3.2 - Management of hypoglycaemia Flashcards
EXAM
Identify risk a factors for the mother and fetus related to poor glycaemic control during pregnancy
polyhydramnios
- preeclampsia
- C/S
- PPH
- perinatal death
- macrosomia (shoulder dystocia, perineal trauma)
- birth trauma
- neonatal hypoglycaemia, hypocalcaemia, magnesaemia
- respiratory distress syndrome
- hyperbilirubinaemia
- neonatal polycythaemia
-baby starts producing it’s own insulin due to the increase glucose in the fetal circulation. when born excess glucose not available however baby still have insulin in their system
EXAM
Explain the role of the midwife in caring for the infant with hypoglycamia
- routine bgl’s post birth
- administer glucogel if required
- Formula and EBM top ups
- regular feeding plan
- maintain temp
- recognise deterioration
- aim for bgl over 2.6
exam
Demonstrate an understanding of procedural pain and it’s management in the neonate
- breast feeding at the time
- glucose
- S2S
*
EXAM
Reflect upon safety factors in relation to administration of medications to the vulnerable neonate
- 6 rights’s
- double checking of drug/dose/patient
- check to bedside
- quiet area if possible
*
Risk Factors
- Decreased Hepatic glucose production/stores
- Increase rate of glucose utilisation
- Abnormalities of endocrine regulation
- Inherited disorders
- Other factors
Decreased hepatic glucose production/stores (inadequate substrate supply)
- Reduced glycogen stores
- reduced fat stores ie - Prem infant
Increased rate of glucose utilisation
- cold stress
- rapidly depletes brown fat stores
- exhaustion of glycogen stores
- Asphyxia
- O2 supplies is limited so the infant relies on anaerobic metabolism for energy production
- RDS prom ^WOB increases on the metabolic demand
Abnormalities of endocrine regulation
- hyperinsulinaemia (excess insulin)
- IDM (most cause of common cause of endocrine distrubance
- Congenital hyperinsulinaemia
- Beckwick-wiedemann syndrome
Inherited disorder
Syndromes:
- Growth hormone or cortisol deficiency
- Cogneital hypothyriodism
- Congenital adrenal hyperplasia
- trisomy 21
Metabolic disorders
- checked on the NST
- disorders associated with deficiencies of specific enzymes
- glycogen store disease
- Fructose 1 6 diphosphatase
- hepatic deficiency which impacts gluconeogenesis
- galactosemia
- Maple syrup urine disease
- It means the body cannot process certain amino acids (the “building blocks” of protein), causing a harmful build-up of substances in the blood and urine.
Other factors
- infant with sepsis
- Defectos of glucose transports
- GLUT 1 and GLUT 2 deficiency
thermoregulation
- S2S
- Kangaroo care
- dry wraps
- hats
- temp
- large surface area
- lack of subcutaneous fat
- limited metabolic reserves
- decreased ability to shiver
- become cold quickly
Glycaemic control
- glucose
- breastfeeding
- enteral feeding
- intravenous dextrose
- blood glucose levels
oxygen and respiratory status
- acrocyanosis & peripheral cyanosis is a normal finding in neonates
- more cyanosis means decrease O2 saturations
- management
- nasal cannulas
- CPAP
- Ventilation
- physical assessment
- oximetry
- arterial blood gases
mentimeter
Neonatal blood glucose levels should be maintained in the scn
at or above 2.6mmol
Infants who are hypoglycaemic
can be asymptomatic
subtle
A high pitched cry in the hypoglycaemic infant indicates
CNS excitation
cerebal irritation from lack of glucose
Glycolysis
the breakdown of glucose into co2+ Ho2 and ATP
Premature infants are at risk of hypoglycaemia due to
delayed feeding establishment
decreased glycogen stores and brown fat
increased likelihood of perinatal asphyxia and respiratory compromise
What complication may arise from unresolved hypoglycaemia
seizures
sucrose is thought to aid pain management for neonates by
stimulating b endorphins and dopamine and acetylcholine release
PIPER stands for
paediatric infant perinatal emergency retrieval
