Neonatal Hypoglycaemia Flashcards
What is hypoglycaemia defined as in neonates?
Plasma glucose of less than 2.6mmol/L
Is hypoglycaemia common in babies?
It is a common problem in neonates during the first few days of life, but thereafter is uncommon without diabetes
Why are infants at a higher risk of hypoglycaemia?
- High energy requirements
- Relatively poor reserves of glucose from gluconeogenesis and glycogenolysis
What is the result of infants being at high risk of hypoglycaemia with fasting?
Infants should never be starved for more than 4 hours, e.g. pre-operatively
What are the causes of neonatal hypoglycaemia?
- Hyperinsulinism
- Limited glycogen stores
- Increased glucose use
- Decreased gluconeogenesis
- Depleted glycogen stores
What is the most common cause of neonatal hypoglycaemia?
Hyperinsulinism
What is neonatal hypoglycaemia caused by hyperinsulinism also known as?
Persistent hyperinsulinaemia hypoglycaemia of infancy
When is hyperinsulinism very commonly seen?
In infants born to mothers with diabetes
When does neonatal hypoglycaemia caused by limited glycogen stores occur?
- Premature newborns
- Newborns that have IUGR
What can cause increased glucose use in a neonate?
- Hyperthermia
- Polycythaemia
- Sepsis
- Growth hormone deficiency
What can cause decreased gluconeogenesis in a neonate?
- Inborn errors of metabolism
- Adrenal insufficiency
What can cause depleted glycogen stores in a neonate?
- Starvation
- Asphyxia-perinatal stress
What are the categories of risk factors for neonatal hypoglycaemia?
- Maternal
- Neonatal
What are the maternal risk factors for neonatal hypoglycaemia?
- Gestational diabetes
- Eclampsia
- Drug use
What are the neonatal risk factors for neonatal hypoglycaemia?
- Small for gestational age
- Inadequate feeding
- Respiratory distress
How serious is neonatal hypoglycaemia?
It can show no symptoms, or can be life threatening
What are some potential signs and symptoms of neonatal hypoglycaemia?
- Tremors
- Weak or high pitched cry
- Lethargy
- Hunger or refusal to feed
- Sweating
- Pallor
- Central nervous system signs
What CNS signs may be present in neonatal hypoglycaemia?
- Irritability
- Headache
- Seizures
- Coma
How is neonatal hypoglycaemia initially identified?
Screening for hypoglycaemia is done on every neonate on admission via the heel prick test
What needs to be done if the heel-prick test is positive for hypoglycaemia?
Need to confirm diagnosis
What further samples need to be collected when the cause of neonatal hypoglycaemia is unknown?
- Blood at time of hypoglycaemia
- First available urine sample
What tests are done on blood for neonatal hypoglycaemia when the cause is unknown?
- GH
- IGF-1
- Cortisol
- Insulin
- C-peptide
- Fatty acids
- Ketones
- Glycerol
- Branched-chain amino acids
- Lactate
- Pyruvate
What tests are done on urine in neonatal hypoglycaemia when the cause is known?
Check for organic acids
What are the differential diagnoses of neonatal hypoglycaemia?
The way neonatal hypoglycaemia presents is vague, and may be confused with;
- Hypocalcaemia
- Sepsis
- CNS disorders
- Cardiorespiratory problems
How is neonatal hypoglycaemia at birth treated?
Glucose IV infusion 10%
How can neonatal hypoglycaemia be treated when it is less severe, borderline, or asymptomatic?
Early introduction of breast milk
Why might early introduction of breast milk not be an option in the management of mild neonatal hypoglycaemia?
If the newborn is having difficulty latching, or breastfeeding is not an option
What can be done if early introduction of breast milk is not possible in mild neonatal hypoglycaemia?
Oral glucose
What should be done in any infant at risk of hypoglycaemia?
Their blood sugar should be taken 1 hour after birth
What are the complications of neonatal hypoglycaemia?
The neurological sequelae may be permanent if hypoglycaemia persists, and include;
- Neurological damage that results in mental retardation
- Developmental delay
- Personality disorders
- Recurrent seizure activity
- Impaired cardiovascular function
