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Neonatal Hypoglycemia

Neonatal Hypoglycemia. Stan Jack, D.O. Saint Joseph Hospital Family Practice Residency. Neonatal Hypoglycemia - Significance. Persistent or recurrent hypoglycemia can result in impaired neurologic development and intellectual function

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Neonatal Hypoglycemia

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  1. Neonatal Hypoglycemia Stan Jack, D.O. Saint Joseph Hospital Family Practice Residency

  2. Neonatal Hypoglycemia - Significance • Persistent or recurrent hypoglycemia can result in impaired neurologic development and intellectual function • Other sequela include spasticity, ataxia, and seizure disorder

  3. Neonatal Hypoglycemia - Definition • Plasma glucose <40 mg/dL on the first day of life • Plasma glucose <40-50 mg/dL after 24 hours of age • Note: whole blood glucose ~15% lower than plasma glucose measurements

  4. Neonatal Hypoglycemia - Pathogenesis • Glucose in utero comes from mother • After cord cut, glucose in newborn falls during first 2 hours, stabilizing by 4-6 hrs (transition period) • Dependent on glycogen storage depletion and carbohydrate intake

  5. Neonatal Hypoglycemia - Causes • Diminished glucose production (premature, IUGR) • Increased glucose utilization secondary to hyperinsulinism (infants of diabetic mothers, Beckwith-Weidmann, erythroblastosis, perinatal asphyxia) • Maternal tx with beta blockers • Sepsis

  6. Neonatal Hypoglycemia - Causes (continued) • Polycythemia • Metabolic disorders (inborn errors of carbohydrate / amino acid metabolism) • Endocrine disorders (low levels of cortisol, growth hormone, epinephrine, or glucagon) • Heart failure

  7. Neonatal Hypoglycemia - Clinical Manifestations • Frequently asymptomatic • Jittery, tremulous • Decreased tone • Irritable or lethargic; seizures • Apnea, bradycardia, cyanosis, tachypnea • Poor feeding

  8. Neonatal Hypoglycemia - Screening • Not routinely monitored unless at risk for hypoglycemia (next slide) • If screening done, obtain sample before feedings

  9. Neonatal Hypoglycemia - Risk Factors • Prematurity • Small or large for gestational age • Infants of diabetic mothers • ICU infants (i.e. sepsis) • Infants of mothers treated with beta blockers

  10. Neonatal Hypoglycemia - Management • If lower than 40 mg/dL, surveillance until feedings well established and glucose normal • If asymptomatic and term, obtain blood sample and immediately offer breast or formula feeding (consider gavage); recheck 20-30 minutes after feeding

  11. Neonatal Hypoglycemia - Management (continued) • If symptomatic OR not tolerating enteral feeds OR plasma glucose <20-25 OR if persistently <40 even after feeds, start parenteral glucose • Bolus 200 mg/kg (2 ml/kg 10% dextrose in H2O) over 1 minute followed by glucose infusion of 8 mg/kg per minute • If requirements high (>12.5%) may need central venous catheter

  12. Neonatal Hypoglycemia - Summary • Prolonged hypoglycemia may result in long-term morbidity • May be asymptomatic • Screening is based on risk factors

  13. Neonatal Hypoglycemia - Summary (continued) • If asymptomatic and glucose is moderately low, begin with feeding and surveillance • Symtomatic infants with very low glucose levels will need parenteral replacement • Do not hesitate to run things by your upper level, attending, or the neonatologist

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