Chapter 19: Hypoglycemia (Newborn)

Question 1

Hypoglycemia

Answer 1

low blood glucose
< 30 mg/dL for newborn
-it is not abnormal for the newborn to have a blood glucose of 30 mg/dL for the first hour and then rise above 40 to 60 mg/dL within 12 hours
-preterm and high risk newborns are considered hypoglycemia below 50 to 60 mg/dL because they cannot tolerate glucose levels like term newborns because their lack of fat stores

Question 2

How does A newborn get Hypoglycemia

Answer 2

-occurs rapidly in newborns
-SGA newborns have higher glucose needs than term newborns
>in utero, glucose is provided by continuous placental transfer from maternal circulation; in utero fetal glucose levels are maintained at 60 to 70% of the maternal level
-after the umbilical cord is cut and the glucose supply is halted, the newborn has to use liver glycogen and adipose tissue stores to supply glucose
>gluconeogenesis and ketogenesis are underdeveloped, and glucose levels can fall rapidly after birth; glucose is the main source of energy for the newborns brain, and levels lower than 30 mg/dL result in shunting of increased blood volumes to the brain to compensate

Question 3

At-risk newborns for Hypoglycemia

Answer 3

• small for gestational age (SGA)
• preterm newborns
• large for gestational age (LGA)
• stressed newborns; newborns with a diabetic mother,
• newborns who are poor feeders

Question 4

Signs and Symptoms of a Newborn with Hypoglycemia

Answer 4

• lethargy
• jitteriness
• poor feeding
• cyanosis
• apneic episodes
• tachypnea
• high-pitched or weak cry
• eye rolling
• seizures
• prolonged hypoglycemia can produce neurological damage

Question 5

Diagnosis of Hypoglycemia in a newborn

Answer 5

blood glucose obtained by heel sticks (pricking the heel and scooping the dripping heel blood into the appropriate neonatal laboratory tubes that require 1 mL of blood for testing

Question 6

Prevention of Hypoglycemia

Answer 6

maternal regulation of glucose levels in utero
>a high maternal glucose level while the fetus is in utero stimulates the fetal pancreas to produce insulin. After birth, the maternal glucose is no longer available to the newborn yet the pancreas is still secreting insulin to produce a hyperinsulinemia and hypoglycemia state in the newborn
-feeding the newborn as soon as possible after delivery

Question 7

Nursing Care

Answer 7

• glucose levels monitored; heel stick
• follow established nursery protocol, which requires blood glucose levels at specific intervals for high and low risk newborns
• for newborns on IV therapy, because the basic component of the parenteral fluid is glucose, nurseries maintain routine blood glucose checks
• if stable newborn is found to be hypoglycemic on routine blood glucose check, enteral feedings are started immediately, after feeding the glucose is rechecked at 30 minutes
• accurate documentation of I’s and O’s; a deficit in intake may indicate a risk for hypoglycemia

Question 8

Education/ Discharge Teaching

Answer 8

• taught the S/S
• provide frequent feedings base don cues of the newborn
• frequent feedings are done to prevent any future occurrences of hypoglycemia