1: Neonatology - Hypoglycaemia Flashcards
Define neonatal hypoglycaemia
Blood glucose less than 2.6mmol/L
What are the 4 etiological categories of neonatal hypoglycaemia
- Decreased stores
- Increased use
- High insulin
- Other
What are 3 causes of decreased glucose stores
- Pre-mature
- IUGR
- In-born errors metabolism
What are 5 causes of glucose being utilised more
- Sepsis
- Seizures
- Perinatal asphyxia
- Polycythaemia
- Haemolytic disease
What are 2 causes of high neonatal insulin
- Maternal DM
2. Beckwith weiderman syndrome
What medication causes neonatal hypoglycaemia if taken in-utero
B-blockers
What are 5 risk-factors of neonatal hypoglycaemia
- Birth weight <2.5Kg or <3rd centile
- Pre-mature
- Diabetic mother
- Birth asphyxia
- Maternal B-blockers
Explain glucose in neonates
Transient decrease in glucose after birth - during which time foetus metabolises fats and ketones.
What are symptoms of neonatal hypoglycaemia
Jitteriness
Apnea
Hypotonia
Drowsiness
How soon after birth should infant be fed to prevent hpyoglycaemia
1h
What defines severe or symptomatic blood-glucose
Blood glucose <1 or symptomatic
How is severe or symptomatic hypoglycaemia managed
- Bolus 10% Glucose
- Followed by IV 10% Glucose infusion
What defines moderate hypoglycaemia
- 1 - 1.6
- Or <1 on two occasions
What should be done in moderate hypoglycaemia
Enteral feed:
- Check enteral food regimen
- NG tube if not tolerating
- IV: if not tolerating milk
Fluids:
- BG >1 = increase dose 10% dextrose
- BG <1 = bolus 10% glucose then infusion
Define resistant hypoglycaemia
Glucose requirement >8mg/Kg/min
