The association between dysglycemia and neonatal respiratory distress syndrome severity as well as short-term clinical outcomes at hospital admission.

OBJECTIVE

To evaluate the impact of admission blood glucose levels on disease severity and short-term outcomes in neonates with neonatal respiratory distress syndrome (NRDS).

METHODS

This retrospective cohort study included 219 NRDS neonates admitted to a tertiary hospital in China (August 2022-April 2024). Participants were categorized into hypoglycemia (n = 38), normoglycemia (n = 143), and hyperglycemia (n = 38) groups based on initial whole-blood glucose. Associations between glucose levels, NRDS severity, and clinical outcomes were analyzed.

RESULTS

The incidence of severe NRDS was significantly higher in the hyperglycemia group compared to the normoglycemia group (56.4% vs. 38.7%, P = 0.019). Hyperglycemia positively correlated with prolonged mechanical ventilation, oxygen therapy, and elevated lactate levels (all P < 0.05). Neonates with hyperglycemia also exhibited higher rates of specific complications, including intracranial hemorrhage (ICH) and bronchopulmonary dysplasia (BPD), whereas those with hypoglycemia were more susceptible to hypoxic-ischemic encephalopathy and necrotizing enterocolitis. Separate multivariate logistic regression analyses revealed distinct predictive patterns: admission hyperglycemia exhibited a strong inverse (negative) association with arterial pH (OR = 0.000; 95% CI: 0.000-0.009) and a direct (positive) association with WBC count (OR = 1.086; 95% CI: 1.025-1.150). Conversely, admission hypoglycemia demonstrated an inverse association with pulmonary surfactant use (OR = 0.327; 95% CI: 0.124-0.859) and a direct positive association with patent ductus arteriosus (OR = 3.775; 95% CI: 1.441-9.890).

CONCLUSION

Admission hyperglycemia predicts severe NRDS, prolonged respiratory support, and distinct complication profiles. Both hypoglycemia and hyperglycemia demonstrate specific independent predictors linked to metabolic disturbances and increased treatment demands. These findings highlight the clinical relevance of early glucose monitoring, providing new insights that admission dysglycemia may serve as an early biomarker of disease severity to guide risk stratification and personalized management of NRDS.