Neonatal Hypoglycaemia and Precocious Puberty Flashcards
What is the definition of hypoglycaemia?
Abnormally low plasma glucose level in a neonate, enough to cause seconday naurologicla injury (<2.5mmol/l).
What is the mechanism of hypoglycaemia in a neonate?
May be transient (<1/52) or prolonged. Due to any condition that increases metabolic demand. Neonates have impaired ketogenesis and hepatic glycogen stores, therefor eincreased demand will quickly lead to a fall in glucose. Highest risk at 6-12h post delvery. Majority due to hyperinsulinism .
What are the transient causes of neonatal hypoglycaemia?
prematurity, IUGR, prenatal asphyxia, Beckwyth Wiedemann syndrome, hypothermia, sepsis, maternal diabetes, erythroblastosis fetalis (increased insulin) B agonist tocolytics (terbutaline)
What are the prolonged causes of neonatal hypoglycaemia?
Congenital hyperinsulinism, inborn errors of metabolism, nesidioblastosis/islet cell adenoma.
What is the epidemiology of neonatal hypoglycaemia?
10% neonates if first feed after 6h.
What would you find in history and exam of a neonate with hypoglycaemia?
Irritability, tremulousness, birsk Moro, poor feeding, aopnea, tachypnea, distress, lethargy, drowsy, low temperature, seizures.
Specific: macrosomia (hyperinsulinism) jaundice (galactosaemia and sepsis) hepatomegaly (GSDs).
What investigations would you do for hypoglycaemia?
Routine bloods: low glucose and high ketones.
Specific bloods: Insulin (hperinsulinism) c-peptide, cortisol (hypoadrenalism) GH (hypopitiutarism) lactate/pyruvate (GSDs) ketone bodies, NH4.
WHat is the management of hypoglycaemia?
Mild symptoms: if no contraindications, managed with increased enteral feeds. Monitor blood sugar.
Severe symptoms:
- IV dextrose bolus 2-5mg/kg 10% DX followed by infusion. 5-8mg/kg/min.
- Volume increase if there is need for increased glucose (not strength)
- Dextrose >12.5% infused through central venous line not peripheral.
- Reqiring >10mg/kg/min IV consider glucagon IM/IV, diazoxide/ocreotide (reduce insulin), hydrocortisone if adrenal insuficiency suspected.
Surgery may be required for islet cell adenoma/mesidioblastosis. Caproscopic or open pancreatectomy.
What are the complications/ prognosis of hypoglycaemia?
Untreated, low head size, IQ, brain anomalies.50% survivors have long term cmx.
What is the definition of Precocious puberty (partial)?
Early partial sexual developpment, minimal development in absence of other pubertal stigmata.
Premature thelarche: isolared breast. Adrenarche: pubic hair. Menarche: bleed
What is the aetiology of Precocious puberty (partial)?
PT: period of relatively high but decreasing activity of HPO axis at 6m-2y.
PA: Early maturation of normal androgen secretion
PM: Spontaneous regression of ovarian cyst, hypothyroid, McAlbSyn (see complete)
What is the epidemiology of Precocious puberty (partial)?
PT relatively commoni n Afrocaribbean. PA also.
What is the history/ exam of Precocious puberty (partial)?
PT: isolated unilateral or bilateral breast development between 6m-2y. Non progressive and associated with no areolar development.
PA: Self limiting, inccrease in growth rate.
PM: May occur physiologically postnatally. Distinguish from foul smelling blood discharfe, form trauma infection or abuse. And bleeding from the urinary tract. Detailed hx and exmaination required.
Which investigations should be done in Precocious puberty (partial)?
General:may not be necessary in PT.
Pathology: LSH/FSH/Oes levels, GNRH/ACTH testing
Radiology: USS ovaries and uterus, bone age radiograph
Culture of urine, vagina discharge.
What is the management of Precocious puberty (partial)?
Specialist paediatric endocrinologist. No intervention usually requried
