Glucose Control

Question 1

Transient first 2-3 hours of life

Answer 1

intrapartum glucose administration
maternal treatment - BB, ant diabetic drugs
IDM
neonatal problems: IUGR, birth asphyxia, hypothermia, hyperviscosity

Question 2

Persistent or recurrent

Answer 2

Inadequate glycogen stores - prem, IUGR
Impaired glucose production - IEOM (galactosaemia, propionic acidemia, defects carnitine metabolism), endocrine and severe hepatic dysfunction
Increased glucose utilisation - excessive insulin (BWS, IUGR) or without hyperinsulinism (sepsis, asphyxia, polycythaemia, heart failure)

Question 3

Profound and prolonged hypoglycaemia

Answer 3

permanent and transient structural changes in the brain

grey/white matter damage - commonly in parieto-occipital regions

Question 4

At risk of hypoglycaemia

Answer 4

symptoms of hypoglycaemia
LGA
perinatal stress - birth asphyxia, maternal eclampsia, IUGR, MAS
prem/postmature delivery
IDM
family history of genetic form hypoglycaemia
congenital syndrome - BWS

Question 5

Specific management

Answer 5

Hyperinsulinism - diazoxide, glucagon
IUGR - IV glucose and glucagon
Adrenocortical insufficiency - hydrocortisone
IEOM - aim provide enough calories to prevent hypoglycaemia

Question 6

Emergency management

Answer 6

oral or NGT feeding of dextrose or milk
if Sx are severe
- 200mg/kg of dextrose (2ml/kg of 10% dextrose solution) IV
- check glucose again 15-30 minutes
- continuous IV dextrose infusion if hypoglycaemia persistent/ recurring