Neonatal Hypoglycemia - NEET PG Pediatrics

Definition

Neonatal hypoglycemia is defined  when the plasma glucose level is less than 30 mg/dL in the first 24 hours of life and less than 45 mg/dL (2.5 mmol/L) thereafter. Neurologic damage including mental retardation, recurrent seizure activity, developmental delay, and personality abnormalities are some of the most severe long-term effects. 

Read this blog further to get a quick overview of this important topic for PEDIATRICS and ace your NEET PG/NExT exam preparation.

High Risk Neonates for Hypoglycemia                             

• SFD (small for date)/IUGR/Preterm
• Large for date neonates /infant of diabetic mother
• Neonatal hypothermia
• Neonatal sepsis
• Regular blood glucose monitoring is recommended in high risk neonates at regular intervals (2 hours, 6 hours, 12 hours, 24 hours, 48 hours, 72 hours of life). Blood glucose values are lowest b/w 1-3 hours of life.

Clinical Features       

• Jitteriness > Tremors (most common)
• Jitteriness stops on holding the limb but seizures do not.
• Neonatal seizures
• Lethargy
• Poor feeding
• Apnea, cyanosis
• Stupor, coma
• Increased sweating
• Sudden pallor
• Cardiac arrest

Treatment:    

a)Symptomatic

IV 10% dextrose @ 2ml/kg stat bolus

↓

Continuous IV fluids (@ GIR of 6 mg/kg/min)

↓

Monitor blood glucoses and titrate GIR according to

Blood Glucose value (GIR= glucose infusion

b)Asymptomatic

1. If the Blood Glucose is less than 20 mg/ then start IVF @ GIR of 6mg/kg/min – continue blood glucose monitoring and titrate GIR according to blood glucose levels
2. BG 20 – 40 mg/dl Offer a feed to baby & recheck Blood Glucose after ½ hour– 1 hour

• Case 1: Blood Glucose still low → start IVF @ GIR of 6 mg/kg/min – continue blood glucose monitoring and titrate GIR according to BG value
• Case 2: Blood Glucose is normal → Continue frequent feeding & Blood Glucose monitoring
• Maximum dextrose concentration that can be given via a peripheral access =12.5%

Persistent Hypoglycemia                         

Endocrine Causes

• Congenital hypopituitarism
• Congenital adrenal insufficiency
• Congenital hyperinsulinemia (or) Nesidioblastosis (or) PHHI (Persistent Hyperinsulinemic hypoglycemia of Infancy)
• It is mcc of persistent hypoglycemia during infancy
• Drugs used in treatment
• Octreotide (s/c injection)
• Diazoxide
• Glucagon
• Nifedipine
• Surgery in focal cases

Metabolic Causes

• Glycogen storage disorders
• Galactosemia
• Hereditary fructose intolerance
• Mitochondrial disorders
• Fatty acid oxidation defect

Infant of Diabetic Mother

Complications and congenital malformations are more in babies born to mothers with pre-existing diabetes than those with GDM.

Pathophysiology                                                     

Pederson's Maternal Hyperglycemia/ Fetal

Hyperinsulinemia Hypothesis

Maternal Hyperglycemia

↓

Fetal Hyperglycemia

↓

Hyperplasia and hypertrophy of fetal pancreatic beta cells

↓

Fetal hyperinsulinemia → Neonatal Hypoglycemia

↓

Insulin acts as a Growth Factor for Fetus

Macrosomia LFD	Extra Medullary Hematopoiesis	RDS in Infants
All organs ↑ in size in IDM  except brain Hairy pinna + nt in IDM	Polycythemia Neonatal Hyperbilirubinemia	Insulin inhibits cortisol mediated maturation of surfactant

Problems in IDM

Macrosomia/ Large for Date Baby

• Difficult/ prolonged labour
• ↑ ed chances of birth trauma
  • Perinatal asphyxia/HIE

Metabolic

• Hypoglycemia: presents in 1st 24 hours
• Hypocalcemia
• Hypomagnesemia presents later
• Polycythemia
• Neonatal jaundice

CVS 

• Increased risk of CHD

• Mc congenital abnormality in IDM: C.H.D (Congenital heart disease)
• Mc congenital heart disease in IDM: V.S.D
• Most specific congenital heart disease in IDM: TGA (Transposition of great arteries)

Respiratory System

• More chances of RDS due to delayed maturation of surfactant

CNS

• Mc congenital neurologic abnormality in IDM: Neural tube defects
• Most specific neurologic abnormality in IDM: Sacral agenesis or caudal regression syndrome.
• Overall most specific congenital abnormality in IDM: Sacral agenesis or caudal regression syndrome

Renal

• Renal agenesis
• Duplication of ureter
• Renal vein thrombosis

GI

• Duodenal atresia
• Lazy (small) left colon syndrome

Long Term Problems

• Blindness
• Obesity
• Non ketotic hypoglycemia
• Diabetes mellitus

This is everything that you need to know about Neonatal hypoglycemia  for your PEDIATRICS PREPARATION. For more interesting and informative blog posts like this download the PrepLadder App and keep reading our blog!