Neonatal Hypoglycaemia Lecture note, Paediatrics, Useful for USMLE and PLAB by Gboneme Sandra

1. NEONATAL
HYPOGLYCAEMIA
By GBONEME SANDRA
FINAL YEAR MEDICAL STUDENT,
CMUL

2. Outline
O Introduction and Definition
O Epidemiology
O Etiological factors
O Clinical presentation
O Management

3. Introduction and Definition
O Blood glucose less than 45mg/dl
irrespective of gestational age. (I.E
Preterm or term birth)

4. Epidemiology
O It is the commonest metabolic problem.
O Also, the commonest metabolic
emergency

5. Etiological Factors
O HYPERINSULINAEMIA
 Infants of Diabetic mothers: due to
pancreatic islet hypertrophy.
 Beckitt-Weiderman syndrome:
characterized by macroglosia,
macrosomia, omphalocele, hypoglycemia.
 Insulin producing tumors: Islet cell
adenomas, Nesidoblasts
 Rhesus hemolytic disease.

6. Etiological factors contd
O LIVER FUNCTION: Inadequate storage
and production of glycogen.
 IUGR
 Prematurity
 In born error of metabolism. Eg
Galactosemia
 Starvation

7. Etiological Factors contd
O INCREASED GLUCOSE USE
 Hypothermia
 Asphyxia
 Shock
 Sepsis

8. Etiological Factors contd
O HORMONE DEFICIENCY
 Thyroid hormone
 Cortisol
 Growth hormone

9. Clinical Presentation
O SIGNS and SYMPTOMS
 Tachycardia
 Sweating
 Pallor
 Arrhythmias
 Vomiting
 Jitters
 Tremors
 Coma
 High pitched cry
 Seizures
 Apnea

10. Management
O INVESTIGATION
 Serum glucose level
 Complete blood count plus differentials to
rule out sepsis
 Thyroid function tests
 Cortisol and Growth hormone tests

11. Management
O TREATMENT
 Anticipation and prevention in high risk
infants. I.E infants of diabetic mothers
 Keep a dextrostix chart
 Monitor glucose level within the first hour, then
monitor ever 1-2hours for the first 6-8 hours,
then every 4-6 hours for the next 24 -48
hours.
 Feed within the first hour either orally or via
nasogastric tube.

12. Treatment contd
O For symptomatic neonates: Give 2ml/kg of
10% dextrose stat.
O Then 60mg/kg/24hrs via infusion
O Presence of seizures: Give 4ml/kg of 10%
dextrose stat.
O Maintain glucose levels at 70-120mls/kg
O 0.1ml/kg of IM Glucagon given in cases of
emergency.

13. O Further Reading: Gomella Neonatology

14. Thank you!