Screening guidelines for newborns at risk for low blood glucose Flashcards

1
Q

What are the symptoms of hypoglycemia

A
  • 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
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2
Q

what does the normal range of glucose depend on

A
gestation
nutritional status (glycogen stores)
size
clinical condition
energy needs
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3
Q

Which babies are at high risk of hypoglycemia

A
large babies
SGA
IDM
preterm
perinatal asphyxia
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4
Q

Are there long term consequences of hypoglycemia

A

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.

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5
Q

Is all hypoglycemia bad

A
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
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6
Q

What is the physiology of neonatal hypoglycemia

A

impaired gluconeogenesis
excessive insulin production
altered counter-regulatory hormone production
inadequate substrate supply

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7
Q

Who should we screen and when

A

the infants considered high risk: preterm, LGA, IDM, SGA

at 2 hours of life (after 1 feed) and then Q3-6 hours

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8
Q

What is the typical timing of neonatal hypoglycemia

A

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

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9
Q

How should we screen

A

send to lab (more reliable)
point of care can be unreliable

NB can have 10% variation between whole blood and plasma (latter is higher)

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10
Q

What is the lower limit of the proposed normal BG

A

2.6

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11
Q

What do you do: an at risk baby has a BG of less than 1.8 after their first feed

A

IV dextrose: TFI 80 10%

At this level you should manage with some expedience

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12
Q

What do you do: an at risk baby has a BG of less than 2.0 after a feed

A

IV dextrose: TFI 80 10%

Because it’s after a feed.
If it’s not after a feed you can try to feed

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13
Q

What do you do: an at risk baby has a BG 2.1

A

feed orally and recheck in 60 minutes

You are safe to use PO between 1.8-2.6 unless repeatedly low

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14
Q

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

A

Consider IV dextrose

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15
Q

What are your options for managing asymptomatic hypoglycemia

A

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

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16
Q

Do you bolus glucose

A

a single minibolus of 2 ml/kg 10% at the start of an infusion more rapidly achieves steady state levels, but the benefit in asymptomatic babies is uncertain.

Due to the short duration of action of glucose, repeated miniboluses without an increase in the infusion rate is not recommended.

17
Q

When do you recheck after an intervention

A

IV: 30 minutes
PO: 60 minutes

18
Q

How do you treat symptomatic neonates

A

They should be treated with IV dextrose, especially if they have neurological signs

19
Q

What do you do: you are titrating up and up on your dextrose infusion with repeated episodes of hypoglycemia. When do you add a pharmacological interfvention

A

when GIR is over 10 mg.kg.min

20
Q

What is the first line pharmacological measure

A

glucagon bolus 0.1 mg/kg to 0.3 mg/kg

Then can do infusion: 20 ug/kg/hr

21
Q

Any counfounding concerns you should watch out for

A

Watch the sodium! They get dilutional hyponatremia

try not to exceed 100 ml/kg/day

22
Q

When do you wean IV dextrose

A

when stables sugars x 12 hours

23
Q

Do all kids get screened

A

No
Routine screening of appropriate-for-gestational-age infants at term do not

Only screen: IDM, LGA, SGA, preterm