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
- 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
- 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
|
- 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
Metabolic
- Hypoglycemia: presents in 1st 24 hours
- Hypocalcemia
- Hypomagnesemia presents later
- Polycythemia
- Neonatal jaundice
CVS
- 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
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