Neonatal Hypoglycaemia Flashcards
Describe glucose and its use in the body
- Primary fuel for the body
- Brain cannot store adequate amounts so steady supply is required
What is Hypoglycaemia?
Low blood sugar; insufficient circulating glucose to meet the metabolic demands of the body
<2.6mmol/l
What is Glycogenesis?
Process by which unneeded glucose is converted to glycogen for storage
What is Glycogenolysis?
Process by which glycogen is broken down into glucose
What is Gluconeogenesis?
Production of glucose in the liver by means of non-glucose precursors such as lactate, pyruvate, glycerl and amino acids
What is insulin?
Hormone secreted by pancreatic beta cells in response to increase of plasma glucose
How does insulin regulate blood sugar?
Decreases levels by:
- Promoting glycogen formation
- Suppressing hepatic glucose
- Driving peripheral uptake of glucose
Where is glucagon produced?
Alpha cells in the pancreas
How does glucagon regulate blood sugar?
- Promotes glycogenolysis and gluconeogenesis
- Opposes effect of insulin by raising blood glucose
Describe the process if blood glucose is low
- Pancreatic alpha cells release glucagon
- Glucagon causes liver to release glucose into the blood
- Blood glucose levels increase to normal
Describe the process if blood glucose is high
- Pancreatic beta cells release insulin
- Insulin causes fat cells to take in glucose
- Blood glucose levels decrease to normal
Why should blood glucose levels not be checked within the first 2 hours of birth?
They will be low because babies use amino acids as energy immediately after birth
What are the risk factors associated with Hypoglycaemia?
- <37/40
- <2.5kg
- Born to diabetic mother
- Maternal drugs
- Sepsis
- Perinatal stress/ asphyxia
- Inborn errors of metabolism
What are the general symptoms?
- Abnormal cry
- Poor feeding
- Hypothermia
What are the cardio-respiratory symptoms?
- Tachypnoea
- Apnoea
- Cyanosis
What are the neurological symptoms?
- Tremors/ jitters
- Irritability
- Lethargy
- Hypotonic
- Seizures
What is the difference between convulsions and jitters?
If you hold the limb, convulsions will continue, jitters will stop
In term babies, how is glycogen stored?
- Majority of glycogen stored in 3rd trimester
- 5-8% of liver and muscle weight is glycogen storage
What is different about glycogen storage in preterm infants?
- Available stores are rapidly depleted
- Immature counter regulatory response to low glucose concentrations
What is different about glycogen storage in SGA infants?
- Low glycogen and fat stores
- Inadequate metabolic control
- Polycythaemia
- Chronically stressed foetus may use most of the placentally transferred glucose for growth and survival
What is different about glycogen storage in infants on Diabetic mothers?
- Excessive insulin production = hypoglycaemia
- At cord clamping, glucose supply is removed but insulin production in infant remains elevated
What products cross the placenta?
Glucose does, insulin doesn’t
What are some ways that Hypoglycaemia can be prevented?
- Keep babies warm
- Identify risk groups
- Follow local guidelines
- Feed within 30 mins of delivery
- Frequent feeding 2-3 hourly
- Appropriate monitoring
What are some ways that Hypoglycaemia is treated?
- Glucose gel
- Gastric tube
- Formula
- IV glucose
What are the relevant responsibilities of the midwife?
- Be competent in blood sugar testing
- Keep parents informed
- Accurately record obs
- Report to appropriate senior
- Record advice and treatment delivered
- Record response to treatment
What babies can glucose gel be used for?
Must be >35/40 and <48 hours old
What is the dose of glucose gel?
40% glucose, 0.5ml/kg
How should glucose gel be administered?
- Apply to buccal membranes
- Follow with feed
- Recheck blood sugar in 30-60 minutes
- 3 rounds (max. 6 doses in 48 hrs)
Give 6 advantages of using glucose gel
- Keep mother and baby together
- Potentially no disruption in BF
- Decrease use of formula
- Easy to administer
- Low cost
- Reduced admission to NNU
What can persistent Hypoglycaemia cause?
Long term neurodevelopment sequelae called Hypoglycaemic Brain Injuries
When and why should an MRI scan be done?
- Term infant with blood sugar <1.5mmol/l
- Checks for cerebral injury at 4-7 days PN
What are the risks associated with Hypoglycaemic Brain Injuries?
- Increased risk of ADHD
- Decreased fine motor control and perception
