Screening guidelines for newborns at risk for low blood glucose Flashcards
What are the symptoms of hypoglycemia
- CNS: jittery, tremor, apathy, apnea, seizures, weak or high pitched cry, eyes rolling
- RESP: cyanosis, tachypnea
- GI: difficulty with feeding
- CVS: pallor, sweating, cardiac arrest
- hypothermia
what does the normal range of glucose depend on
gestation nutritional status (glycogen stores) size clinical condition energy needs
Which babies are at high risk of hypoglycemia
large babies SGA IDM preterm perinatal asphyxia
Are there long term consequences of hypoglycemia
asymptomatic: unclear. in preterm babies there is evidence linking hypoglycemia to lower HC and developmental scores
symptomatic: yes. symptomatic hypoglycemia results in neuronal injury,
→ short and long term neurological changes.
Is all hypoglycemia bad
probably not (if asymptomatic) 12-14% of normal breast fed babies will have blood glucose levels less than 2.6 in the first three days of life
What is the physiology of neonatal hypoglycemia
impaired gluconeogenesis
excessive insulin production
altered counter-regulatory hormone production
inadequate substrate supply
Who should we screen and when
the infants considered high risk: preterm, LGA, IDM, SGA
at 2 hours of life (after 1 feed) and then Q3-6 hours
What is the typical timing of neonatal hypoglycemia
Depends on the cause:
LGA and IDM: typically by 3 hours, upper limit 12 hours
Preterm and SGA: vulnerable up to 36 hours
Screening can then stop at 12 and 36 hours respectively
How should we screen
send to lab (more reliable)
point of care can be unreliable
NB can have 10% variation between whole blood and plasma (latter is higher)
What is the lower limit of the proposed normal BG
2.6
What do you do: an at risk baby has a BG of less than 1.8 after their first feed
IV dextrose: TFI 80 10%
At this level you should manage with some expedience
What do you do: an at risk baby has a BG of less than 2.0 after a feed
IV dextrose: TFI 80 10%
Because it’s after a feed.
If it’s not after a feed you can try to feed
What do you do: an at risk baby has a BG 2.1
feed orally and recheck in 60 minutes
You are safe to use PO between 1.8-2.6 unless repeatedly low
What do you do: an at risk baby has a BG of 2.1 → you feed and recheck after 60 minutes and it is 2.4
Consider IV dextrose
What are your options for managing asymptomatic hypoglycemia
Oral feeds: increased frequency of BF, supplement
IV dextrose
Meds: glucagon, steroids, octreotide, diaxoside
No trials have demonstrated a benefit of one over the other