Hypoglycaemia Flashcards
Explain glucose homeostasis in the newborn period
Neonates brains are glucose dependent but they have limited glycogen stores and fat stores. Large increase in stores in 3rd tri
Natural drop in BGL in first hour of life - encourage BF
Glycolysis - this is the process by which glucose is broken down into pyruvate and energy (ATP) - the first stage of cellular respiration. When this is aerobic, this yeilds the most energy most efficiently, and is done when glucose is present in the infants blood
gluconeogenesis - when the infant has low blood sugar, they synthesise glucose from non carbohydrate sources (pyruvate, glycerol, amino acids) - this is gluconeogenesis. This synthesised glucose can then engage in glycolysis, but this process demands oxygen and energy in order to synthesise glucose initially. Overtime, this can lead to hypoglycaemia and hypoxia.
glycogenolysis - when glycogen stores in the liver are catabolised by glucagon to form free glucose, which can then engage in glycolysis. This supports times where the infant requires energy quickly and suddenly, however cannot be maintained long term, as the infant has an immature liver and low glycogen stores
Cumulatively, these processes balance to support glucose homeostasis in the newborn.
identify and explain risk factors for infants experiencing hypoglycaemia
Prematurity and FGR/SGA - limited stores
GDM mother - as mentioned below
Hypothermic baby - using glucose stores to maintan temp
Sleepy uninterested babies eg. jaundiced - not getting enough glucose through feeding
septic - lethargic therefore not feeding and using stores to fight infection
Asphyxiated babies - hypoxic therefore anaerobic resp which will lead to hypoglycaemia
Babies with increased demands - congenital hyperinsulinaemia
Explain the S+S of hypoglycaemia in the neonate
BGL <2.6
Lethargy
Hypotonia
hypothermia
Irritability
High pitched cry
Seizures + brain damage
Care plan for neonate with hypoglycaema - family centred care and MDT
Assess:
S+S as above
Diagnosis:
Actual problem
- Hypoglycaemia
Potential problems
- Hypothermia
- hypoxia
- cardiovascular instability
- poor feeding establishment
- repeated painful procedures
- developmental delay
Plan:
- to maintain BGL >2.6
- to maintain temp within 36.5-37.5
- to establish a feeding plan that promotes breastfeeding which supports maternal request and infants feeding needs
- to ensure adequate nutrition to promote growth and prevent hypoglycaemia
- to minimise the amount of painful procedures conducted and to minimise pain felt by these procedures
- maintain pre-ductal saturations above 95%
- to rule out sepsis
Implement:
- Feed within first hour of life
- BGL before, then 40 mins after
- BGLs 2-3 hourly until stable
If not stable
- IV dextrose bolus and continuous infusion
- glycogel
- maintain warmth
- monitor vital signd
- Ax for S+S of persisting hypoglycaemia
- calm
- support EBM and lactogenesis II
- antibiotics and cultures
Evaluate:
What is the lowest acceptable blood sugar in a neonate and why
2.6mmol/l
This level is the lowest acceptable level where the infant will not sutain brain damage
Explain the importance of glycaemic control during pregnancy
sugar crosses the placenta but insulin does not
therefore infants begin to produce higher levels of insulin
when the baby is born, there is a sudden change in the supply of glucose - no longer constant, small amounts and further apart
The infant is producing too much insulin for this change –> hypoglycaemia
Further, insulin works on cardiac muscle etc. leading to macrosomia
Identify risk factors for the mother and her fetus/neonate related to poor glycaemic control during pregnancy
Explain the safe management of enteral feeding via NGT
- replace NGT 14 daily or APP to minimise risk of infection
- insert with a clean procedure and NTT
- aspirate and check measurements to confirm placement
- assess for signs of distress during feeding
- assess for signs of NEC
