Neonatal hypoglycaemia

Question 1

When is hypoglycaemia most likely to occur?

Answer 1

in the first 24 hours

Question 2

What are 7 causes of neonatal hypotglycaemia?

Answer 2

1. IUGR
2. Maternal diabetes mellitus
3. Preterm
4. Hypothermia
5. Large for dates
6. Polycythaemic
7. Ill for any reason

Question 3

Why can growth-restricted and preterm infants develop neonatal hypoglycaemia?

Answer 3

poor glycogen stores

Question 4

What can cause neonatal hypoglycaemia in the case of maternal diabetes mellitus?

Answer 4

hyperplasia of islet cells in pancreas due to high blood glucose in utero (glucose can cross placenta but insulin can’t) so they have high levels of insulin in neonatal period and therefore low glucose levels

Question 5

What are 6 symptoms of hypoglycaemia in the neonate?

Answer 5

1. Jitteriness
2. Irritability
3. Apnoea
4. Lethargy
5. Drowsiness
6. Seizures

Question 6

Why can many babies tolerate low blood glucose in the first few days of life?

Answer 6

able to utilise lactate as energy stores

Question 7

What is suggested as a threshold considered hypoglycaemia in neonates?

Answer 7

studies suggest >2.6 mmol/L desirable for optimal neurodevelopmental outcome

but during first 24h many asymptomatic infants transiently have blood glucose levels below this

Question 8

What form of hypoglycaemia is thought to be most likely to cause longterm damage?

Answer 8

prolonged, symptomatic hypoglycaemia can cause permanent neurological disability

Question 9

How can hypoglycaemia usually be prevented in the first instance?

Answer 9

early and frequent milk feeding

Question 10

What should be performed in infants at increased risk of hypoglycaemia?

Answer 10

regular blood glucose monitoring at the bedside

Question 11

What are 3 reasons why a newborn being monitored for hypogycaelmia should receive an IV glucose infusion?

Answer 11

1. 2 low values <2.6 mmol/L
2. One very low value <1.6 mmol/L
3. Become symptomatic

Question 12

What concentration of IV glucose should be given if needed?

Answer 12

may need to be increased from 10% to 15% or even 20%

Question 13

What should be done if abnormal blood glucose results are detected?

Answer 13

should confirm in the laboratory

Question 14

How should high-concentration IV infusions of glucose be given to the neonate and why?

Answer 14

via central venous catheter to avoid extravasation into tissues, which may cause skin necrosis and reactive hypoglycaemia

Question 15

What can be given instead of IV glucose infusion if there is difficulty or delay in starting the infusion?

Answer 15

glucagon