Hypoglycaemia

Question 1

What age is a baby considered a neonate?

Answer 1

28 days

Question 2

Why does transient hypoglycaemia occur in neonates?

Answer 2

It is as a result of the change from continuous glucose supply from the mom to intermittent feeding from milk feeds

Question 3

What is the normal drop of glucose 2 hours in for a healthy infant?

Answer 3

-About 2,2mmol/l

Question 4

Why does hypoglycaemia occur?

Answer 4

-As a result of the increased utilisation of glucose compared to the production of glucose

Question 5

What value would mean that the patient is hypoglycaemic?

Answer 5

-a value less than 2,6mmol/l

Question 6

What is the definition of severe hypoglycaemia?

Answer 6

• plasma glucose concentration <1,5mmol/l

- when the infant is symptomatic and experiences apnea and seizures for example

Question 7

How do we test glucose in an infant?

Answer 7

• we can use reagent strips and get blood from the heel/skin prick
• serum glucose concentration from either venous/arterial blood

Question 8

What are the two causes of hypoglycaemia in an infant?

Answer 8

1. Decreased glucose production

2. Increased glucose utilization

Question 9

What are the 3 reasons for inadequate glucose supply?

Answer 9

1. Inadequate intake-poor feeding, less milk production from mother
2. Inadequate glycogen stores-premature
3. Impaired glucose production

Question 10

What are the 2 reasons of increased glucose utilization?

Answer 10

1. Hyperinsulinism-infant of diabetic mother

2. Non-hyperinsulism- sepsis, hypothermia, respiratory distress

Question 11

Which infants are at risk for hypoglycameia?

Answer 11

1. Premature
2. Infants of diabetic mothers
3. Small for gestational age
4. Large for gestational age

Question 12

What are some of the symptoms that neonates can present with?

Answer 12

1. Jitteriness
2. Lethargy, coma
3. tachypnea
4. Seizures
5. poor sucking, poor feeding

Question 13

What are some of the ways we can prevent hypoglycaemia?

Answer 13

1. By giving the infant fluids and feeds within the first hour of birth
2. Place healthy infants on the breast
3. Start intravenous fluids with 10% glucose if milk feeds are contra-indicated
4. Avoid hypothermia

Question 14

What is the management of hypoglycaemic?(1,5-2,6mmol/l)

Answer 14

1. Give milk feeds immediately or intravenous fluids if contradicted(in prematurity)
2. Keep the baby warm
3. Increase volume or frequency of fluids

Question 15

What is the emergency management of hypothermia?

Answer 15

1. Admit to neonatal ICU
2. Get IV access and bolus 3ml/kg 10% glucose. If we cannot access, get an umbilical venous catheter
3. If unable to gain venous access-you can give 0,2ml/kg/dose of glucagon IM