Date of Award

Fall 2017

Document Type


Degree Name

Doctor of Philosophy (PhD)


Health Services Research

Committee Director

Muge Akpinar-Elci

Committee Member

Matthew C. Hoch

Committee Member

Bonnie Van Lunen


Neonatal hypoglycemia is the most common metabolic abnormality in infants and is associated with neurological damage and death. The risk of developing hypoglycemia among infants born from diabetic mothers is even higher. Although much work has been performed addressing issues for treatment and care, research related to neonatal hypoglycemia has been focused on the clinical or individual level risk factors. Contextual risk factors such as hospital characteristics, neighborhood economic status, and regional variations were not considered in earlier studies. Additionally, although healthcare resources utilization of hypoglycemia has been adequately addressed in the adult population, this topic has not been studied in hypoglycemic neonates.

The overarching purpose of this dissertation was to investigate healthcare outcomes and resource utilization related to neonatal hypoglycemia. The first purpose was to conduct a systematic review in order to investigate whether previous studies only focused on clinical risk factors or included a broader health service-related contextual risk factors in assessing the determinants of neonatal hypoglycemia. The second purpose was to identify the key factors associated with increased hospital cost associated with neonatal hypoglycemia in the United States. The third and final purpose of the dissertation was to construct multi-level models that include individual-level and contextual-level characteristics.

The systematic review (Project I) determined that previous studies mainly focus on the clinical characteristics of infants and mothers. The systematic review suggested that contextual variables should be included in future research. Project II found that increased cost was observed, when more than five procedures were performed during the same hospitalization, when hospital bed size was between 100 and 300 or ≥ 400, when hospital length of stay exceeded 15 days, in teaching hospitals, in the presence of chronic conditions, comorbidities, prematurity, and death. In project III we found that infant of diabetic mothers had more than 5-fold increased risk of developing neonatal hypoglycemia compared to infants of non-diabetic mothers. Infants born in urban and teaching hospitals also had significantly higher chance of developing neonatal hypoglycemia. Project III also determined that the inclusion of the contextual risk factors improved the final model that was constructed to predict neonatal hypoglycemia.