Neonatal hypoglycemia

neonatal hypoglycemia

1. Neonatal Hypoglycemia

2. Usual rate of glucose utilization is 4-8 mg per kg/min. Glucose regulatory mechanism is sluggish at birth When glucose demand is increase / when exogenous/ endogenous glucose supply is limited . Prolonged hypoglycemia may result in long term neurologic damage. Background Of Hypoglycemia:

3. Hypoglycemia in the first few days after birth is defined as “blood glucose levels below 40 mg/dl.” In preterm infants, repeated blood glucose level below 50 mg / dl maybe associated with neurodevelopment delay. Defination Of Hypoglycemia:

4. Insulin and glucagon hormones control the blood glucose level. Blood glucose level increases → rate of insulin secretion increases → stimulates liver to store glucose as glycogen → when liver and muscle cells are saturated with glycogen additional glucose is stored as fat. Glucose metabolism:

5. Blood glucose level falls → glucagon level increases → it promotes conversion of glycogen in liver back into glucose (glycogenolysis) → this glucose released in blood. During starvation liver maintain glucose level by gluconeogenesis i.e formation of glucose from amino acids and fat. Continue………

6. Hypothalamus stimulate epinephrine secretion from adrenal, causing further glucose release from liver. After prolong hypoglycemia growth hormone and cortisol secreted that the decrease the rate of glucose utilization by body cells. Continue………

7. Hypoglycemia Normal hypoglycemic counter regulation Insulin ↑ Glucagon ↑ Epinephrine ↑ Growth Hormone ↑ Cortisol ↑ Protein breakdown ↑ Insulin sensitivity ↓ Fat break down ↑ Hepatic glucose output ↑ Gluconeogenesis ↑ Glucose utilization ↓ Ketones ↑ Glucose ↑

8. Decreased substrate availability Etiology Intrauterine growth retardation Inborn e rrors (fructose intolerance) Prolonged fasting without iv glucose Glycogen storage disease Prematurity

9. Infant of diabetic mother Erythroblast sis fetalis High umbilical arterial catheter Islet cell hyperplasia Exchange transfusion Maternal beta mimetic tocolytic agents Abrupt cessation of iv glucose Beckwith- wiedemann syndrome Hyperinsulinemia :

10. Cold stress Sepsis Increase work of breathing Prenatal asphyxia Increase glucose utilization :

11. Pan- hypopituitarism Adrenal insufficiency Hypo thyroidism Other endocrine abnormalities :

12. Polycythemia CNS abnormalities Congenital heart diseases Miscellaneous:

13. Cyanosis Breathing problems Hypotonia Grunting Listlessness Irritability or lethargy Restlessness Altered sensorium Twitching and trenmors seizures Clinical features :

14. Specimen for measurement of glucose should be obtained from heel stick, venipuncture , or from and indwelling catheter that does not have glucose infusing in it Diagnostic workup

15. Infants at risk for hypoglycemia should be screened by measuring blood sugar by glucometer at ages 1, 2, 4, 6, 9 and 12 th. Less frequent measurement are appropriate if blood glucose is stable. Continue surveillance and more frequent measurement may be needed until blood glucose is stable > 14mg/ dl or > 50 mg/ dl in very preterm infants Screening of at risk infants

16. Glucometer reading > 40 mg/dl and infant is feeding normally: Follow usual nursery protocol Glucometer reading 20-40 mg/dl, infant is term and is able to feed: Draw blood for stat blood glucose measurement Feed 5 ml/kg of 5%/ dextrose Repeat blood glucose 20 min after feeding Management

17. Glucometer reading : < 20 mg/dl < 40 mg/dl and NPO or preterm < 40 mg/dl after feeding < 40 mg/dl and symptomatic Draw blood for stat glucose measurement Give iv bolus of 2-3 ml/kg of D10W Begin continuous infusion of D10W at 4-6 mg/kg per min Continue ……

18. If infant of diabetic mother begin D10W at 8-10 mg/kg/min Repeat blood glucose in 20 min and pursue treatment until blood sugar < 40 mg/dl Continue

19. Increase rate of glucose infusion stepwise in 2mg/kg/min increments upto 12-15 mg/kg/min glucose. For persistent hypoglycemia despite above measures:

20. If hypoglycemia is not controlled with dextrose infusion then further management include glucocorticoid,dizoxide,somatostatin or pancreactectomy. Refractory/ Persistant Hypoglycemia

21. When blood glucose is stable for 12-24 hrs, begin decreasing iv infusion by 1-2 ml/hr if blood glucose remain >60 mg/dl Weaning iv dextrose infusion

22. Occipital lobe damage Developmental delay Heart failure COMPLICATIONS