Neonatology - Neonatal Hypoglycaemia

Question 1

Definition

Answer 1

Blood glucose < 2.5 mmol/l or less
- caused by an imbalance between glucose production and utilisation in the neonate

Question 2

Acute hypoglycaemia

Answer 2

Hypoglycaemia in the initial period after birth is a normal physiological adaptation to extra-uterine life, and is usually transient and asymptomatic.

Question 3

Prolonged hypoglycaemia aetiology

Answer 3

When hypoglycaemia persists and becomes symptomatic and it becomes a medical issue, that can be potentially fatal
- Insufficient glucose supply
- Low glycogen or fat stores
- Excessive insulin production
- Increased metabolic demand
- Adrenal or pituitary failure

Question 4

Epidemiology

Answer 4

• Maternal diabetes: infants will have hyperinsulinism
• Immediate cord clamping: sudden cessation in maternal glucose can cause early hypoglycaemia
• Prematurity, small for gestational age, intaurterine growth restricted
• Perinatal stress or asphyxia: this increases metabolic demand and causes hyperinsulinism
• Congential metabolic disorders
• Maternal labetalol use during pregnancy

Question 5

Signs

Answer 5

• hypotonia
• seizures
• apnoea
• cyanosis

Question 6

Symptoms

Answer 6

• poor feeding
• lethargy
• irritability
• jitteriness
• weak, high-pitched cry

Question 7

Diagnosis

Answer 7

FIRST LINE:
- Point of care glucose measurement: heel-prick blood sample using a point-of-cafe glucose meter
GOLD STANDARD: capillary blood gas analysis (point of care testing is less accurate < 2.0 mmol/l

Investigation to consider:
- serum electrolytes, lactate and ammonia
- newborn screening test: offered in all infants on day 5 to identify inborn errors of metabolism.

Question 8

Prevention

Answer 8

Keep warm: immeadiately drying the baby, wrapping them in a towel
Skin-to-skin
Early feed: ideally within 60 minutes of birth

Question 9

Treatment

Answer 9

FIRST LINE: Promote feeds = encouraging feeding for mild hypoglycaemia
Moderate-to-severe: baccal 40% glucose gel: >2 doses are administered within 24 hours period, it requires admission to SCBU
IV glucose: for infants who cannot tolerate oral feeding or in cases of severe or persistent hypoglycaemia,
Monitoring blood glucose levels + treat underlying causes

Question 10

Complications

Answer 10

• Neurological injury: seizures, cerebral palsy
• Cognitive and developmental delays
• Recurrent hypoglycaemia