Screen Mgmt NB at Risk for Low BG Flashcards
Definition of transitional hypoglycemia within the first 72h post-birth?
A blood glucose level <2.6 mmol/L.
Definition of persistent hypoglycemia beyond the first 72h post-birth?
Blood glucose levels <3.3 mmol/L
Clinical signs of hypoglycemia?
Clinical signs (in order of frequency):
- Jitteriness or tremors
- Cyanotic episodes
- Convulsion
- Intermittent apneic spells or tachypnea
- Weak or high-pitched cry
- Limpness or lethargy
- Difficulties feeding
- Eye-rolling
- Sweating, sudden pallor, hypothermia, and cardiac arrest and failure may also occur
4 approaches to defining safe range for BG?
- Use clinical manifestations
- can be difficult to recognize or differentiate from other conditions
-Using normative ranges - Studies on exclusively breastfed, appropriate for gestational age term infants show BG levels fall immediately after birth from 2/3 of maternal level as low as 1.8 mmol/L at 1hr of age. They rise to >2.0 mmol/L which are generally maintained for 72 hours.
12-14% of well, AGA breasftfed infants have BG <2.6 mmol/L in the first 72hr after birth.
Past 72hrs, generally maintain BG >3.3 mmol/L.
Preterm infants may take longer to reach this threshold.
-Using presence or absence of acute normal physiological, metabolic, and endocrine changes
E.g. rise in ketones, GH, cortisol, catecholamines, suppression of insulin
-Using presence or absence of sequelae
Studies of at risk term, prem, SGA infants showed association of short and long term neurological or neuroimaging changes with BG <2.6 mmol/L.
Some studies showed no harm from transient hypoglycemia but rather an increased risk for long-term sequelae with recurrent episodes of hypoglycemia
Infants at risk for hypoglycemia?
- Weight <10th percentile (SGA)
- Intrauterine growth restriction (IUGR)
- Weight >90th percentile (LGA)
- Infants of diabetic mothers (IDMs)
- Preterm infants <37 weeks GA
- Maternal labetalol use
- Late preterm exposure to antenatal steroids
- Perinatal asphyxia
- Metabolic conditions (e.g., CPT-1 deficiency, particularly in Inuit infants)
- Syndromes associated with hypoglycemia (e.g., Beckwith-Wiedemann)
When to do a critical sample beyond the transitional period (72h)? What should it include?
BG <2.8
- confirmatory plasma glucose
- beta-hydroxybutyrate
- bicarbonate
- lactate
- free fatty aciids
- insulin
- growth hormone
- cortisol
- carnitine
- acylcarnitine profiling
When should BG screening of asymptomatic, at-risk infants occur?
At 2 hours of age and ever 3-6hours after that, in conjunction with breastfeeding
When can BG testing be discontinued in LGA and IDMs if levels remain >/=2.6?
12 hours
When can BG testing be discontinued in SGA and preterm infants if levels remain >/=2.6 and feeding has been established?
24 hours
When do asymptomatic at-risk infants require intervention in the first 72h post birth?
<2.6mmol/L, assuming one effective feed
Who should receive enteral supplementation to augment caloric intake before starting IV dextrose? When should you recheck?
Asympttomatic infants wth BG 1.8-2.5mmol/L.
Recheck 30 minutes later
Which infants should get IV dextrose?
- Symptomatic
- Failed to respond to enteral supplementation
- BG =1.8 despite an effective feed
When can dextrose gels be used?
- As an alternative to IV therapy in asymptomatic infants with BG <2.6 in CONJUNCTION with enteral supplementation
- Symptomatic infants as a temporizing measure to raise BG while waiting to establish IV dextrose bolus and infusion
At what BG level should infants beyond the first 72h of life be investigated further?
=2.8
Therapeutic target for infants with persistent hypoglycemia?
> /=3.3
