Hypoglycemia

Question 1

3 steps in treatment and prevention of hypoglycemia

Answer 1

1. identify the newborn at risk of developing hypoglycemia
   • 2. recognize the symptoms of hypogycemia
   • 3. early treatment( continuous oral feeding or IV fuid therapy)

Question 2

Definition of hypoglycemia

Answer 2

Neonatal hypoglcemia is defned as the plasma glucose of less than
2.5 mmol/L( or less than 45mg/dl)
• It is the most common metabolic disorder in the neonatal period.
• It can be persistent or resistant
• Persistent hypoglycemia is the hypoglycemia persisting for more than
one week despite the appropriate therapy while resistant
hypoglycemia is the one with the requirement of the glucose infusion
rate of more than 12mg/kg/min

Question 3

Which newborn are at risk for hypoglycemia

Answer 3

• All preterms babies and newborns less than 2000 grams
• Large for gestational age especially those born from a diabetic mother
• Any newborn who is sick ( HIE, RDS, SHOCK, polycythemia) at birth or
has poor suck, no cry, refusing to feed or delay in feeding.
• Abandoned newborns
• Newborns with hypothermia

Question 4

Describe causes of hypoglycemia

Answer 4

• Depleted in glycogen stores is the most common causes(lack or
inadequate feeding, any stress at birth ie. HIE, wet baby, cold
environment…)
• Decreased in glycogenolysis, gluconeogenesis, use of alternate
fuels(IEM, adrenal insufciency…)
• Persistent hyperinsulinemia of infancy
• Increased usage of glucose( sepsis, hyperthermia, GH defciency,
polycythemia,…)
• Limited glycogen stores( prematurity, IUGR, …)

Question 5

Give symptoms of hypoglycemia

Answer 5

• In neonatal period, symptoms of hypoglycemia are nonspecifcs and
can present as any other disease:
• -poor feeding and sucking
• -lethargy with or without poor cry
• -temperature instability
• -convulsions, jiteriness, hypotonia…
• -poor respiratory efort

Question 6

What is the treatment of hypoglycemia

Answer 6

• The treatment of hypoglycemia consists of raising the blood glucose
level to its normal range either by using the oral feeding or IV infusion
• If the neonate is able to suck, he can be put directly on the breast, in
case of poor sucking the NGT can be inserted.
• If the glucose is not corrected with oral feeding or in case of any
contraindication to oral feeding, IV infusion with 10% dextrose must
be initiated. The iv treatment consists of 2mls/kg of 10% dextrose per
kg as a slow bolus over 3-5 minutes and start the maintenance.
• Check the glucose afer 15-30 minutes, if still low repeat the bolus
• The highest strength of dextrose which can be given via the peripheral
line is 12.5%, once the strength is 15% the central line must be
inserted.
• In case of resistant or/and persistent hypoglycemia drugs like
hydrocortisone, glucagon, diazoxide and octreotide can be used in
tertiary institution where further investigations must be done’