Neonatal Hypoglycemia

Question 1

Definition

Answer 1

• In the first 24 hours: blood glucose < 40 mg/dl ( 2.2 mmol/l)
• Above 24 hours after birth: blood glucose < 45 mg/dl (2.5 mmol/l) y WHO recommends keeping blood glucose > 47 mg/dl (2.6 mmol/l)

Question 2

Risk factors for hypoglycemia

Answer 2

😱most common 
1. Increased demand or decreased supply (⬇️ energy store )
o 😱Small for gestational age 
o 😱Preterm 
o Perinatal asphyxia 
o Polycythemia o Hypothermia 
o Neonatal sepsis

2. Hyperinsulinism e.g.
   o 😱Large for gestational age e.g. Infant of diabetic mother
   o Hemolytic disease of newborn
   o Beckwith Wiedemann syndrome
3. Endocrinopathy (no hormones that anti agonize insulin➡️⬆️insulin➡️⬇️glucose)
   o Growth hormone deficiency
   o Congenital adrenal hyperplasia

4. Inborn errors of metabolism 
o Glycogen storage disease
 o Galactosemia 
o Organic academia 
o Fatty acid oxidation defects

Question 3

Clinical manifestations

Answer 3

1. Asymptomatic: common presentation
2. Symptomatic:

🌝Adrenergic

• Jitteriness
• Tachypnea
• Pallor
• tem instability
• vomiting
• tachycardia
• hunger

🌝Neuroglycopenic sx

• Weak or high-pitched cry
• Apneic episodes
• Lethargy or floppiness, poor feeding
• Cyanosis
• Convulsions or eye-rolling
• coma

Question 4

Management

Answer 4

-Normoglycemic high-risk infants should receive oral or gavage feeding with human milk or formula started as soon as possible (at 1–3 hr of age) and continued at 2–3 hr intervals for 24–48 hr.
-If the infant cannot tolerate oral feeding or if asymptomatic transient neonatal hypoglycemia develops, give IV glucose infusion at a rate of 4-6 mg/kg/min (up to 8 for newborn of diabetic mother).
(10% dextrose—->100mg\ml
Glucose intake (mg/kg/min) = fluid rate (ml/hr) × % glucose / 6 × weight (kg)

• 🧿😱In symptomatic hypoglycemia (other than seizures), 10% glucose (2 ml/kg), whereas if seizures are present, double the dose, i.e. 4 ml/kg, followed by a continuous infusion of glucose at 6-8 mg/kg/min, adjusting the rate to maintain blood glucose levels in the normal range.
• hydrocortisone 2.5 mg /kg 6hourly
• diazoxide iv
• octreotide
• Glucagon

Persistent hypoglycemia y Investigate for endocrinopathy y Investigate for inborn errors of metabolism