Neonatal Hypoglycemia : Consequences and Management
Hypoglycemia, indicates a decrease in the blood sugar level. Hypoglycemia is the most typical metabolic problem in neonates. Infants having blood sugar level of less than 40 mg/dl in the initial 24 hours of life are said to be hypoglycemic.
In preterm infants, repeated blood glucose levels beneath 50 mg/dl may be linked to impaired neural development.
Glucose is the major energy source intended for neonates and about 90% of total glucose in neonates is utilized and consumed by the brain. The brain depends on blood glucose as it’s a key way to obtain fuel. Decrease level of glucose can impair the brain’s ability to function.
Extended hypoglycemia may result in seizures and serious brain injury. Hypergylcemia in pregnant women is one the major cause behind neonatal hypoglycemia. After delivery when the source of glucose (the umbilical cord) cut down and the neonate’s insulin production metabolizes the pre-existing glucose.
Neonates have limited glycogen stores so it may lead to decrease glucose level. The mother’s blood glucose is transferred to the fetus during pregnancy and thus insulin is secreted in large quantity which results in increased tissue and fat deposition so the Infants of diabetic mothers are often larger than other babies. They usually have large organs. The liver, adrenal glands, and heart are most likely to get increased so they require large amounts of glucose.
It may be due to hyperinsulinemia, increased glucose utilization as in cold stress, sepsis, perinatal asphyxia, hyperinsulinism, or persistent hyperinsulinemic hypoglycemia of infancy (PHHI), is the frequent cause of hypoglycemia in the first 3 months of life. In hypoglycemia there is decreased availability of glucose for the CNS as brain utilizes glucose as well as adrenergic stimulation caused by a decreasing or low blood sugar level.
It is usually asymptomatic. During the first few days of life, symptoms may vary from asymptomatic to severe central nervous system abnormalities and in few neonates may lead to cardiopulmonary disturbances. Other symptoms include jitteriness, cyanosis irritability, lethargy, seizures, apnea, grunting etc.Monitoring of glucose is necessary so the blood sugar level of hypoglycemic neonates should be measured after every few hours of birth. This can be done using a heel stick. Testing should be continue until the glucose level stays normal for about 12 to 24 hours.
Treatment is initiated parenterally of 5% or 10% of dextrose with or without oral sugar containing liquids. It is absorbed from the intestine, resulting in a rapid increase in blood glucose concentration when administered orally.Diazoxide, octreotide and glucagon are other options to treat neonatal hypoglycemia. Do not use dextrose 25% or dextrose 50% Intravenously or large Intravenous volume boluses as this creates rebound hypoglycemia in infants who are hyperinsulinemic.In severe cases partial pancreatectomy is performed which is now becoming a treatment of choice for persistent hyperinsulinemic hypoglycemia of the neonate.
1. Hilarie Cranmer(April 24th, 2014) Neonatal hypoglycemia treatment and management, retrieved from http://emedicine.medscape.com/article/802334-overview
2. Kimberly G Lee,(October 29th, 2013) low blood sugars- newborns retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/007306.htm
3. Neonatal hypoglycemia, intensive care nursery house staff manual retrieved from http://www.ucsfbenioffchildrens.org/pdf/manuals/52_Hypoglycemia.pdf
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