 1.15(0.75,1.77) 0.5153 1.01(0.62,1.65) 0.9584 Gestational diabetes mellitus 1.93(1.37,2.71) 0.0001 1.61(1.12,2.32) 0.0109 1.57(1.07,2.30) 0.0202 Preeclampsia 1.92(0.95,3.87) 0.0678 1.28(0.60,2.72) 0.5232 1.35(0.62,2.92) 0.4531 Meconium-stained amniotic fluid 0.90(0.38,2.12) 0.8086 0.82(0.32,2.08) 0.6710 Premature rupture of membrane 1.19(0.85,1.66) 0.3100 1.14(0.79,1.63) 0.4915 Maternal diabetes mellitus 1.62(0.91,2.87) 0.0990 1.21(0.65,2.27) 0.5418 1.20(0.64,2.27) 0.5698 Maternal hypertension 0.99(0.55,1.77) 0.9710 0.89(0.47,1.70) 0.7234 *The reduced model included variables with a univariate p-value < 0.1 in the multivariable logistic regression. Results are reported as odds ratios (ORs) with 95% confidence intervals (CIs). p-value < 0.05 is considered statistically significant. Supplementary Table 1: Timing of the first hypoglycemic episode in hypoglycemic LGA neonates. Among maternal factors, GDM was independently associated with hypoglycemia (OR = 1.57, 95% CI: 1.07–2.30, p = 0.0202), indicating a 57% higher risk in neonates born to mothers with GDM. In contrast, maternal weight, height, BMI, parity, PROM, meconium-stained amniotic fluid, and hypertension showed no significant associations in either univariate or multivariable models. Discussion During the study period (January 1, 2012–December 31, 2021), our hospital recorded 14,198 births, with 798 (5.6%) identified as large-for-gestational-age (LGA), consistent with global prevalence rates ( 16 ). Of these, 697 full-term LGA neonates met inclusion criteria, with 253 (36.3%) experiencing early hypoglycemia (blood glucose ≤ 40 mg/dL within the first four hours of life). The reported incidence of early hypoglycemia in LGA infants varies across studies, ranging from 8.1 to 35.7% ( 6 , 11 , 16 – 18 ). This variation is likely due to differences in definitions of hypoglycemia and timing of blood sampling. The frequency of hypoglycemia in our study was higher than in previous reports ( 6 , 11 , 16 , 17 ), likely due to the inclusion of infants born to mothers with GDM and the early glucose monitoring at 0.5 hours post-birth. Our findings are consistent with Hosagasi et al. ( 19 ), who reported a similar high incidence in at-risk neonates. Analysis of the timing of the first hypoglycemic episodes revealed that most hypoglycemic episodes (98.4%) occurred within the first hour, with 39.1% at 0.5 hours and 59.3% at 1 hour; only 1.58% occurred at 2 hours (Fig. 2 ). The mean blood glucose in hypoglycemic neonates (37.3 ± 7.0 mg/dL) was significantly lower than in non-hypoglycemic neonates (42.3 ± 8.3 mg/dL, p < 0.0001) (Table 1 ), reaching a lowest level at 1 hour, consistent with prior research ( 16 ). This indicates a rapid postnatal decline in blood glucose levels in LGA neonates, who reach their lowest level at one hour of life. Compared to our earlier study on small-for-gestational-age (SGA) infants ( 20 ), LGA neonates developed hypoglycemia earlier, predominantly within 1 hour. In contrast, in SGA infants, it predominantly occurred within two hours. It reflects differences in metabolic dynamics. Among the 253 hypoglycemic neonates, 103 (40.7%) required transfer to the neonatal ward for IV glucose infusion due to persistent hypoglycemia despite repeated oral feeding attempts (Fig. 2 ). Of these 103 neonates, 55 (53.4%) required IV glucose at 0.5 hours, and 47(45.63%) at 1 hour. These neonates had higher rates of respiratory distress, hyperbilirubinemia, clinical sepsis, and low Apgar scores, with their mothers showing higher BMI, GDM, multiparity, preeclampsia, and PROM (Table 3 ). Our study found a higher rate of IV glucose infusion in hypoglycemic LGA neonates. Christopher T. Cummings et al ( 21 ) reported that only 10% of LGA neonates required IV glucose infusion. This difference may be related to institutional policies; in our nursery, infants undergo four-hour observation before the feeding. Additionally, our study population had higher rates of respiratory distress and clinical sepsis, necessitating additional treatment. In this study, no infants experienced severe symptoms such as tremors, stupor, coma, or convulsions. This may be due to close monitoring and early intervention, including repeated feedings and intravenous glucose when oral feeding was insufficient. GDM was a significant maternal risk factor for neonatal hypoglycemia in LGA infants (OR = 1.61, 95% CI: 1.12–2.32, p = 0.011), indicating a 1.61-fold increased risk in LGA neonates born to mothers with GDM. This is likely due to fetal hyperinsulinism resulting from prolonged exposure to maternal hyperglycemia. Our findings are consistent with previous studies( 22 – 24 ), reinforcing the need for strict postnatal glucose monitoring in neonates born to GDM mothers. Pre-existing maternal diabetes showed a marginal association in univariate analysis (OR = 1.62, 95% CI: 0.91–2.87, p = 0.099) but was not significant in the multivariate model. While the observed trend suggests a possible association, further studies with larger sample sizes are needed to confirm this finding. Prior reports ( 25 – 27 ) that linked pre-pregnancy obesity with neonatal hypoglycemia, Wang and Luo ( 26 ) further reported that pre-pregnancy BMI ≥ 25 kg/m² was a risk factor for neonatal hypoglycemia. However, in this study, maternal obesity and BMI were not significant risk factors for neonatal hypoglycemia in multivariate analysis. However, maternal obesity and high BMI were more common in mothers of hypoglycemic LGA infants requiring intravenous glucose. Preeclampsia has also been associated with an increased risk of neonatal hypoglycemia, particularly in preterm infants ( 28 ). Preeclampsia and advanced maternal age (≥ 35 years) lost significance in our multivariate models (p = 0.067 and p = 0.087, respectively), suggesting mediation by other factors. Our data revealed that preeclampsia was more prevalent in mothers of hypoglycemic LGA infants requiring IV glucose, suggesting that more severe hypoglycemia occurs in infants born to mothers with preeclampsia, higher BMI, or overweight status. Multivariate analysis identified respiratory distress (OR = 2.28, 95% CI: 1.48–3.51, p = 0.0002) as a significant independent neonatal risk factor for early hypoglycemia. Potentially due to elevated insulin levels in LGA infants, which may impair surfactant production and delay pulmonary maturation, increasing the risk of respiratory distress ( 29 – 31 ). This finding is consistent with Yang et al(reference) ( 32 ), who reported a 1.9-fold increased risk of respiratory distress in newborns born to mothers with GDM in a meta-analysis. Hypoglycemic LGA infants also had lower gestational ages, 5-minute Apgar scores, and higher rates of clinical sepsis and lethargy compared to non-hypoglycemic infants (Table 1 ). Similar trends were observed in hypoglycemic LGA infants requiring IV glucose (Table 3 ). Male sex has been associated with adverse perinatal outcomes( 33 ) and has an increased risk of hypoglycemia in infants of GDM mothers ( 34 – 37 ). Unexpectedly, this study found female sex was a risk factor (OR = 1.47, 95% CI: 1.05–2.07, p = 0.026) for early hypoglycemia. This suggests a potential sex-specific difference in hypoglycemia susceptibility among LGA neonates and the need for further investigation. Given the high incidence of early hypoglycemia in LGA neonates, routine glucose screening within the first hour post-birth and early feeding are critical to stabilize blood glucose and prevent severe episodes, particularly in infants with respiratory distress, female sex, or maternal GDM. Therefore, we recommend that LGA infants, if they are in stable condition after birth, should be fed as soon as possible to maintain their blood sugar levels and prevent hypoglycemia. Conclusion Early hypoglycemia in LGA infants is not rare, with an incidence of 36.29% within the first 4 hours of life. Female sex, respiratory distress, and maternal GDM were independent risk factors. Early glucose monitoring and prompt intervention are crucial to preventing severe hypoglycemia. Frequent early feeding is recommended to stabilize blood glucose levels and reduce the need for IV glucose therapy. These findings have important clinical implications for neonatal care and should be integrated into glucose screening protocols. Declarations Acknowledgements Not applicable. Clinical trial number Not applicable. Authors’ contributions All authors contributed to the study’s conception and design. Patient demographic and clinical data were systematically retrieved and verified from the hospital’s electronic medical record system by Chia-Yu Wang, Lin-Yen Wang, and Lin-Yu Wang. Statistical analyses were performed by Chung-Han Ho, who ensured methodological rigor and the validity of the analytical results. The initial manuscript draft was prepared by Chia-Yu Wang under the scholarly supervision and critical revision of Lin-Yu Wang. All authors have read and approved the final manuscript. Funding The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Data availability The datasets used and/or analyzed during the current study are available from corresponding author upon reasonable request . Ethics approval and consent to participate This study was approved by the institutional review board of Chi Mei Medical Center and was in accordance with the 1964 Helsinki Declaration and its later amendments. Approval number was 11403-018. Informed written consents were obtained from the patients’ parents to conduct and publish this research. Consent for publication Not Applicable. Competing interests The authors declare no competing interests. Financial Disclosure Statement: The authors declare no financial conflicts of interest or disclosures References Harris DL, Weston PJ, Gamble GD, Harding JE. Glucose Profiles in Healthy Term Infants in the First 5 Days: The Glucose in Well Babies (GLOW) Study. 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Incidence and Risk Factors for Hypoglycemia During Fetal-to-Neonatal Transition in Premature Infants. Front Pead. 2020;8:34. Yildiz Atar H, Baatz JE, Ryan RM. Molecular Mechanisms of Maternal Diabetes Effects on Fetal and Neonatal Surfactant. Child (Basel Switzerland). 2021;8(4). Michael Weindling A. Offspring of diabetic pregnancy: short-term outcomes. Semin Fetal Neonatal Med. 2009;14(2):111–8. Fung GP, Chan LM, Ho YC, To WK, Chan HB, Lao TT. Does gestational diabetes mellitus affect respiratory outcome in late-preterm infants? Early Hum Dev. 2014;90(9):527–30. Yang F, Liu H, Ding C. Gestational diabetes mellitus and risk of neonatal respiratory distress syndrome: a systematic review and meta-analysis. Diabetol Metab Syndr. 2024;16(1):294. Hammond EI, STUDIES IN FETAL AND INFANT MORTALITY. II. DIFFERENTIALS IN MORTALITY BY SEX AND RACE. Am J Public Health Nation's Health. 1965;55(8):1152–63. Lary JM, Paulozzi LJ. Sex differences in the prevalence of human birth defects: a population-based study. Teratology. 2001;64(5):237–51. Bekedam DJ, Engelsbel S, Mol BW, van der Buitendijk SE. Pal-de Bruin KM. Male predominance in fetal distress during labor. Am J Obstet Gynecol. 2002;187(6):1605–7. Tundidor D, García-Patterson A, María MA, Ubeda J, Ginovart G, Adelantado JM, et al. Perinatal maternal and neonatal outcomes in women with gestational diabetes mellitus according to fetal sex. Gend Med. 2012;9(6):411–7. Bracero LA, Cassidy S, Byrne DW. Effect of gender on perinatal outcome in pregnancies complicated by diabetes. Gynecol Obstet Invest. 1996;41(1):10–4. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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1","display":"","copyAsset":false,"role":"figure","size":70394,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eStudy cohort selection flowchart.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 798 large-for-gestational-age newborns were identified (birth weight \u0026gt;90th percentile). Exclusions: 42 incomplete records, 5 chromosomal anomalies, 11 congenital malformations, 17 congenital infections, and preterm large-for-gestational-age newborns (\u0026lt;37 weeks). Final cohort: 697 term large-for-gestational-age neonates. Of these, 253 (36.3%) developed hypoglycemia (hypoglycemia group), and 444 had no hypoglycemia (non-hypoglycemia group).\u003c/p\u003e","description":"","filename":"image1.png","url":"https://assets-eu.researchsquare.com/files/rs-7545928/v1/0e97830896af3e8c71ec57d3.png"},{"id":94211619,"identity":"c7891d71-4d45-47e5-b808-dae907bbd4ca","added_by":"auto","created_at":"2025-10-23 15:46:58","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":47904,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTiming of first hypoglycemic episode in large-for-gestational-age neonates.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBar chart showing the distribution of first hypoglycemic episodes among large-for-gestational-age neonates. Black bars indicate neonates not requiring intravenous glucose infusion; gray bars indicate those requiring intravenous glucose infusion.\u003c/p\u003e","description":"","filename":"image2.png","url":"https://assets-eu.researchsquare.com/files/rs-7545928/v1/ebb737747c43bf7bc55ce34e.png"},{"id":94211623,"identity":"db25d349-26fb-46c5-b2b2-8831bdeb65cd","added_by":"auto","created_at":"2025-10-23 15:46:58","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":22030,"visible":true,"origin":"","legend":"\u003cp\u003eBox plot showingblood glucose levels over the first 4 hours in LGA neonates, comparing hypoglycemicand non-hypoglycemic groups. Boxes represent the interquartile range, with whiskers indicating the range of values.\u003c/p\u003e","description":"","filename":"image3.png","url":"https://assets-eu.researchsquare.com/files/rs-7545928/v1/9979b80d570b4a1e0b67bb7d.png"},{"id":94213424,"identity":"93e8a8e1-8fc7-41e5-8fce-6c953592d3ec","added_by":"auto","created_at":"2025-10-23 16:02:58","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":20907,"visible":true,"origin":"","legend":"\u003cp\u003eBox plot showing blood glucose levels over the first 4 hours in hypoglycemic LGA neonates, comparing those with and without intravenous (IV) glucose infusion. Boxes represent the interquartile range, with whiskers indicating the range of values.\u003c/p\u003e","description":"","filename":"image4.png","url":"https://assets-eu.researchsquare.com/files/rs-7545928/v1/42b03bd257c2fa7b33f1ffbd.png"},{"id":95525539,"identity":"f0a55578-7d40-4384-8c4b-26d8bfde8a84","added_by":"auto","created_at":"2025-11-10 10:05:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1688960,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7545928/v1/a666b2c0-ccf4-4dcd-bdcc-625f6f9ae4cd.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Frequency and Risk Factors for Early Hypoglycemia in Full-term LGA Infants: A Retrospective Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHypoglycemia is the most common metabolic disorder occurring in the neonatal period, and blood glucose concentrations change rapidly in the hours after birth (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The abrupt cessation of continuous maternal glucose supply after birth can lead to transient hypoglycemia in newborns. Blood glucose levels typically reach their lowest point as low as 30 mg/dL within 30 to 90 minutes post-birth and then gradually normalize (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Undiagnosed or prolonged hypoglycemia can lead to brain injury and adverse neurodevelopmental outcomes (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eLarge-for gestational-age (LGA) infants, defined as having a birth weight above the 90th percentile for gestational age(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), are at increased risk of hypoglycemia due to fetal hyperinsulinism, often triggered by maternal hyperglycemia during pregnancy. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). This hyperinsulinism drives excessive intrauterine growth by increasing fetal fat and protein stores(\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). LGA births are often associated with maternal diabetes; however, hypoglycemia also occurs in 15\u0026ndash;19% of LGA infants born to non-diabetic mothers (\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn 2011, the American Academy of Pediatrics (AAP) recommended routine glucose monitoring for at-risk neonates, targeting levels above 40 mg/dL (2.22 mmol/L) from birth to 4 hours and above 45 mg/dL (2.5 mmol/L) from 4 to 24 hours, using repeated oral feeding or intravenous glucose administration (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Screening at-risk infants and managing low blood glucose levels in the immediate postnatal period are critical aspects of neonatal care. However, current screening guidelines rely more on expert opinion due to limited evidence (\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). In Taiwan, evidence on early hypoglycemia among full-term LGA infants remains limited. Therefore, this study aims to determine the incidence, identify neonatal and maternal risk factors, and characterize blood glucose patterns of early hypoglycemia in full-term LGA infants admitted to a well-baby nursery in Southern Taiwan, with the goal of informing local screening and management protocols.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eWe conducted a retrospective, single-center study through a structured review of medical records of term LGA neonates born between January 1, 2012, and December 31, 2021, and admitted to the well-baby nursery of a tertiary medical center in Southern Taiwan. The nursery admits newborns with a gestational age over 35 weeks who appear healthy after birth, and, as part of routine policy, all newborns undergo a four-hour observation period, with fasting glucose monitored in those at high risk. Blood glucose levels were measured at 0.5, 1, 2, and 4 hours of life in neonates at risk of hypoglycemia, in accordance with the 2011 AAP recommendations (\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eEligible participants were term LGA neonates, defined as birth weight above the 90th percentile for gestational age based on the Lubchenco Growth Curve (\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e), with term gestation defined as 37 weeks to 41 weeks and 6 days. Infants with chromosomal anomalies, major congenital malformations, congenital infections, or without blood glucose testing within the first four hours of life were excluded.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e1. Blood Glucose Testing\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eCapillary blood samples were collected via heel pricks, and glucose concentrations were measured using the Fora MD Control POCT S10 glucometer (model TD-4258; TaiDoc Technology Corporation, New Taipei City, Taiwan). The glucometer was calibrated monthly for accuracy. Glucose values below 40 mg/dL were confirmed using an automated biochemical analyzer (TBA-c16000; Toshiba Medical Systems Corporation, Tokyo, Japan). Blood glucose screening was performed at 0.5, 1, 2, and 4 hours before feeding.\u003c/p\u003e\n\u003cp\u003eHypoglycemia was defined as blood glucose levels below 40 mg/dL from birth to four hours of life, or below 45 mg/dL from four to 24 hours, according to AAP recommendations (\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e). Symptoms of hypoglycemia included tremors, jitteriness, irritability, seizures, lethargy, poor feeding, and apnea. Neonates with initial blood glucose levels below 40 mg/dL received immediate feeding, followed by reevaluation after 30 minutes. Persistent hypoglycemia was managed with intravenous (IV) glucose infusion. Neonates with repeated low glucose levels or symptoms were transferred to the neonatal ward. Hypoglycemia episodes were defined as one or more consecutive readings below 40 mg/dL.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e2. Definition of study parameters\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eRespiratory distress was defined as tachypnea (respiratory rate\u0026thinsp;\u0026gt;\u0026thinsp;60 breaths/min) with signs such as grunting, retractions, nasal flaring, or cyanosis. Pregnancy-induced hypertension (PIH) was a systolic blood pressure\u0026thinsp;\u0026ge;\u0026thinsp;140 mmHg or diastolic\u0026thinsp;\u0026ge;\u0026thinsp;90 mmHg, and preeclampsia was PIH with proteinuria after 20 weeks\u0026rsquo; gestation. Gestational diabetes mellitus (GDM) was diagnosed via an abnormal oral glucose tolerance test (OGTT) under Taiwanese prenatal care protocols, using thresholds of fasting glucose\u0026thinsp;\u0026ge;\u0026thinsp;92 mg/dL and \u0026lt;\u0026thinsp;126 mg/dL, 1-hour\u0026thinsp;\u0026ge;\u0026thinsp;180 mg/dL, or 2-hour\u0026thinsp;\u0026ge;\u0026thinsp;153 mg/dL and \u0026lt;\u0026thinsp;200 mg/dL. Meconium-stained amniotic fluid was defined as the presence of meconium before delivery, and premature rupture of membranes (PROM) as rupture before labor onset. Clinical sepsis followed standard neonatal sepsis criteria.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e3. Statistical Analysis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eData are presented as means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation for continuous variables and as frequencies with percentages for categorical variables. Comparisons between hypoglycemic and non-hypoglycemic neonates were performed using Pearson\u0026rsquo;s chi-square test or Fisher\u0026rsquo;s exact test for categorical variables and the Mann-Whitney U test for continuous variables. Blood glucose levels at various post-birth time points were visualized using box plots. To identify risk factors for early hypoglycemia in LGA neonates, logistic regression with Firth\u0026rsquo;s penalized likelihood approach was employed to account for rare events. Both full and reduced logistic regression models were developed. The full model included all potential confounders to provide the most accurate estimation of independent associations, while the reduced model included variables with a univariate p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.1 in the multivariable logistic regression. Results are reported as odds ratio (OR) with 95% confidence interval (CI). All statistical analyses were performed using SAS statistical software (version 9.4; SAS Institute, Inc., Cary, NC, USA), with p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003e1. Clinical Characteristics of LGA Infants and Maternal Demographics in Hypoglycemia and Non-Hypoglycemia Groups\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn our study, 798 newborns were identified as LGA, defined by a birth weight above the 90th percentile for gestational age. Blood glucose concentration was measured for all infants after birth. Our analysis excluded 42 newborns due to incomplete medical records, 5 with chromosome anomalies, 11 with congenital malformations, and 17 with congenital infections. LGA newborns born before 37 weeks of gestation were excluded, resulting in a final cohort of 697 newborns that met the inclusion criteria. Among these 697 LGA neonates, 253 (36.29%) experienced at least one hypoglycemic episode and were categorized into the \"hypoglycemia group,\" while the remaining 444 neonates without hypoglycemia episodes comprised the \"non-hypoglycemia group.\"(Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eAmong neonates with hypoglycemia (n\u0026thinsp;=\u0026thinsp;253), 129 (50.99%) were male and 124 (49.01%) were female. Compared with the non-hypoglycemic group, these neonates had lower gestational age and 5-minute Apgar scores, as well as higher rates of clinical sepsis, respiratory distress, and lethargy. No significant differences were observed in sex, delivery mode, birth weight, head and chest circumference, body length, 1-minute Apgar score, or hypothermia (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Regarding maternal characteristics, both groups were comparable in age, weight, Body Mass Index (BMI), height, preeclampsia, prior history of LGA, meconium-stained amniotic fluid, PROM, maternal diabetes mellitus, and hypertension. However, mothers of the hypoglycemic group had significantly higher rates of multiparity and GDM (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eClinical characteristics of LGA infants in hypoglycemic and non-hypoglycemic groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHypoglycemia\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;253,36.3%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNon-hypoglycemia\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;444,63.7%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0605\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e129(50.99)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e259(58.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e124(49.01)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e185(41.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMode of delivery, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.1183\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVaginal delivery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e98(38.74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e199(44.82)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCesarean section\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e155(61.26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e245(55.18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBirth weight (g), Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3896.97\u0026thinsp;\u0026plusmn;\u0026thinsp;269.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3885.02\u0026thinsp;\u0026plusmn;\u0026thinsp;204.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.7875\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGestational age(weeks), Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e38.58\u0026thinsp;\u0026plusmn;\u0026thinsp;1.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e38.93\u0026thinsp;\u0026plusmn;\u0026thinsp;1.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMacrosomia, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.4592\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;4000 g\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e188(74.31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e341(76.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;=4000 g\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e65(25.69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e103(23.20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWeek of delivery, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0731\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;40 weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e214(84.58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e351(79.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;=40 weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e39(15.42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e93(20.95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHead circumference, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e35.42\u0026thinsp;\u0026plusmn;\u0026thinsp;1.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e35.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.8693\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChest circumference, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e35.06\u0026thinsp;\u0026plusmn;\u0026thinsp;1.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e34.99\u0026thinsp;\u0026plusmn;\u0026thinsp;1.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.4396\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBody height, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e52.89\u0026thinsp;\u0026plusmn;\u0026thinsp;1.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e52.78\u0026thinsp;\u0026plusmn;\u0026thinsp;2.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.3001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eApgar score (1 min), Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7.94\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.7512\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eApgar score (5 min), Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8.94\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0224\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClinical sepsis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e27(10.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20(4.50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0018\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRespiratory distress\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e81(32.02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e63(14.19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBirth trauma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9(3.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12(2.70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.5256\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypothermia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e57(22.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e95(21.40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.7275\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003elethargy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12(4.74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7(1.58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0136\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBlood glucose level, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0.5 hour\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e46.17\u0026thinsp;\u0026plusmn;\u0026thinsp;8.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e65.67\u0026thinsp;\u0026plusmn;\u0026thinsp;13.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1 hour\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e40.26\u0026thinsp;\u0026plusmn;\u0026thinsp;8.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e62.82\u0026thinsp;\u0026plusmn;\u0026thinsp;13.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2 hour\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e61.15\u0026thinsp;\u0026plusmn;\u0026thinsp;18.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e72.98\u0026thinsp;\u0026plusmn;\u0026thinsp;12.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4 hour\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e72.39\u0026thinsp;\u0026plusmn;\u0026thinsp;16.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e75.23\u0026thinsp;\u0026plusmn;\u0026thinsp;13.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.6324\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSevere hypoglycemia (\u0026lt;\u0026thinsp;25 mg/dL), n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2(0.79)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0(0.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.1314\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003ea. Categorical variables analysis by Chi-square test or Fisher's exact test, continuous variables analysis by Mann-Whitney U test.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eb. Values are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation or number (%)\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003ec. LGA: large for gestational age.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMaternal demographic characteristics in hypoglycemic and non-hypoglycemic groups of LGA neonates.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHypoglycemia\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;253, 36.3%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNon-hypoglycemia\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;444, 63.7%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaternal age, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33.00\u0026thinsp;\u0026plusmn;\u0026thinsp;4.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33.01\u0026thinsp;\u0026plusmn;\u0026thinsp;4.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.8931\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaternal age\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0869\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;35 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e147(58.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e287(64.64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;=35 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e106(41.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e157(35.36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaternal weight (kg), Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e77.31\u0026thinsp;\u0026plusmn;\u0026thinsp;13.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e75.81\u0026thinsp;\u0026plusmn;\u0026thinsp;12.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.1051\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaternal height (cm), Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e161.35\u0026thinsp;\u0026plusmn;\u0026thinsp;5.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e161.19\u0026thinsp;\u0026plusmn;\u0026thinsp;7.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.9270\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29.72\u0026thinsp;\u0026plusmn;\u0026thinsp;4.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29.52\u0026thinsp;\u0026plusmn;\u0026thinsp;10.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0759\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.1567\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18.5\u0026ndash;24.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41(16.21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e71(15.99)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25.0-29.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e103(40.71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e216(48.65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e30\u0026ndash;34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e75(29.64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e114(25.68)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;=35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e34(13.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43(9.68)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParity, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0221\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrevious history with LGA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41(16.21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e64(14.41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.5250\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGestational diabetes mellitus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e91(35.97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e100(22.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreeclampsia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17(6.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16(3.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0625\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMeconium-stained amniotic fluid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8(3.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16(3.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.7585\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePremature rupture of membrane\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e81(32.02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e126(28.38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.3122\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaternal diabetes mellitus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24(9.49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27(6.08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0969\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaternal hypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19(7.51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34(7.66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.9436\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003ea. Categorical variables analysis by Chi-square test or Fisher's exact test, continuous variables analysis by Mann-Whitney U test.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eb. Values are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation or number (%)\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e2. Incidence of Hypoglycemia at Different Hours of Life and Incidence of Hypoglycemia Requiring IV Glucose Treatment\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe overall incidence of hypoglycemia among LGA neonates was 34.99%. Most cases occurred within the first hour of life: 39.13% (n\u0026thinsp;=\u0026thinsp;99) at 0.5 hours and 59.29% (n\u0026thinsp;=\u0026thinsp;150) at 1 hour, while only 1.58% (n\u0026thinsp;=\u0026thinsp;4) occurred at 2 hours, indicating that 98.41% of hypoglycemic episodes developed within the first hour (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Among the 253 hypoglycemic neonates, 103 (40.71%) required intravenous glucose infusion due to persistent hypoglycemia despite repeated early feeding (Supplement Digital Content 1, Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Of these, 55 neonates presented with symptoms such as jitteriness, lethargy, and tachypnea, though no seizures were reported. The majority of IV glucose treatments were initiated at 0.5 hours (53.40%, n\u0026thinsp;=\u0026thinsp;55) and 1 hour (47.00%, n\u0026thinsp;=\u0026thinsp;47), with only one neonate (0.97%) requiring intervention at 2 hours (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003e3. Clinical Characteristics of LGA Infants and Maternal Demographics in Hypoglycemic Infants with and without IV Glucose Infusion\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAmong hypoglycemic neonates, 56 males and 47 females required IV glucose infusion. No significant differences were observed between infusion and non-infusion groups in sex, gestational age, birth weight, anthropometric measures, or mode of delivery. However, neonates receiving IV glucose had lower 1- and 5-minute Apgar scores and higher rates of respiratory distress and clinical sepsis (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Regarding maternal factors, no differences were found in height, meconium-stained amniotic fluid, diabetes mellitus, or hypertension. In contrast, mothers of neonates requiring IV glucose were significantly older, heavier, and had higher BMI, multiparity rates, and increased incidences of GDM and PROM (Supplement Digital Content 2).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eClinical characteristics of hypoglycemic LGA neonates with and without intravenous (IV) glucose infusion.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eHypoglycemic LGA\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWith IV glucose\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;103, 40.7%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWithout IV glucose\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;150, 59.3%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.3727\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e56(54.37)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e73(48.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e47(45.63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e77(51.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMode of delivery, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.8137\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVaginal delivery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e39(37.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e59(39.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCesarean section\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e64(62.14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e91(60.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBirth weight (g), Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3920.42\u0026thinsp;\u0026plusmn;\u0026thinsp;323.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3880.87\u0026thinsp;\u0026plusmn;\u0026thinsp;224.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.6901\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGestational age (weeks), Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e38.52\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e38.61\u0026thinsp;\u0026plusmn;\u0026thinsp;1.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.4875\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMacrosomia, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0555\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;4000 gm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e70(67.96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e118(78.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;=4000 gm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e33(32.04)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e32(21.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWeek of delivery, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;40 weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e90(87.38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e124(82.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;=40 weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e13(12.62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e26(17.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHead circumference (cm), Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e35.59\u0026thinsp;\u0026plusmn;\u0026thinsp;1.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e35.31\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0446\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChest circumference (cm), Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e35.25\u0026thinsp;\u0026plusmn;\u0026thinsp;1.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e34.93\u0026thinsp;\u0026plusmn;\u0026thinsp;1.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0550\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBody height (cm), Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e52.77\u0026thinsp;\u0026plusmn;\u0026thinsp;1.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e52.97\u0026thinsp;\u0026plusmn;\u0026thinsp;1.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.5542\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eApgar score (1 min), Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7.82\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7.98\u0026thinsp;\u0026plusmn;\u0026thinsp;0.142\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0028\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eApgar score (5 min), Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0012\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClinical sepsis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e21(20.39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6(4.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHyperbilirubinemia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e55(53.40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17(11.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRespiratory distress\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e54(52.43)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27(18.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBirth trauma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4(3.88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5(3.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.0000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypothermia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17(16.50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e40(26.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0573\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLethargy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7(6.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5(3.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.2366\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBlood glucose level, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0.5 hour\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e43.69\u0026thinsp;\u0026plusmn;\u0026thinsp;7.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e47.87\u0026thinsp;\u0026plusmn;\u0026thinsp;8.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1 hour\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e37.25\u0026thinsp;\u0026plusmn;\u0026thinsp;6.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e42.33\u0026thinsp;\u0026plusmn;\u0026thinsp;8.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2 hour\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e49.50\u0026thinsp;\u0026plusmn;\u0026thinsp;19.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e69.16\u0026thinsp;\u0026plusmn;\u0026thinsp;12.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4 hour\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e72.70\u0026thinsp;\u0026plusmn;\u0026thinsp;17.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e72.18\u0026thinsp;\u0026plusmn;\u0026thinsp;16.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.6324\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003ea. Categorical variables analysis by Chi-square test or Fisher's exact test, continuous variables analysis by Mann-Whitney U test.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eb. Values are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation or number (%)\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003ec. LGA: large for gestational age\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e4. Blood Glucose Levels\u003c/b\u003e\u003c/p\u003e\n\u003ch3\u003e4.A. Mean Blood Glucose Levels in Hypoglycemia vs. Non-Hypoglycemia Groups\u003c/h3\u003e\n\u003cp\u003eIn the hypoglycemia group, mean glucose levels were 46.17\u0026thinsp;\u0026plusmn;\u0026thinsp;8.46 mg/dL at 0.5 hours, 40.26\u0026thinsp;\u0026plusmn;\u0026thinsp;8.16 mg/dL at 1 hour, 61.15\u0026thinsp;\u0026plusmn;\u0026thinsp;18.47 mg/dL at 2 hours, and 72.39\u0026thinsp;\u0026plusmn;\u0026thinsp;16.68 mg/dL at 4 hours (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The lowest observed mean glucose occurred at 1 hour (40.26\u0026thinsp;\u0026plusmn;\u0026thinsp;8.16 mg/dL), with two neonates recording below 25 mg/dL. Compared with the non-hypoglycemia group, mean glucose was significantly lower at all time points: 0.5 hours (46.17 vs. 65.67 mg/dL, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), 1 hour (40.26 vs. 62.82 mg/dL, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), 2 hours (61.15 vs. 72.98 mg/dL, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), and 4 hours (72.39 vs. 75.23 mg/dL, p\u0026thinsp;=\u0026thinsp;0.0213) (Supplement Digital Content 3).\u003c/p\u003e\u003cp\u003e\u003cem\u003e4.B. Mean Blood Glucose Levels in Hypoglycemic LGA Infants with and without IV Glucose Infusion\u003c/em\u003e\u003c/p\u003e\u003cp\u003eOf the 253 hypoglycemic neonates, 103 (40.7%) required IV glucose. Their mean glucose levels were 43.69\u0026thinsp;\u0026plusmn;\u0026thinsp;7.12 mg/dL at 0.5 hours, 37.25\u0026thinsp;\u0026plusmn;\u0026thinsp;6.98 mg/dL at 1 hour, 49.50\u0026thinsp;\u0026plusmn;\u0026thinsp;19.30 mg/dL at 2 hours, and 72.70\u0026thinsp;\u0026plusmn;\u0026thinsp;17.37 mg/dL at 4 hours (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The lowest value occurred at 1 hour (37.25\u0026thinsp;\u0026plusmn;\u0026thinsp;6.98 mg/dL), with two infants below 25 mg/dL. Compared with those not requiring IV infusion, the IV group had significantly lower glucose at 0.5 hours (43.69 vs. 47.87 mg/dL, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), 1 hour (37.25 vs. 42.33 mg/dL, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), and 2 hours (49.50 vs. 69.16 mg/dL, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), but levels were comparable at 4 hours (72.70 vs. 72.18 mg/dL, p\u0026thinsp;=\u0026thinsp;0.6324) (Supplement Digital Content 4).\u003c/p\u003e\u003cp\u003e\u003cb\u003e5. Risk factors for early hypoglycemia\u003c/b\u003e\u003c/p\u003e\n\u003ch3\u003eCombined Effects of Neonatal and Maternal Factors on Hypoglycemia in LGA Neonates\u003c/h3\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e summarizes the multivariable analysis of neonatal and maternal risk factors for hypoglycemia in LGA neonates, adjusting for potential confounders. Respiratory distress (OR\u0026thinsp;=\u0026thinsp;2.28, 95% CI: 1.48\u0026ndash;3.51, p\u0026thinsp;=\u0026thinsp;0.0002) was a strong independent predictor, more than twofold increased risk. Female sex was also significantly associated with hypoglycemia (OR\u0026thinsp;=\u0026thinsp;1.47, 95% CI: 1.05\u0026ndash;2.07, p\u0026thinsp;=\u0026thinsp;0.0258). Although clinical sepsis and lethargy showed significance in univariate analyses, these associations were no longer evident after multivariable adjustment. Other neonatal factors, including cesarean section, macrosomia, Apgar scores, delivery\u0026thinsp;\u0026ge;\u0026thinsp;40 weeks, hypothermia, and birth trauma, showed no association.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMaternal demographic characteristics in hypoglycemic LGA neonates with and without intravenous (IV) glucose infusion.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eHypoglycemic LGA\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWith IV glucose\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;103, 40.7%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWithout IV glucose\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;150, 59.3%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaternal age, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32.21\u0026thinsp;\u0026plusmn;\u0026thinsp;4.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33.54\u0026thinsp;\u0026plusmn;\u0026thinsp;4.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0318\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaternal age\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.1105\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;35 year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e66(64.08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e81(54.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;=35 year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37(35.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e69(46.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaternal weight (kg), Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e80.06\u0026thinsp;\u0026plusmn;\u0026thinsp;14.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e75.42\u0026thinsp;\u0026plusmn;\u0026thinsp;12.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0060\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaternal height (cm), Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e161.92\u0026thinsp;\u0026plusmn;\u0026thinsp;5.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e160.96\u0026thinsp;\u0026plusmn;\u0026thinsp;5.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.1238\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30.55\u0026thinsp;\u0026plusmn;\u0026thinsp;5.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29.15\u0026thinsp;\u0026plusmn;\u0026thinsp;4.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0247\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.1055\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18.5\u0026ndash;24.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15(14.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26(17.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25.0-29.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35(33.98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e68(45.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e30\u0026ndash;34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e34(33.01)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41(27.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;=35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19(18.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15(10.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParity, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.70\u0026thinsp;\u0026plusmn;\u0026thinsp;0.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.95\u0026thinsp;\u0026plusmn;\u0026thinsp;0.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0035\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrevious history with LGA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13(12.62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28(18.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.1998\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGestational diabetes mellitus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e45(43.69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46(30.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0340\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreeclampsia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11(10.68)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6(4.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0371\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMeconium-stained amniotic fluid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3(2.91)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5(3.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.0000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePremature rupture of membrane\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41(39.81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40(26.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0277\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaternal diabetes mellitus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14(13.59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10(6.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0648\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaternal hypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8(7.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11(7.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.8977\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003ea. Categorical variables analysis by Chi-square test or Fisher's exact test, continuous variables analysis by Mann-Whitney U test.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eb. Values are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation or number (%)\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003ec. LGA: large for gestational age.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eLogistic regression with Firth\u0026rsquo;s approach assessing combined neonatal and maternal risk factors for hypoglycemia in LGA neonates.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnivariate OR (95%CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReduced model *\u003c/p\u003e\u003cp\u003e(95%CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003efull model (95%CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNeonatal factor\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.35(0.99,1.83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.0613\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.05(1.32,3.17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0150\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.47(1.05,2.07)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.0258\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMode of delivery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVaginal delivery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCesarean section\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.28(0.94,1.76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e01205\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.24(0.85,1.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.2717\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMacrosomia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;4000 g\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;=4000 g\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.15(0.80,1.64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.4539\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.16(0.74,1.82)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.5232\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWeek of delivery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;40 weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;=40 weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.69(0.46,1.04)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.0788\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.91(0.59,1.41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.6670\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.98(0.62,1.55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.9340\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHead circumference (cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.95(0.85,1.07)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.4162\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.94(0.82,1.08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.3876\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChest circumference (cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.03(0.93,1.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.5443\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.02(0.90,1.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.7577\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eApgar score (1 min)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.80(0.53,1.23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.3159\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.23(0.75,2.02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.4143\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eApgar score (5 min)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.33(0.10,1.08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.0677\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.87(0.52,1.46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.6044\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.85(0.47,1.55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.5999\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClinical sepsis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.51(1.38,4.58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.0026\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.37(0.70,2.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.3605\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.40(0.71,2.76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.3391\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHyperbilirubinemia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.92(1.97,4.34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.05(1.32,3.17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0013\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.09(1.33,3.28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.0015\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRespiratory distress\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.84(1.95,4.13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.24(1.48,3.41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.28(1.48,3.51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.0002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBirth trauma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.34(0.56,3.23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.5086\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.18(0.44,3.18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.7379\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypothermia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.07(0.74,1.55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.7181\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.21(0.81,1.83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.3525\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLethargy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.02(1.18,7.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.0215\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.10(0.38,3.13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.8652\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.05(0.35,3.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.9365\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMaternal factor\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaternal age\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.00(0.97,1.04)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.9756\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaternal age\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;=35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.32(0.96,1.81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.0873\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.83(0.59,1.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.2666\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.13(0.79,1.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.5038\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaternal weight (kg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.01(0.99,1.02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.1394\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaternal height (cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.00(0.98,1.03)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.8063\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.00(0.99,1.02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.7728\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18.5\u0026ndash;24.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25.0-29.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.82(0.53,1.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.3982\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.82(0.50,1.32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.4080\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e30\u0026ndash;34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.14(0.70,1.84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.6041\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.93(0.55,1.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.7780\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;=35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.37(0.76,2.47)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.3012\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.86(0.43,1.69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.6546\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.14(0.95,1.37)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.1741\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.20(0.97,1.49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.0992\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrevious history with LGA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.15(0.75,1.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.5153\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.01(0.62,1.65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.9584\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGestational diabetes mellitus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.93(1.37,2.71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.0001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.61(1.12,2.32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0109\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.57(1.07,2.30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.0202\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreeclampsia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.92(0.95,3.87)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.0678\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.28(0.60,2.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.5232\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.35(0.62,2.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.4531\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMeconium-stained amniotic fluid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.90(0.38,2.12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.8086\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.82(0.32,2.08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.6710\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePremature rupture of membrane\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.19(0.85,1.66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.3100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.14(0.79,1.63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.4915\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaternal diabetes mellitus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.62(0.91,2.87)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.0990\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.21(0.65,2.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.5418\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.20(0.64,2.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.5698\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaternal hypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.99(0.55,1.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.9710\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.89(0.47,1.70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.7234\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e*The reduced model included variables with a univariate p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.1 in the multivariable logistic regression. Results are reported as odds ratios (ORs) with 95% confidence intervals (CIs). p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 is considered statistically significant.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cb\u003eSupplementary Table\u0026nbsp;1: Timing of the first hypoglycemic episode in hypoglycemic LGA neonates.\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAmong maternal factors, GDM was independently associated with hypoglycemia (OR\u0026thinsp;=\u0026thinsp;1.57, 95% CI: 1.07\u0026ndash;2.30, p\u0026thinsp;=\u0026thinsp;0.0202), indicating a 57% higher risk in neonates born to mothers with GDM. In contrast, maternal weight, height, BMI, parity, PROM, meconium-stained amniotic fluid, and hypertension showed no significant associations in either univariate or multivariable models.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eDuring the study period (January 1, 2012\u0026ndash;December 31, 2021), our hospital recorded 14,198 births, with 798 (5.6%) identified as large-for-gestational-age (LGA), consistent with global prevalence rates (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Of these, 697 full-term LGA neonates met inclusion criteria, with 253 (36.3%) experiencing early hypoglycemia (blood glucose\u0026thinsp;\u0026le;\u0026thinsp;40 mg/dL within the first four hours of life). The reported incidence of early hypoglycemia in LGA infants varies across studies, ranging from 8.1 to 35.7% (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). This variation is likely due to differences in definitions of hypoglycemia and timing of blood sampling. The frequency of hypoglycemia in our study was higher than in previous reports (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), likely due to the inclusion of infants born to mothers with GDM and the early glucose monitoring at 0.5 hours post-birth. Our findings are consistent with Hosagasi et al. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), who reported a similar high incidence in at-risk neonates.\u003c/p\u003e\u003cp\u003eAnalysis of the timing of the first hypoglycemic episodes revealed that most hypoglycemic episodes (98.4%) occurred within the first hour, with 39.1% at 0.5 hours and 59.3% at 1 hour; only 1.58% occurred at 2 hours (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The mean blood glucose in hypoglycemic neonates (37.3\u0026thinsp;\u0026plusmn;\u0026thinsp;7.0 mg/dL) was significantly lower than in non-hypoglycemic neonates (42.3\u0026thinsp;\u0026plusmn;\u0026thinsp;8.3 mg/dL, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), reaching a lowest level at 1 hour, consistent with prior research (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). This indicates a rapid postnatal decline in blood glucose levels in LGA neonates, who reach their lowest level at one hour of life. Compared to our earlier study on small-for-gestational-age (SGA) infants (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), LGA neonates developed hypoglycemia earlier, predominantly within 1 hour. In contrast, in SGA infants, it predominantly occurred within two hours. It reflects differences in metabolic dynamics.\u003c/p\u003e\u003cp\u003eAmong the 253 hypoglycemic neonates, 103 (40.7%) required transfer to the neonatal ward for IV glucose infusion due to persistent hypoglycemia despite repeated oral feeding attempts (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Of these 103 neonates, 55 (53.4%) required IV glucose at 0.5 hours, and 47(45.63%) at 1 hour. These neonates had higher rates of respiratory distress, hyperbilirubinemia, clinical sepsis, and low Apgar scores, with their mothers showing higher BMI, GDM, multiparity, preeclampsia, and PROM (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Our study found a higher rate of IV glucose infusion in hypoglycemic LGA neonates. Christopher T. Cummings et al (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) reported that only 10% of LGA neonates required IV glucose infusion. This difference may be related to institutional policies; in our nursery, infants undergo four-hour observation before the feeding. Additionally, our study population had higher rates of respiratory distress and clinical sepsis, necessitating additional treatment. In this study, no infants experienced severe symptoms such as tremors, stupor, coma, or convulsions. This may be due to close monitoring and early intervention, including repeated feedings and intravenous glucose when oral feeding was insufficient.\u003c/p\u003e\u003cp\u003eGDM was a significant maternal risk factor for neonatal hypoglycemia in LGA infants (OR\u0026thinsp;=\u0026thinsp;1.61, 95% CI: 1.12\u0026ndash;2.32, p\u0026thinsp;=\u0026thinsp;0.011), indicating a 1.61-fold increased risk in LGA neonates born to mothers with GDM. This is likely due to fetal hyperinsulinism resulting from prolonged exposure to maternal hyperglycemia. Our findings are consistent with previous studies(\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), reinforcing the need for strict postnatal glucose monitoring in neonates born to GDM mothers.\u003c/p\u003e\u003cp\u003ePre-existing maternal diabetes showed a marginal association in univariate analysis (OR\u0026thinsp;=\u0026thinsp;1.62, 95% CI: 0.91\u0026ndash;2.87, p\u0026thinsp;=\u0026thinsp;0.099) but was not significant in the multivariate model. While the observed trend suggests a possible association, further studies with larger sample sizes are needed to confirm this finding. Prior reports (\u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) that linked pre-pregnancy obesity with neonatal hypoglycemia, Wang and Luo (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) further reported that pre-pregnancy BMI\u0026thinsp;\u0026ge;\u0026thinsp;25 kg/m\u0026sup2; was a risk factor for neonatal hypoglycemia. However, in this study, maternal obesity and BMI were not significant risk factors for neonatal hypoglycemia in multivariate analysis. However, maternal obesity and high BMI were more common in mothers of hypoglycemic LGA infants requiring intravenous glucose.\u003c/p\u003e\u003cp\u003ePreeclampsia has also been associated with an increased risk of neonatal hypoglycemia, particularly in preterm infants (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Preeclampsia and advanced maternal age (\u0026ge;\u0026thinsp;35 years) lost significance in our multivariate models (p\u0026thinsp;=\u0026thinsp;0.067 and p\u0026thinsp;=\u0026thinsp;0.087, respectively), suggesting mediation by other factors. Our data revealed that preeclampsia was more prevalent in mothers of hypoglycemic LGA infants requiring IV glucose, suggesting that more severe hypoglycemia occurs in infants born to mothers with preeclampsia, higher BMI, or overweight status.\u003c/p\u003e\u003cp\u003eMultivariate analysis identified respiratory distress (OR\u0026thinsp;=\u0026thinsp;2.28, 95% CI: 1.48\u0026ndash;3.51, p\u0026thinsp;=\u0026thinsp;0.0002) as a significant independent neonatal risk factor for early hypoglycemia. Potentially due to elevated insulin levels in LGA infants, which may impair surfactant production and delay pulmonary maturation, increasing the risk of respiratory distress (\u003cspan additionalcitationids=\"CR30\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). This finding is consistent with Yang et al(reference) (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e), who reported a 1.9-fold increased risk of respiratory distress in newborns born to mothers with GDM in a meta-analysis. Hypoglycemic LGA infants also had lower gestational ages, 5-minute Apgar scores, and higher rates of clinical sepsis and lethargy compared to non-hypoglycemic infants (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Similar trends were observed in hypoglycemic LGA infants requiring IV glucose (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Male sex has been associated with adverse perinatal outcomes(\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e) and has an increased risk of hypoglycemia in infants of GDM mothers (\u003cspan additionalcitationids=\"CR35 CR36\" citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Unexpectedly, this study found female sex was a risk factor (OR\u0026thinsp;=\u0026thinsp;1.47, 95% CI: 1.05\u0026ndash;2.07, p\u0026thinsp;=\u0026thinsp;0.026) for early hypoglycemia. This suggests a potential sex-specific difference in hypoglycemia susceptibility among LGA neonates and the need for further investigation.\u003c/p\u003e\u003cp\u003eGiven the high incidence of early hypoglycemia in LGA neonates, routine glucose screening within the first hour post-birth and early feeding are critical to stabilize blood glucose and prevent severe episodes, particularly in infants with respiratory distress, female sex, or maternal GDM. Therefore, we recommend that LGA infants, if they are in stable condition after birth, should be fed as soon as possible to maintain their blood sugar levels and prevent hypoglycemia.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eEarly hypoglycemia in LGA infants is not rare, with an incidence of 36.29% within the first 4 hours of life. Female sex, respiratory distress, and maternal GDM were independent risk factors. Early glucose monitoring and prompt intervention are crucial to preventing severe hypoglycemia. Frequent early feeding is recommended to stabilize blood glucose levels and reduce the need for IV glucose therapy. These findings have important clinical implications for neonatal care and should be integrated into glucose screening protocols.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study\u0026rsquo;s conception and design. Patient demographic and clinical data were systematically retrieved and verified from the hospital\u0026rsquo;s electronic medical record system by Chia-Yu Wang, Lin-Yen Wang, and Lin-Yu Wang. Statistical analyses were performed by Chung-Han Ho, who ensured methodological rigor and the validity of the analytical results. The initial manuscript draft was prepared by Chia-Yu Wang under the scholarly supervision and critical revision of Lin-Yu Wang. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from corresponding author upon reasonable request\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the institutional review board of Chi Mei Medical Center and was in accordance with the 1964 Helsinki Declaration and its later amendments. Approval number was 11403-018. Informed written consents were obtained from the patients\u0026rsquo; parents to conduct and publish this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinancial Disclosure Statement:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no financial conflicts of interest or disclosures\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHarris DL, Weston PJ, Gamble GD, Harding JE. Glucose Profiles in Healthy Term Infants in the First 5 Days: The Glucose in Well Babies (GLOW) Study. 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Neonatology. 2022;119(1):77\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBegum T, Begum GA, Chowdhury MA, Ahmed W, Badrudddoza M. Neonatal Outcomes of Large-for-Gestational Age Infants with or without Gestational Diabetes Mellitus. Chattagram Maa-O-Shishu Hospital Medical. Coll J. 2018;16(2):25\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDas S, Irigoyen M, Patterson MB, Salvador A, Schutzman DL. Neonatal outcomes of macrosomic births in diabetic and non-diabetic women. Archives disease Child Fetal neonatal Ed. 2009;94(6):F419\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOpara PI, Jaja T, Onubogu UC. Morbidity and mortality amongst infants of diabetic mothers admitted into a special care baby unit in Port Harcourt, Nigeria. Ital J Pediatr. 2010;36(1):77.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCao Y, Yang Y, Liu L, Ma J. Analysis of risk factors of neonatal hypoglycemia and its correlation with blood glucose control of gestational diabetes mellitus: A retrospective study. Medicine. 2023;102(35):e34619.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang Y, Luo B, diabetes mellitus based on International Association of Diabetes Pregnancy Study Groups criteria]. [Risk factors analysis of gestational. Nan fang yi ke da xue xue bao = J South Med Univ. 2019;39(5):572\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHung TH, Hsieh TT. Pregestational body mass index, gestational weight gain, and risks for adverse pregnancy outcomes among Taiwanese women: A retrospective cohort study. Taiwan J Obstet Gynecol. 2016;55(4):575\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMitchell NA, Grimbly C, Rosolowsky ET, O'Reilly M, Yaskina M, Cheung PY, et al. Incidence and Risk Factors for Hypoglycemia During Fetal-to-Neonatal Transition in Premature Infants. Front Pead. 2020;8:34.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYildiz Atar H, Baatz JE, Ryan RM. Molecular Mechanisms of Maternal Diabetes Effects on Fetal and Neonatal Surfactant. Child (Basel Switzerland). 2021;8(4).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMichael Weindling A. Offspring of diabetic pregnancy: short-term outcomes. Semin Fetal Neonatal Med. 2009;14(2):111\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFung GP, Chan LM, Ho YC, To WK, Chan HB, Lao TT. Does gestational diabetes mellitus affect respiratory outcome in late-preterm infants? Early Hum Dev. 2014;90(9):527\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYang F, Liu H, Ding C. Gestational diabetes mellitus and risk of neonatal respiratory distress syndrome: a systematic review and meta-analysis. Diabetol Metab Syndr. 2024;16(1):294.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHammond EI, STUDIES IN FETAL AND INFANT MORTALITY. II. DIFFERENTIALS IN MORTALITY BY SEX AND RACE. Am J Public Health Nation's Health. 1965;55(8):1152\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLary JM, Paulozzi LJ. Sex differences in the prevalence of human birth defects: a population-based study. Teratology. 2001;64(5):237\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBekedam DJ, Engelsbel S, Mol BW, van der Buitendijk SE. Pal-de Bruin KM. Male predominance in fetal distress during labor. Am J Obstet Gynecol. 2002;187(6):1605\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTundidor D, Garc\u0026iacute;a-Patterson A, Mar\u0026iacute;a MA, Ubeda J, Ginovart G, Adelantado JM, et al. Perinatal maternal and neonatal outcomes in women with gestational diabetes mellitus according to fetal sex. Gend Med. 2012;9(6):411\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBracero LA, Cassidy S, Byrne DW. Effect of gender on perinatal outcome in pregnancies complicated by diabetes. Gynecol Obstet Invest. 1996;41(1):10\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"large-for-gestational-age, neonatal hypoglycemia, gestational diabetes mellitus, blood glucose screening, risk factors","lastPublishedDoi":"10.21203/rs.3.rs-7545928/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7545928/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e: The purpose of this study was to investigate the incidence of early hypoglycemia in full-term large-for-gestational-age (LGA) neonates within the first four hours of life, to identify associated neonatal and maternal risk factors, and to characterize the corresponding blood glucose patterns.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eWe conducted a retrospective, single-center study reviewing medical records of full-term LGA neonates (birth weight \u0026gt;90th percentile) born from January 1, 2012, to December 31, 2021, and admitted to a well-baby nursery at a tertiary medical center in Southern Taiwan. Blood glucose was measured at 0.5, 1-, 2-, and 4-hours post-birth. Hypoglycemia was defined as blood glucose ≤40 mg/dL. Neonatal and maternal characteristics were compared between hypoglycemic and non-hypoglycemic groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Of 697 LGA neonates, 253 (36.3%) experienced hypoglycemia, with 98.42% of cases occurring within 1 hour (mean glucose: 40.26±8.16 mg/dL). Among 253 hypoglycemic neonates, 103 (40.7%) required intravenous glucose infusion for persistent hypoglycemia despite repeated early feeding. Multivariate logistic regression analysis identified respiratory distress (OR=2.24, 95% CI: 1.48–3.41), female sex (OR=2.05, 95% CI: 1.32–3.17), and maternal gestational diabetes mellitus (GDM) (OR=1.61, 95% CI: 1.12–2.32) were independent risk factors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eEarly hypoglycemia is prevalent in LGA neonates, particularly those with female sex, respiratory distress, or maternal GDM. Routine glucose screening within the first hour and early feeding are crucial in preventing severe hypoglycemic episodes.\u003c/p\u003e","manuscriptTitle":"Frequency and Risk Factors for Early Hypoglycemia in Full-term LGA Infants: A Retrospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-23 15:46:53","doi":"10.21203/rs.3.rs-7545928/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a9bb4056-0815-4ef8-9ab5-3591eb39f5ff","owner":[],"postedDate":"October 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-07T07:24:07+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-23 15:46:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7545928","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7545928","identity":"rs-7545928","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}