This document provides guidelines for monitoring and treating hypoglycemia in breastfed neonates. It summarizes that transient hypoglycemia is common in healthy newborns and usually resolves on its own without treatment. Routine glucose monitoring is unnecessary for healthy term infants and could harm breastfeeding. The guidelines define hypoglycemia, recommend thresholds for plasma glucose levels by infant age, and identify at-risk infants that may require monitoring. Clinical signs of hypoglycemia are also outlined.
pediatrics emergency, hypoglycemia of infancy.
Glucose level can drop if:
There is too much insulin in the blood (hyperinsulinism). Insulin is a hormone that pulls glucose from the blood.
The baby is not producing enough glucose.
The baby's body is using more glucose than is being produced.
The baby is not able to feed enough to keep glucose level up.
This document discusses neonatal hypoglycemia and hyperglycemia. It begins by explaining the physiology of glucose homeostasis in newborns, including their dependence on maternal glucose prenatally and the body's response to low blood sugar through gluconeogenesis and ketone production. It then defines hypoglycemia, discusses its incidence in high-risk newborns, and identifies potential etiologies like hyperinsulinism. Clinical features and diagnostic methods are outlined, along with treatment approaches focused on early feeding and prevention in at-risk infants.
Neonatal hypoglycemia occurs when blood glucose levels drop dangerously low in newborns. It affects 5-15% of infants and can cause neurological damage if untreated. The document discusses the causes, signs, classifications, diagnosis, treatment and prevention of neonatal hypoglycemia. It emphasizes the importance of monitoring blood glucose levels in at-risk infants, providing IV dextrose or feeding to raise glucose, and supporting breastfeeding to help prevent hypoglycemia. Nursing care focuses on stabilizing blood glucose through nutrition and medical management.
Neonatal Hypoglycemia and Infant of a Diabetic MotherThe Medical Post
This document discusses hypoglycemia in infants of diabetic mothers. It begins by outlining the risks of hypoglycemia in these infants, including transient drops in blood glucose levels after birth due to high insulin levels. It then discusses the causes, symptoms, diagnosis and management of hypoglycemia. Key points include the importance of monitoring blood glucose levels, treating low levels aggressively with IV dextrose boluses and infusions, and addressing any other issues such as hypocalcemia.
Neonatal hypoglycemia is defined as a blood glucose level below certain thresholds in the first days of life and can be caused by decreased glucose production, increased utilization, or hyperinsulinemia. Common signs include tremors, hypotonia, and changes in consciousness. Management involves warming the baby, giving intravenous dextrose or glucagon, and carefully advancing milk feeds while monitoring blood glucose. Hypoglycemia can cause long term neurological complications if not properly treated.
This document discusses the case of a term male infant born without complications who experienced episodes of hypoglycemia. At 2 hours of age he was jittery with a blood glucose of 35 mg/dL and improved after feeding. On the second day of life he again had low glucose of 35 mg/dL. At 2 weeks he presented with fussiness, jitteriness, staring spells, somnolence, and seizures with glucose less than 10 mg/dL, requiring IV glucose treatment. He continued having recurrent hypoglycemic episodes over the following weeks.
This document discusses neonatal hypoglycemia in a newborn baby referred from another hospital. It provides details on the baby's condition, history, treatment and monitoring. It also includes an overview of neonatal glucose homeostasis, the definition of hypoglycemia, classification of neonatal hypoglycemia, special considerations for preterm infants, SGA infants and infants of diabetic mothers. It outlines who should be screened for hypoglycemia and the recommended frequency of blood glucose monitoring based on risk factors.
This document discusses neonatal hypoglycemia, including its definition, causes, screening, management, and long-term outcomes. Some key points:
- Hypoglycemia is common in newborns due to immature metabolic pathways and dependence on glucose. It can cause neurological damage if persistent.
- Definitions vary but typically include blood glucose levels below 45 mg/dL, or 36 mg/dL for asymptomatic babies with risk factors.
- Causes include decreased stores, increased utilization, and endocrine disorders like hyperinsulinemia.
- At-risk babies should be screened at birth and every few hours. Treatment involves glucose boluses and intravenous infusions to maintain safe blood glucose levels.
pediatrics emergency, hypoglycemia of infancy.
Glucose level can drop if:
There is too much insulin in the blood (hyperinsulinism). Insulin is a hormone that pulls glucose from the blood.
The baby is not producing enough glucose.
The baby's body is using more glucose than is being produced.
The baby is not able to feed enough to keep glucose level up.
This document discusses neonatal hypoglycemia and hyperglycemia. It begins by explaining the physiology of glucose homeostasis in newborns, including their dependence on maternal glucose prenatally and the body's response to low blood sugar through gluconeogenesis and ketone production. It then defines hypoglycemia, discusses its incidence in high-risk newborns, and identifies potential etiologies like hyperinsulinism. Clinical features and diagnostic methods are outlined, along with treatment approaches focused on early feeding and prevention in at-risk infants.
Neonatal hypoglycemia occurs when blood glucose levels drop dangerously low in newborns. It affects 5-15% of infants and can cause neurological damage if untreated. The document discusses the causes, signs, classifications, diagnosis, treatment and prevention of neonatal hypoglycemia. It emphasizes the importance of monitoring blood glucose levels in at-risk infants, providing IV dextrose or feeding to raise glucose, and supporting breastfeeding to help prevent hypoglycemia. Nursing care focuses on stabilizing blood glucose through nutrition and medical management.
Neonatal Hypoglycemia and Infant of a Diabetic MotherThe Medical Post
This document discusses hypoglycemia in infants of diabetic mothers. It begins by outlining the risks of hypoglycemia in these infants, including transient drops in blood glucose levels after birth due to high insulin levels. It then discusses the causes, symptoms, diagnosis and management of hypoglycemia. Key points include the importance of monitoring blood glucose levels, treating low levels aggressively with IV dextrose boluses and infusions, and addressing any other issues such as hypocalcemia.
Neonatal hypoglycemia is defined as a blood glucose level below certain thresholds in the first days of life and can be caused by decreased glucose production, increased utilization, or hyperinsulinemia. Common signs include tremors, hypotonia, and changes in consciousness. Management involves warming the baby, giving intravenous dextrose or glucagon, and carefully advancing milk feeds while monitoring blood glucose. Hypoglycemia can cause long term neurological complications if not properly treated.
This document discusses the case of a term male infant born without complications who experienced episodes of hypoglycemia. At 2 hours of age he was jittery with a blood glucose of 35 mg/dL and improved after feeding. On the second day of life he again had low glucose of 35 mg/dL. At 2 weeks he presented with fussiness, jitteriness, staring spells, somnolence, and seizures with glucose less than 10 mg/dL, requiring IV glucose treatment. He continued having recurrent hypoglycemic episodes over the following weeks.
This document discusses neonatal hypoglycemia in a newborn baby referred from another hospital. It provides details on the baby's condition, history, treatment and monitoring. It also includes an overview of neonatal glucose homeostasis, the definition of hypoglycemia, classification of neonatal hypoglycemia, special considerations for preterm infants, SGA infants and infants of diabetic mothers. It outlines who should be screened for hypoglycemia and the recommended frequency of blood glucose monitoring based on risk factors.
This document discusses neonatal hypoglycemia, including its definition, causes, screening, management, and long-term outcomes. Some key points:
- Hypoglycemia is common in newborns due to immature metabolic pathways and dependence on glucose. It can cause neurological damage if persistent.
- Definitions vary but typically include blood glucose levels below 45 mg/dL, or 36 mg/dL for asymptomatic babies with risk factors.
- Causes include decreased stores, increased utilization, and endocrine disorders like hyperinsulinemia.
- At-risk babies should be screened at birth and every few hours. Treatment involves glucose boluses and intravenous infusions to maintain safe blood glucose levels.
This document discusses neonatal hypoglycemia. It begins by explaining glucose physiology in fetuses and the adaptations required at birth. It then defines neonatal hypoglycemia and discusses the various etiologies including endocrine disorders, decreased substrate availability, and increased glucose utilization. Symptoms, screening, and management including prevention, treatment with oral feeds or IV therapy, and treatment of persistent or severe hypoglycemia are covered. The importance of aggressively managing hypoglycemia to prevent neurological damage is emphasized.
Neonatal hypoglycemia can be caused by inadequate substrate in small or preterm infants, relative hyperinsulinemia in infants of diabetic mothers or large babies, or sickness. Symptoms range from none to seizures or coma. High risk infants should be screened for blood glucose levels, with intervention if levels drop below thresholds. Asymptomatic infants with levels over 20mg/dL can be treated with frequent feeding and monitoring, while symptomatic infants receive IV glucose. Hypoglycemia management may also include medical treatments like hydrocortisone or diazoxide. Persistent cases require identifying underlying causes through additional laboratory tests and treatments.
This document discusses neonatal hypoglycemia. It begins by defining neonatal hypoglycemia and noting the controversial operational thresholds used. It then describes the clinical features and various potential etiologies including increased glucose utilization, decreased production, prematurity, IUGR, and various stressors. The management sections cover prevention, anticipation through screening, diagnosis, treatment primarily with IV dextrose infusion, and adjunct therapies. It notes most cases resolve in 2-3 days but persistent or recurrent hypoglycemia may require further evaluation. The significance of hypoglycemia and potential long-term neurological outcomes are described depending on severity and duration. Long-term neurodevelopmental follow-up is recommended.
- Newborns are at risk of hypoglycemia in the first few days of life as glucose levels fall after birth and then rise again. Hypoglycemia is defined as a blood glucose level below 40 mg/dL or 50 mg/dL for preterm infants. Infants at high risk include those with low birth weight, prematurity, or other conditions.
- Symptomatic hypoglycemia can cause issues like tremors, apnea or seizures while asymptomatic hypoglycemia may not show symptoms. Treatment depends on whether hypoglycemia is symptomatic or asymptomatic and may involve oral feeds, IV dextrose solutions or other medications in more severe cases. Screening protocols are recommended for at-risk infants to monitor
This document discusses neonatal hypoglycemia. It begins by defining neonatal hypoglycemia and describing the typical blood glucose levels in newborns compared to older children and adults. It then discusses the main causes of hypoglycemia including decreased production/stores, increased utilization, and hyperinsulinemic hypoglycemia. The clinical manifestations, diagnosis, management, and outcomes of neonatal hypoglycemia are described. Recurrent or resistant hypoglycemia may require additional treatment such as hydrocortisone, diazoxide, or octreotide to help control blood glucose levels. Infants with symptomatic hypoglycemia should be followed long term to monitor for potential neurological or developmental issues.
The document discusses the management of neonatal hypoglycemia. It defines hypoglycemia and lists its common causes such as excess insulin, limited glycogen storage, and decreased gluconeogenesis. It classifies hypoglycemia as transient or persistent and describes the management and treatment approaches for each type. Nursing management plays an important role in prevention, maintaining normal blood glucose levels, and treating hypoglycemic events. Untreated hypoglycemia can lead to serious complications affecting the brain and heart.
Neonatal hypoglycemia is a common metabolic problem in newborns that can cause neurological injury if left untreated. The Sugar Babies trial was a randomized controlled trial conducted in New Zealand that compared the effects of administering 40% dextrose gel or placebo gel to newborns at risk of hypoglycemia. The trial found that fewer babies in the dextrose gel group failed treatment compared to the placebo group. Babies receiving dextrose gel were also less likely to need additional intravenous dextrose treatment or to be admitted to the NICU specifically for hypoglycemia. The study demonstrated that dextrose gel provides an effective first-line treatment for neonatal hypoglycemia.
This document defines neonatal hypoglycemia and provides classifications and risk factors. Neonatal hypoglycemia is defined as a blood glucose level below 35 mg/dL and can be mild (25-35 mg/dL) or severe (<25 mg/dL). It may cause neurological or autonomic symptoms. Risk factors include infants of diabetic mothers, prematurity, IUGR, and genetic metabolic disorders. Diagnosis involves blood glucose testing of at-risk infants. Treatment is intravenous glucose boluses or infusion, with monitoring until stable. Prevention focuses on early feeding of high-risk infants. Prognosis depends on severity and underlying cause.
This document discusses neonatal hypoglycemia, including definitions, risks, screening and management. Key points:
- Hypoglycemia is associated with increased mortality and neurological impairments if untreated.
- Risks include prematurity, IUGR, infant of diabetic mother. Screen high risk babies within 1 hour of life and all others at 3-4 hours.
- Treatment includes feeding every 3 hours, IV glucose if needed. Persistent hypoglycemia may indicate underlying metabolic disorders requiring further testing and management.
- Long term studies are still needed to better understand outcomes of treated vs untreated neonatal hypoglycemia in developing countries.
This document discusses neonatal hypoglycemia. It begins by defining hypoglycemia in newborns as a blood glucose level below 40 mg/dL, regardless of symptoms. The main causes of neonatal hypoglycemia include increased glucose utilization due to conditions like hyperinsulinism in infants of diabetic mothers, decreased glucose production due to prematurity or IUGR, or increased utilization combined with decreased production due to perinatal stress. Symptoms of hypoglycemia are non-specific. Management involves prevention by screening at-risk babies, treatment with IV dextrose or adjunctive therapies like glucagon or hydrocortisone if needed, and evaluating for underlying causes if hypoglycemia is persistent or recurrent. Prolong
Neonatal hypoglycemia can occur in high-risk infants such as those born to diabetic mothers or who are preterm/small for gestational age. Symptoms may include jitteriness, apnea, or seizures. Management involves early feeding and glucose monitoring to prevent and detect hypoglycemia. For levels under 1.5 mmol/L, IV dextrose is given with frequent monitoring until levels rise above 2.6 mmol/L. Persistent hypoglycemia may require increased dextrose concentration or addition of medications like glucagon or hydrocortisone. Recurrent hypoglycemia suggests underlying conditions like hyperinsulinemia which require additional investigation and treatment with drugs to reduce insulin secretion.
This document discusses glucose regulation and hypoglycemia in infants. It notes that hypoglycemia is defined as a blood glucose level below 40 mg/dL and can cause long term neurological damage if prolonged. The mechanisms that control blood glucose levels like insulin and glucagon are described. Causes, signs, and treatments of hypoglycemia in infants are provided, including feeding, intravenous dextrose infusions, and medications if needed to stabilize blood glucose. Screening and monitoring of at-risk infants is recommended.
This document discusses neonatal hypoglycemia, including its definition, causes, symptoms, management, and long-term effects. Some key points include:
- Neonatal hypoglycemia is defined as a blood glucose level of <40mg% regardless of gestational age or symptoms. It can be caused by increased glucose utilization, decreased production or stores, or endocrine deficiencies.
- Common risk factors include babies of diabetic mothers, large or small for gestational age infants, and prematurity. Symptoms range from tremors to seizures. Treatment involves early feeding, IV glucose therapy, and identifying and treating the underlying cause.
- Without treatment, hypoglycemia can lead to long-term neurological impairments in 25
The document discusses neonatal hypoglycemia, including its definition, symptoms, risk factors, treatment, and monitoring. Some key points:
- Neonatal hypoglycemia is defined as a blood glucose level below certain thresholds in the first 24 hours and thereafter. It is a common problem in newborns.
- Babies at higher risk include preterms, those of diabetic mothers, or experiencing other stresses. Symptoms can be nonspecific.
- Treatment involves glucose administration via IV bolus or infusion to raise blood glucose to the normal range. Frequent monitoring is needed until levels stabilize.
- Persistent or resistant hypoglycemia may require additional drugs or referral to a specialist to investigate underlying
1) Hypoglycemia is common in newborns, affecting 1-3 per 1000 live births, with risk decreasing with increasing gestational age.
2) Significant neurodevelopmental deficits can occur in neonates who experience prolonged hypoglycemia. Studies in monkeys and infants show neuronal injury, particularly in parieto-occipital cortex and other regions.
3) There is no consensus on the definition and threshold for treating hypoglycemia. Guidelines generally recommend treating if blood glucose is less than 50 mg/dL in symptomatic newborns or less than 36 mg/dL in at-risk but asymptomatic newborns.
Neonatal hypoglycemia is defined as a blood glucose level below a certain operational threshold, depending on the clinical state and age of the neonate. The main causes include hyperinsulinemic hypoglycemia, decreased production/stores, and increased utilization or decreased production due to perinatal stress, infections, or defects in carbohydrate or amino acid metabolism. Symptoms range from being asymptomatic to neurological or neuroglycopenic symptoms. Management involves frequent feeding or intravenous glucose infusion depending on the severity of hypoglycemia. Recurrent or persistent hypoglycemia requires investigating for underlying causes and treating with drugs like hydrocortisone, diazoxide, or octreotide.
This document discusses a case of neonatal diabetes mellitus (NDM) in an infant. Key points:
1. The infant presented with hyperglycemia after birth and was diagnosed with NDM after ruling out other causes.
2. Treatment with NPH insulin was initially tried but glycemic control remained inadequate.
3. Insulin glargine was then started and provided excellent glycemic control with no episodes of hypoglycemia, allowing the infant to be shifted to a step-down unit.
4. NDM is a rare condition characterized by persistent hyperglycemia within the first month of life requiring insulin treatment. It can be transient or permanent and is caused by defects in insulin secretion
A male infant was delivered via elective C-section at 36 weeks and 5 days gestation due to the mother's history of two previous C-sections. The infant presented with hypoglycemia which is common in infants of diabetic mothers. The infant was admitted to the NICU for monitoring and treatment of hypoglycemia, including intravenous fluids and corticosteroids. After several days of blood sugar monitoring and treatment, the infant's blood sugars stabilized and he was discharged.
9 способов повысить эффективность финансовых организаций при помощи FAST SearchMichael Kozloff
Маркетинг, исследования и продуктовые инновации
Исследования рынков и клиентов
Разработка новых продуктов
Поиск в интранет информации и экспертов
Governance, Risk Management, Compliance (GRC)
Соответствие требованиям регуляторов (152ФЗ…)
Ускорение подготовки ответов для разных органов
Объединение разрозненных информационных архивов
Улучшение клиентского обслуживания
Единая версия правды о клиентах (know your client)
Повышение эффективности многоканального обслуживания
Поиск результатов бизнес-анализа
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise stimulates the production of endorphins in the brain which elevate mood and reduce stress levels.
This document discusses neonatal hypoglycemia. It begins by explaining glucose physiology in fetuses and the adaptations required at birth. It then defines neonatal hypoglycemia and discusses the various etiologies including endocrine disorders, decreased substrate availability, and increased glucose utilization. Symptoms, screening, and management including prevention, treatment with oral feeds or IV therapy, and treatment of persistent or severe hypoglycemia are covered. The importance of aggressively managing hypoglycemia to prevent neurological damage is emphasized.
Neonatal hypoglycemia can be caused by inadequate substrate in small or preterm infants, relative hyperinsulinemia in infants of diabetic mothers or large babies, or sickness. Symptoms range from none to seizures or coma. High risk infants should be screened for blood glucose levels, with intervention if levels drop below thresholds. Asymptomatic infants with levels over 20mg/dL can be treated with frequent feeding and monitoring, while symptomatic infants receive IV glucose. Hypoglycemia management may also include medical treatments like hydrocortisone or diazoxide. Persistent cases require identifying underlying causes through additional laboratory tests and treatments.
This document discusses neonatal hypoglycemia. It begins by defining neonatal hypoglycemia and noting the controversial operational thresholds used. It then describes the clinical features and various potential etiologies including increased glucose utilization, decreased production, prematurity, IUGR, and various stressors. The management sections cover prevention, anticipation through screening, diagnosis, treatment primarily with IV dextrose infusion, and adjunct therapies. It notes most cases resolve in 2-3 days but persistent or recurrent hypoglycemia may require further evaluation. The significance of hypoglycemia and potential long-term neurological outcomes are described depending on severity and duration. Long-term neurodevelopmental follow-up is recommended.
- Newborns are at risk of hypoglycemia in the first few days of life as glucose levels fall after birth and then rise again. Hypoglycemia is defined as a blood glucose level below 40 mg/dL or 50 mg/dL for preterm infants. Infants at high risk include those with low birth weight, prematurity, or other conditions.
- Symptomatic hypoglycemia can cause issues like tremors, apnea or seizures while asymptomatic hypoglycemia may not show symptoms. Treatment depends on whether hypoglycemia is symptomatic or asymptomatic and may involve oral feeds, IV dextrose solutions or other medications in more severe cases. Screening protocols are recommended for at-risk infants to monitor
This document discusses neonatal hypoglycemia. It begins by defining neonatal hypoglycemia and describing the typical blood glucose levels in newborns compared to older children and adults. It then discusses the main causes of hypoglycemia including decreased production/stores, increased utilization, and hyperinsulinemic hypoglycemia. The clinical manifestations, diagnosis, management, and outcomes of neonatal hypoglycemia are described. Recurrent or resistant hypoglycemia may require additional treatment such as hydrocortisone, diazoxide, or octreotide to help control blood glucose levels. Infants with symptomatic hypoglycemia should be followed long term to monitor for potential neurological or developmental issues.
The document discusses the management of neonatal hypoglycemia. It defines hypoglycemia and lists its common causes such as excess insulin, limited glycogen storage, and decreased gluconeogenesis. It classifies hypoglycemia as transient or persistent and describes the management and treatment approaches for each type. Nursing management plays an important role in prevention, maintaining normal blood glucose levels, and treating hypoglycemic events. Untreated hypoglycemia can lead to serious complications affecting the brain and heart.
Neonatal hypoglycemia is a common metabolic problem in newborns that can cause neurological injury if left untreated. The Sugar Babies trial was a randomized controlled trial conducted in New Zealand that compared the effects of administering 40% dextrose gel or placebo gel to newborns at risk of hypoglycemia. The trial found that fewer babies in the dextrose gel group failed treatment compared to the placebo group. Babies receiving dextrose gel were also less likely to need additional intravenous dextrose treatment or to be admitted to the NICU specifically for hypoglycemia. The study demonstrated that dextrose gel provides an effective first-line treatment for neonatal hypoglycemia.
This document defines neonatal hypoglycemia and provides classifications and risk factors. Neonatal hypoglycemia is defined as a blood glucose level below 35 mg/dL and can be mild (25-35 mg/dL) or severe (<25 mg/dL). It may cause neurological or autonomic symptoms. Risk factors include infants of diabetic mothers, prematurity, IUGR, and genetic metabolic disorders. Diagnosis involves blood glucose testing of at-risk infants. Treatment is intravenous glucose boluses or infusion, with monitoring until stable. Prevention focuses on early feeding of high-risk infants. Prognosis depends on severity and underlying cause.
This document discusses neonatal hypoglycemia, including definitions, risks, screening and management. Key points:
- Hypoglycemia is associated with increased mortality and neurological impairments if untreated.
- Risks include prematurity, IUGR, infant of diabetic mother. Screen high risk babies within 1 hour of life and all others at 3-4 hours.
- Treatment includes feeding every 3 hours, IV glucose if needed. Persistent hypoglycemia may indicate underlying metabolic disorders requiring further testing and management.
- Long term studies are still needed to better understand outcomes of treated vs untreated neonatal hypoglycemia in developing countries.
This document discusses neonatal hypoglycemia. It begins by defining hypoglycemia in newborns as a blood glucose level below 40 mg/dL, regardless of symptoms. The main causes of neonatal hypoglycemia include increased glucose utilization due to conditions like hyperinsulinism in infants of diabetic mothers, decreased glucose production due to prematurity or IUGR, or increased utilization combined with decreased production due to perinatal stress. Symptoms of hypoglycemia are non-specific. Management involves prevention by screening at-risk babies, treatment with IV dextrose or adjunctive therapies like glucagon or hydrocortisone if needed, and evaluating for underlying causes if hypoglycemia is persistent or recurrent. Prolong
Neonatal hypoglycemia can occur in high-risk infants such as those born to diabetic mothers or who are preterm/small for gestational age. Symptoms may include jitteriness, apnea, or seizures. Management involves early feeding and glucose monitoring to prevent and detect hypoglycemia. For levels under 1.5 mmol/L, IV dextrose is given with frequent monitoring until levels rise above 2.6 mmol/L. Persistent hypoglycemia may require increased dextrose concentration or addition of medications like glucagon or hydrocortisone. Recurrent hypoglycemia suggests underlying conditions like hyperinsulinemia which require additional investigation and treatment with drugs to reduce insulin secretion.
This document discusses glucose regulation and hypoglycemia in infants. It notes that hypoglycemia is defined as a blood glucose level below 40 mg/dL and can cause long term neurological damage if prolonged. The mechanisms that control blood glucose levels like insulin and glucagon are described. Causes, signs, and treatments of hypoglycemia in infants are provided, including feeding, intravenous dextrose infusions, and medications if needed to stabilize blood glucose. Screening and monitoring of at-risk infants is recommended.
This document discusses neonatal hypoglycemia, including its definition, causes, symptoms, management, and long-term effects. Some key points include:
- Neonatal hypoglycemia is defined as a blood glucose level of <40mg% regardless of gestational age or symptoms. It can be caused by increased glucose utilization, decreased production or stores, or endocrine deficiencies.
- Common risk factors include babies of diabetic mothers, large or small for gestational age infants, and prematurity. Symptoms range from tremors to seizures. Treatment involves early feeding, IV glucose therapy, and identifying and treating the underlying cause.
- Without treatment, hypoglycemia can lead to long-term neurological impairments in 25
The document discusses neonatal hypoglycemia, including its definition, symptoms, risk factors, treatment, and monitoring. Some key points:
- Neonatal hypoglycemia is defined as a blood glucose level below certain thresholds in the first 24 hours and thereafter. It is a common problem in newborns.
- Babies at higher risk include preterms, those of diabetic mothers, or experiencing other stresses. Symptoms can be nonspecific.
- Treatment involves glucose administration via IV bolus or infusion to raise blood glucose to the normal range. Frequent monitoring is needed until levels stabilize.
- Persistent or resistant hypoglycemia may require additional drugs or referral to a specialist to investigate underlying
1) Hypoglycemia is common in newborns, affecting 1-3 per 1000 live births, with risk decreasing with increasing gestational age.
2) Significant neurodevelopmental deficits can occur in neonates who experience prolonged hypoglycemia. Studies in monkeys and infants show neuronal injury, particularly in parieto-occipital cortex and other regions.
3) There is no consensus on the definition and threshold for treating hypoglycemia. Guidelines generally recommend treating if blood glucose is less than 50 mg/dL in symptomatic newborns or less than 36 mg/dL in at-risk but asymptomatic newborns.
Neonatal hypoglycemia is defined as a blood glucose level below a certain operational threshold, depending on the clinical state and age of the neonate. The main causes include hyperinsulinemic hypoglycemia, decreased production/stores, and increased utilization or decreased production due to perinatal stress, infections, or defects in carbohydrate or amino acid metabolism. Symptoms range from being asymptomatic to neurological or neuroglycopenic symptoms. Management involves frequent feeding or intravenous glucose infusion depending on the severity of hypoglycemia. Recurrent or persistent hypoglycemia requires investigating for underlying causes and treating with drugs like hydrocortisone, diazoxide, or octreotide.
This document discusses a case of neonatal diabetes mellitus (NDM) in an infant. Key points:
1. The infant presented with hyperglycemia after birth and was diagnosed with NDM after ruling out other causes.
2. Treatment with NPH insulin was initially tried but glycemic control remained inadequate.
3. Insulin glargine was then started and provided excellent glycemic control with no episodes of hypoglycemia, allowing the infant to be shifted to a step-down unit.
4. NDM is a rare condition characterized by persistent hyperglycemia within the first month of life requiring insulin treatment. It can be transient or permanent and is caused by defects in insulin secretion
A male infant was delivered via elective C-section at 36 weeks and 5 days gestation due to the mother's history of two previous C-sections. The infant presented with hypoglycemia which is common in infants of diabetic mothers. The infant was admitted to the NICU for monitoring and treatment of hypoglycemia, including intravenous fluids and corticosteroids. After several days of blood sugar monitoring and treatment, the infant's blood sugars stabilized and he was discharged.
9 способов повысить эффективность финансовых организаций при помощи FAST SearchMichael Kozloff
Маркетинг, исследования и продуктовые инновации
Исследования рынков и клиентов
Разработка новых продуктов
Поиск в интранет информации и экспертов
Governance, Risk Management, Compliance (GRC)
Соответствие требованиям регуляторов (152ФЗ…)
Ускорение подготовки ответов для разных органов
Объединение разрозненных информационных архивов
Улучшение клиентского обслуживания
Единая версия правды о клиентах (know your client)
Повышение эффективности многоканального обслуживания
Поиск результатов бизнес-анализа
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise stimulates the production of endorphins in the brain which elevate mood and reduce stress levels.
This document provides information about photographs from the Kennedy/Bouvier families between 1932 and 1972. It lists over 65 photographs available for review including images of Jacqueline Bouvier as a young woman in 1947, Jackie Kennedy at horse shows and hunts in the 1960s, portraits of Caroline Kennedy from 1965, and photos of Jackie Kennedy with John F. Kennedy Jr. and Caroline at horse races in 1971.
The relationship between test and production code quality (@ SIG)Maurício Aniche
The document discusses the relationship between test code and production code. It describes a study that analyzed code produced with and without test-driven development (TDD) and found no significant difference in class design quality. Interviews revealed that developer experience is more important than TDD alone. The document also discusses a tool called Metric Miner that facilitates mining software repositories to study patterns in test code and their implications for production code quality.
Technology management in the age of the customerLithium
Don’t look now, but your company is losing control. Customers are now in the driver’s seat. Learn more by reading this Forrester Report on "Technology Management
In The Age Of The Customer."
The document is a student paper on global warming written by Awadh Jumaan Awadh. It discusses the causes of global warming such as the industrial revolution and greenhouse gas emissions. It also examines the effects of global warming like rising sea levels and threats to human health and plant life. Finally, it proposes solutions such as using alternative energy sources, reducing car usage, and recycling to address the impacts of climate change.
Racial segregation in America caused colored citizens to be discriminated against and have some of their rights taken away, making them feel trapped and despised. Simple rights like sitting wherever they wanted on the bus or drinking from any water fountain were denied. In response, people like Rosa Parks and Martin Luther King Jr. fought for equal rights and desegregation through protests and speeches advocating for rights for all. Over time, many changes have occurred, but the fight for continued progress is still ongoing.
Este documento lista os nomes de ruas localizadas na cidade de São Paulo nos anos 1960, incluindo Rua Bela Cintra, Rua Barão de Itapetininga, Rua Carlos de Almeida e Rua Augusta.
The document discusses the various building blocks that make up Drupal, including nodes, modules, fields, blocks, views, themes, features, taxonomy, menus, paths, and content types. It explains that Drupal is a content management framework composed of manageable building blocks, with nodes and modules being the core building blocks. Features are described as the macro-level building blocks that allow dynamically generating custom modules using other Drupal components.
RAF Tabtronics is a custom transformer and inductor manufacturer serving various industries including aerospace, defense, medical, and industrial. They have two manufacturing facilities and emphasize high quality, reliability, and technical expertise in electromagnetic design. Their products and services help power technologies for companies like Lockheed Martin, GE Aviation, and Moog.
O documento discute o uso de métricas de código para medir a qualidade do software. Algumas métricas mencionadas incluem linhas de código por método, complexidade ciclomática, coesão, acoplamento e comentários. O documento também discute como métricas de projeto como committers, artefatos modificados e números de testes podem ser usados para obter insights sobre o processo de desenvolvimento.
This study investigated complementary feeding practices for children in their first year of life in Botucatu, Brazil. The researchers interviewed 1,238 caregivers of children under 1 year old during a vaccination campaign. They found that complementary foods were introduced early, leading to low rates of exclusive breastfeeding under 4 months (36.9%). Children under 4 months commonly consumed tea (30.7%) and fruits (54.1%). Food given to children was often inappropriate for their age, such as family foods given to children aged 6-8 months (48.8%) and soup given to over 8 months (71.6%). The findings suggest interventions are needed in the city to promote proper complementary feeding practices.
IFS UK proudly supported 2013 British GT4 champion Rick Parfitt Jnr in the defence of his title in 2014. More information at http://www.ifsworld.com/uk/company/about-ifs/british-gt-racing/
The document summarizes war crimes and human rights violations occurring in the Democratic Republic of Congo. It describes the displacement of over 250,000 people and accusations that two militia leaders organized attacks killing over 200 villagers. It also details accounts of rape, murder, looting, and recruitment of child soldiers impacting civilians in violation of basic human rights. Witnesses recount attacks by soldiers involving rape, murder of family members, looting of homes, and abuse of civilians.
This document is a catalog from America's Finest Gifts, Awards, and Trophies listing various trophy and gift items available for purchase. It includes over 50 pages showcasing equestrian, western, and polo themed trophies, trays, plates, bowls, and other items made of materials like pewter, bronze, crystal, glass, and aluminum. The trophies and gifts range in price from $35 to over $28,000 and can be customized with engraving or the addition of appliques. The catalog provides images and descriptions of each item as well as dimensions, materials, and pricing.
The document discusses the stages of childhood maturity from birth through adulthood. It describes how children are free from worries at birth but gain responsibilities as they age. Key stages discussed include going to camp, noticing physical changes, forming relationships, overcoming challenges, finishing school, entering the job market, starting a family, and eventually facing death. The conclusion reflects on making the most of life and focusing on positivity rather than past drama.
This document discusses hypoglycemia in neonates. Some key points:
1. Hypoglycemia is defined as a blood sugar level below 40 mg/dL and can be caused by conditions like prematurity, growth restriction, and maternal diabetes.
2. Screening for hypoglycemia is recommended in high-risk infants, such as preterms, small for gestational age infants, and infants of diabetic mothers.
3. Asymptomatic hypoglycemia may be initially treated with supervised breastfeeding or formula feeding. Symptomatic hypoglycemia requires treatment with intravenous dextrose infusion.
4. Recurrent or resistant hypoglycemia may require investigating the cause and treating with drugs like hydroc
Gestational diabetes is a form of diabetes that develops during pregnancy and usually resolves after giving birth. It occurs when hormones produced during pregnancy interfere with the mother's body's ability to produce and use insulin properly. This can cause high blood glucose levels. Left untreated, gestational diabetes can increase the risk of complications for both mother and baby, such as preeclampsia in the mother, and macrosomia, shoulder dystocia, and jaundice in the baby. It is diagnosed through a glucose tolerance test between 24-28 weeks of gestation. Treatment may involve lifestyle modifications like diet and exercise or insulin therapy if needed. Close monitoring during pregnancy and screening for diabetes after pregnancy is important.
Neonatal hypoglycemia and hyperglycemia Dr vijitha ASVijitha A S
Neonatal hypoglycemia and hyperglycemia BY Dr VIJITHA A S
Hypoglycemia is most common metabolic problem seen in newborns
No universally accepted definition ; Hypoglycemia cut off variable
This document discusses neonatal hypoglycemia, including transitional hypoglycemia that commonly occurs in healthy newborns versus more prolonged pathologic hypoglycemia. It reviews the physiology of glucose homeostasis in newborns and risk factors for hypoglycemia. Guidelines from the Pediatric Endocrine Society and American Academy of Pediatrics for screening and managing neonatal hypoglycemia are compared, noting differences in the recommended blood glucose thresholds that should prompt treatment.
This document discusses neonatal hypoglycemia, including transitional hypoglycemia that commonly occurs in healthy newborns versus more prolonged pathologic hypoglycemia. It describes the differences in recommendations from the Pediatric Endocrine Society and American Academy of Pediatrics for evaluating and managing neonatal hypoglycemia. Specifically, it highlights the lack of an agreed upon definition for neonatal hypoglycemia and differences in the recommended blood glucose threshold that warrants treatment. It also reviews risk factors for neonatal hypoglycemia and signs and symptoms.
Neonatal diabetes mellitus (NDM) is a rare form of diabetes that occurs in the first few months of life, with an estimated incidence of 1 in 90,000-160,000 live births. There are over 20 known genetic causes of NDM. Hyperglycemia in neonates is most commonly seen in the first few days after birth due to stress or excessive glucose administration. Treatment involves starting an intravenous insulin infusion when blood glucose levels persistently exceed 250 mg/dL. Genetic testing is recommended for cases of diabetes diagnosed before 12 months of age to determine the cause and best treatment approach. The most common genetic causes of NDM are alterations in the KCNJ11 and ABCC8 genes and chromosome 6
Screening guidelines for newborns at risk for low blood glucoseALlie Contreras
This document provides guidelines for screening newborns at risk for low blood glucose (neonatal hypoglycemia). It summarizes the current evidence and expert consensus on key questions around defining hypoglycemia, determining risk factors, optimal screening timing and methods, intervention thresholds, and treatment approaches. While evidence is limited, the guidelines aim to standardize pragmatic screening and management until further research provides more definitive answers. The recommendations are meant to balance the potential risks of asymptomatic low blood glucose with the costs and discomfort of repeated testing.
This document discusses neonatal hypoglycemia and glucose homeostasis in newborns. It begins by outlining glucose regulation in fetal life and the physiological transition that occurs after birth as the newborn adapts from receiving continuous glucose from the placenta to intermittent feeding. This transition involves endocrine changes including a fall in insulin and a rise in stress hormones that stimulate gluconeogenesis and glycogenolysis. The document then discusses the lower glucose threshold for insulin secretion in newborns compared to older infants, which can lead to transient hypoglycemia. It reviews studies showing normal glucose and ketone levels over the first days of life and defines thresholds for hypoglycemia.
Transient Neonatal Hypoglycemia, Revisited discusses glucose homeostasis in neonates and the types and management of neonatal hypoglycemia. After birth, neonates undergo a physiological transition as they adapt to intermittent feeding from transplacental glucose supply. This involves endocrine changes and the activation of pathways like glycogenolysis and gluconeogenesis to maintain blood glucose levels. Insulin secretion in neonates is not suppressed until very low glucose levels due to a lower threshold for insulin release that helps support growth in fetal life. Exposure to hypoxia after birth can prolong this fetal pattern of insulin secretion. Careful management is needed to avoid overtreatment of transitional hypoglycemia while preventing brain injury from severe hypoglycemia.
This document summarizes neonatal hyperglycemia. It defines hyperglycemia in newborns as a blood glucose level >125 mg/dL or plasma glucose >150 mg/dL. The main causes of neonatal hyperglycemia are high rates of parenteral glucose infusion, prematurity, stress, sepsis, drugs like glucocorticoids and phenytoin, and rare cases of neonatal diabetes mellitus. Management involves monitoring blood glucose levels and administering insulin therapy if levels exceed 180-200 mg/dL to prevent risks like increased mortality and intraventricular hemorrhage in extremely premature infants.
Neonatal hypocalcemia can present with jitteriness, seizures, and other neurological symptoms. It is commonly seen in preterm infants, infants of diabetic mothers, and those with perinatal asphyxia or maternal conditions affecting calcium homeostasis. Diagnosis is made via serum calcium and magnesium levels. Treatment involves calcium gluconate administered intravenously or orally as well as magnesium supplementation if hypomagnesemia is also present. Close monitoring is needed given risks of complications. Late onset hypocalcemia may require increased oral calcium intake and reduced phosphate intake.
This document discusses neonatal hypoglycemia, including its definition, causes, signs and symptoms, and treatment. It defines neonatal hypoglycemia as a plasma glucose level below 40 mg/dL. Causes include increased glucose utilization, decreased substrate availability, or both. Signs are non-specific and include jitteriness, apnea, and seizures. Treatment involves oral feeds, IV dextrose if needed, and medications like hydrocortisone or diazoxide for persistent hypoglycemia. Close monitoring of at-risk infants is important to prevent neurological damage from prolonged hypoglycemia.
This document provides an overview of diabetes mellitus and anti-diabetic agents. It defines the four main types of diabetes as type 1, type 2, other specific types, and gestational diabetes. Type 1 is characterized by beta cell destruction and absolute insulin deficiency. Type 2 involves insulin resistance and relative insulin deficiency. The document discusses insulin preparations including short-acting insulins like regular insulin and rapid-acting analogs like insulin lispro, as well as long-acting insulins. It provides details on their mechanisms of action, onset/duration times, and advantages over other insulins. Laboratory tests for diagnosing and monitoring diabetes including blood glucose, HbA1c, and ketone measurements are also summarized
Persistent hypoglycemia in newborns can be caused by hyperinsulinemia. There are different types including transient, prolonged, and congenital hyperinsulinemic hypoglycemia. Congenital hyperinsulinemia is often due to genetic defects affecting insulin secretion and can lead to permanent brain injury if not treated aggressively. Initial treatment involves maintaining blood glucose levels through increased carbohydrate intake and intravenous glucose. Medications like diazoxide and octreotide aim to reduce insulin secretion. For resistant cases, genetic testing and imaging can help determine if surgery is required to remove part of the pancreas producing excess insulin. Early diagnosis and management are important to prevent hypoglycemia-induced brain damage in newborns.
This document discusses neonatal hypoglycemia, including its definition, causes, risk factors, signs and symptoms, treatment, and prevention. Key points include: 1) Hypoglycemia is common in newborns and is caused by limited glycogen stores, hyperinsulinism, diminished glucose production, and limited glucose delivery; 2) Treatment involves IV glucose boluses followed by continuous infusion to maintain blood glucose levels; 3) Hypoglycemia can lead to neurological impairments if not addressed promptly. Early screening and treatment of at-risk infants can help prevent complications.
Gestational diabetes is glucose intolerance first recognized during pregnancy. It occurs due to placental hormones causing insulin resistance. Risk factors include obesity, family history of diabetes, and advanced maternal age. It is screened for and diagnosed using a 75g oral glucose tolerance test. Treatment involves lifestyle modifications like diet and exercise as well as insulin therapy if needed. Close monitoring of blood glucose and fetal well-being is required. Management aims to prevent complications in both mother and baby.
This document discusses gestational diabetes mellitus (GDM). It defines GDM as glucose intolerance that begins during pregnancy and usually disappears after delivery. Risk factors for GDM include family history of diabetes, obesity, and previous GDM. Women at high risk should be screened between 16-18 weeks of pregnancy using a glucose challenge test, and all pregnant women should be screened between 24-28 weeks. Diagnosis is made if two or more values on an oral glucose tolerance test are abnormal. Management involves medical nutrition therapy, blood glucose monitoring, and possibly insulin therapy to control blood sugar levels and minimize risks to both mother and baby.
This document summarizes diabetes mellitus (DM) and its management during pregnancy. It discusses the different types of DM, including pre-existing type 1 and type 2 DM as well as gestational DM. It outlines the physiological changes in pregnancy that can affect blood sugar levels. Diagnosis and treatment aims to achieve tight glycemic control before and during pregnancy to prevent complications such as fetal macrosomia and neonatal hypoglycemia. Management involves medical nutrition therapy, exercise, insulin therapy, and monitoring throughout pregnancy and the postpartum period. Complications of both maternal DM and infant outcomes are also summarized.
This document provides information on gestational diabetes mellitus (GDM), including its definition, risk factors, effects during pregnancy, screening and diagnosis guidelines, management, and fetal surveillance. GDM is glucose intolerance that begins during pregnancy and usually resolves after delivery. It increases risks for both mother and baby, so screening and treatment are important. Guidelines recommend screening all pregnant women for GDM, and treating it with medical nutrition therapy, exercise and possibly insulin to control blood glucose levels if needed. Close fetal monitoring is also recommended during pregnancy.
Gestational diabetes mellitus (GDM) is glucose intolerance that begins or is first diagnosed during pregnancy. The risks associated with GDM are similar to those with pregestational diabetes. Screening and diagnosis typically involves a 75g oral glucose tolerance test. Management of GDM focuses on achieving metabolic control through diet, exercise, insulin or oral hypoglycemic agents. Fetal surveillance is important during pregnancy and delivery should be monitored closely due to risks of complications. Postpartum care involves glucose monitoring and determining if diabetes persists after delivery.
Similar to Guidelines For Glucose Monitoring And Treatment Of Hypoglycemia In Breastfed Neonates (20)
Este documento fornece informações sobre a anatomia e fisiologia da glândula mamária. Resume que a mama é composta de tecido glandular, gordura e tecido conjuntivo, e descreve o desenvolvimento da mama desde a embriogênese até a puberdade. Também aborda a anatomia da mama adulta e a fisiologia da produção de leite, incluindo os hormônios envolvidos.
The 2008 IBLCE examination saw the largest candidate population in its history with 3,323 candidates taking the exam across 37 countries and territories. The exam was administered in 13 languages and saw continued growth in candidates from outside the United States, Canada, and Australia. Analysis of exam results found a pass rate of 93.56% with a mean score of 77.87% and standard deviation of 8.21%.
This document provides an overview of the Third Edition (Revised) of the Wellstart International Lactation Management Self-Study Modules, Level I. It was developed by Wellstart International, a nonprofit organization focused on educating healthcare providers about optimal infant and young child feeding. The Third Edition was reviewed by 30 volunteer experts from around the world and updated to ensure the information is current and internationally relevant. It is intended to be available at low or no cost globally to support breastfeeding education.
AvaliaçãO Do Impacto De Um Programa De Puericultura Na PromoçãO Da Amamentaçã...Biblioteca Virtual
1) O estudo avaliou o impacto de um programa de puericultura na promoção da amamentação exclusiva em uma coorte de 112 crianças no Sul do Brasil.
2) A prevalência de amamentação exclusiva no primeiro mês foi de 95%, caindo progressivamente para 81%, 64%, 53%, 39% e 35% nos meses seguintes.
3) A mediana da duração da amamentação exclusiva foi de 4 meses, maior do que as taxas nacionais brasileiras, indicando a eficácia do programa.
AnáLise Da Efetividade De Um Programa De Incentivo Ao Aleitamento Materno Exc...Biblioteca Virtual
O documento analisa a efetividade de um programa de incentivo ao aleitamento materno exclusivo em uma comunidade carente de São Paulo. Os principais resultados são: 100% das mulheres eram desempregadas, 51,8% aderiram ao programa mas 48,2% abandonaram por motivos desconhecidos, e no momento da alta apenas 17,3% relataram aleitamento exclusivo até os seis meses.
The 2008 IBLCE examination saw the largest candidate population in its history with 3,323 candidates taking the exam across 37 countries and territories. The exam was administered in 13 languages and saw continued growth in candidates from outside the United States, Canada, and Australia. Analysis of exam results found a pass rate of 93.56% with a mean score of 77.87% and standard deviation of 8.21%.
The document summarizes monitoring results from the Baby Feeding Law Group (BFLG) project on marketing practices of baby formula companies in the UK. It finds that Danone, maker of Aptamil and Cow & Gate formulas, continues advertising claims promoting follow-on formulas and undermining breastfeeding, despite rulings against such claims from the Advertising Standards Authority. The report provides examples of non-compliant magazine and television ads, and calls on Trading Standards offices to take action against illegal marketing practices.
The document summarizes statistics from the 2008 IBLCE lactation consultant examination. It reported that:
- 3,323 candidates took the exam across 37 countries, representing the largest candidate population in the exam's history.
- Less than half of candidates were from the US, with over 30% from other countries, indicating the credential has become a global standard.
- The exam was administered in 13 languages across 5 continents, and was taken online or on paper.
- 771 candidates took the exam for recertification purposes after 5 years of practice.
PromoçãO, ProtecçãO E Apoio. Apoio RepresentaçõEs Sociais Em Aleitamento MaternoBiblioteca Virtual
Este documento resume uma dissertação de mestrado sobre representações sociais em aleitamento materno. O trabalho analisou as percepções de profissionais de saúde e puérperas de dois hospitais sobre o aleitamento materno, comparando um hospital credenciado pela Iniciativa Hospital Amigo da Criança e outro não credenciado. Entre os principais achados, destacam-se a culpabilização da mulher no desmame, os efeitos das rotinas médicas no aleitamento e diferenças nas percepções entre os profissionais dos dois hosp
O Ensino De Aleitamento Materno Na GraduaçãO Em Medicina Um Estudo De CasoBiblioteca Virtual
Este documento descreve uma dissertação de mestrado sobre o ensino de aleitamento materno na graduação em medicina da Universidade Federal de Juiz de Fora. O estudo avaliou o nível de formação teórica e prática dos alunos, sua confiança em lidar com o tema e em transmitir informações às futuras mães. Os resultados sugerem que é necessária uma reavaliação do ensino teórico com foco prático para preparar melhor os médicos.
No Seio Da FamíLia AmamentaçãO E PromoçãO Da SaúDe No Programa De SaúDe Da ...Biblioteca Virtual
Este documento apresenta os resultados de uma pesquisa sobre a implementação da promoção da saúde no Programa de Saúde da Família em cinco municípios brasileiros. A pesquisa avaliou os conhecimentos e atividades de profissionais de saúde em relação à promoção do aleitamento materno, e entrevistou mães sobre sua experiência com o programa. Os resultados mostraram que os programas capacitaram bem suas equipes, que demonstraram conhecimentos acima da média sobre aleitamento materno. No entanto, as at
This document is the third edition of Wellstart International's self-study modules on lactation management at level 1. It contains pre-tests and post-tests, 3 modules that cover the basics of breastfeeding and common problems, and annexes with additional resources. The modules are designed to teach health care providers about promoting and supporting breastfeeding.
AnáLise Da Efetividade De Um Programa De Incentivo Ao Aleitamento Materno Exc...Biblioteca Virtual
O documento analisa a efetividade de um programa de incentivo ao aleitamento materno exclusivo em uma comunidade carente de São Paulo. Os principais resultados foram: 100% das mulheres eram desempregadas, 51,8% aderiram ao programa mas 48,2% abandonaram por motivos desconhecidos, e no momento da alta apenas 17,3% relataram aleitamento exclusivo até os seis meses.
AvaliaçãO Do Impacto De Um Programa De Puericultura Na PromoçãO Da Amamentaçã...Biblioteca Virtual
1) O estudo avaliou o impacto de um programa de puericultura na promoção da amamentação exclusiva em uma coorte de 112 crianças acompanhadas desde o nascimento.
2) A prevalência de amamentação exclusiva no primeiro mês foi de 95%, caindo progressivamente para 81%, 64%, 53%, 39% e 35% nos meses seguintes.
3) A mediana da duração da amamentação exclusiva foi de 4 meses, maior do que as taxas nacionais brasileiras, indicando a eficácia do programa.
Iblce Regional Office In Europe Candidate Information GuideBiblioteca Virtual
This document provides information for candidates applying to take the International Board Certified Lactation Consultant (IBCLC) certification exam. It outlines the eligibility requirements including the necessary educational background, clinical experience providing breastfeeding counseling, and professional lactation education. Candidates must meet the eligibility criteria for one of several pathways that differ in their required hours of clinical experience depending on a candidate's educational background and profession. The document reviews the application process and provides sample exam questions to help candidates prepare for the rigorous international certification exam.
A ImportâNcia Da AmamentaçãO Para A SaúDe Da Mulher Que AmamentaBiblioteca Virtual
O documento discute os benefícios da amamentação para a saúde da mulher, incluindo proteção contra câncer de mama e ovário, recuperação pós-parto mais rápida, e prevenção de osteoporose. A amamentação também ajuda no controle de natalidade através da produção de hormônios que inibem a ovulação.
AmamentaçãO E Uso De AntiinflamatóRios NãO EsteróIdes Pela Nutriz InformaçõEs...Biblioteca Virtual
1) O documento analisa as informações contidas nas bulas de medicamentos antiinflamatórios não esteróides em comparação com as evidências científicas sobre seu uso durante a amamentação.
2) Foi encontrada referência à segurança de uso durante a amamentação em apenas 14 de 27 medicamentos, e 9 de 10 medicamentos considerados seguros aconselhavam evitar o uso ou suspender a amamentação.
3) As bulas são discordantes das evidências científicas sobre a compatibilidade desses medicamentos com a amamentação, sendo necess
Este documento descreve a anatomia e fisiologia da amamentação. Resume a estrutura da mama, incluindo lobos, alvéolos e ductos, e explica os processos de mamogénese, mastogénese e lactogénese, que envolvem o desenvolvimento da mama durante a puberdade, gravidez e após o parto.
Contribution Of Environmental Factors To The Risk Of Male InfertilityBiblioteca Virtual
This study investigated the relationship between environmental exposures and male infertility in 225 men seeking infertility treatment in Argentina. The men were grouped based on reported exposures to pesticides, solvents, heat, or a mixture. Semen analysis and hormone levels were compared between exposure groups. Results showed that exposure to pesticides was associated with lower sperm counts and higher estrogen levels, while solvent exposure was linked to lower LH levels, with effects being more pronounced in men with primary infertility. The study suggests environmental factors contribute to male infertility severity and may worsen genetic or medical risk factors.
This document provides information on contraindications and conditions where breastfeeding may or may not be advised. It lists situations where breastfeeding is not recommended, such as if the baby has galactosemia or the mother has active untreated tuberculosis. It also outlines conditions where the benefits of breastfeeding outweigh the risks, such as if the mother is a hepatitis B carrier or smokes, as long as she takes certain precautions. The document is intended as a factsheet for GPs and pharmacists on breastfeeding recommendations.
- Video recording of this lecture in English language: https://youtu.be/RvdYsTzgQq8
- Video recording of this lecture in Arabic language: https://youtu.be/ECILGWtgZko
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Can Traditional Chinese Medicine Treat Blocked Fallopian Tubes.pptxFFragrant
There are many traditional Chinese medicine therapies to treat blocked fallopian tubes. And herbal medicine Fuyan Pill is one of the more effective choices.
Discover the benefits of homeopathic medicine for irregular periods with our guide on 5 common remedies. Learn how these natural treatments can help regulate menstrual cycles and improve overall menstrual health.
Visit Us: https://drdeepikashomeopathy.com/service/irregular-periods-treatment/
“Environmental sanitation means the art and science of applying sanitary, biological and physical science principles and knowledge to improve and control the environment therein for the protection of the health and welfare of the public”.The overall importance of sanitation are to provide a healthy living environment for everyone, to protect the natural resources (such as surface water, groundwater, soil ), and to provide safety, security and dignity for people when they defecate or urinate .Sanitation refers to public health conditions such as drinking clean water, sewage treatment, etc. All the effective tools and actions that help in keeping the environment clean come under sanitation. Sanitation refers to public health conditions such as drinking clean water, sewage treatment. All the effective tools and actions that help in keeping the environment clean and promotes public health is the necessary in todays life.
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
Dr. Tan's Balance Method.pdf (From Academy of Oriental Medicine at Austin)GeorgeKieling1
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Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
About AOMA: The Academy of Oriental Medicine at Austin offers a masters-level graduate program in acupuncture and Oriental medicine, preparing its students for careers as skilled, professional practitioners. AOMA is known for its internationally recognized faculty, award-winning student clinical internship program, and herbal medicine program. Since its founding in 1993, AOMA has grown rapidly in size and reputation, drawing students from around the nation and faculty from around the world. AOMA also conducts more than 20,000 patient visits annually in its student and professional clinics. AOMA collaborates with Western healthcare institutions including the Seton Family of Hospitals, and gives back to the community through partnerships with nonprofit organizations and by providing free and reduced price treatments to people who cannot afford them. The Academy of Oriental Medicine at Austin is located at 2700 West Anderson Lane. AOMA also serves patients and retail customers at its south Austin location, 4701 West Gate Blvd. For more information see www.aoma.edu or call 512-492-303434.
The Children are very vulnerable to get affected with respiratory disease.
In our country, the respiratory Disease conditions are consider as major cause for mortality and Morbidity in Child.
Selective alpha1 blockers are Prazosin, Terazosin, Doxazosin, Tamsulosin and Silodosin majorly used to treat BPH, also hypertension, PTSD, Raynaud's phenomenon, CHF
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
CLASSIFICATION OF H1 ANTIHISTAMINICS-
FIRST GENERATION ANTIHISTAMINICS-
1)HIGHLY SEDATIVE-DIPHENHYDRAMINE,DIMENHYDRINATE,PROMETHAZINE,HYDROXYZINE 2)MODERATELY SEDATIVE- PHENARIMINE,CYPROHEPTADINE, MECLIZINE,CINNARIZINE
3)MILD SEDATIVE-CHLORPHENIRAMINE,DEXCHLORPHENIRAMINE
TRIPROLIDINE,CLEMASTINE
SECOND GENERATION ANTIHISTAMINICS-FEXOFENADINE,
LORATADINE,DESLORATADINE,CETIRIZINE,LEVOCETIRIZINE,
AZELASTINE,MIZOLASTINE,EBASTINE,RUPATADINE. Mechanism of action of 2nd generation antihistaminics-
These drugs competitively antagonize actions of
histamine at the H1 receptors.
Pharmacological actions-
Antagonism of histamine-The H1 antagonists effectively block histamine induced bronchoconstriction, contraction of intestinal and other smooth muscle and triple response especially wheal, flare and itch. Constriction of larger blood vessel by histamine is also antagonized.
2) Antiallergic actions-Many manifestations of immediate hypersensitivity (type I reactions)are suppressed. Urticaria, itching and angioedema are well controlled.3) CNS action-The older antihistamines produce variable degree of CNS depression.But in case of 2nd gen antihistaminics there is less CNS depressant property as these cross BBB to significantly lesser extent.
4) Anticholinergic action- many H1 blockers
in addition antagonize muscarinic actions of ACh. BUT IN 2ND gen histaminics there is Higher H1 selectivitiy : no anticholinergic side effects
2. ABM PROTOCOLS 179
found no difference in neurologic outcome be- tient. Rather, it is characterized by a value(s)
tween asymptomatic hypoglycemic infants and that is unique to each individual and varies
euglycemic control infants, with 94% and 95% with both their state of physiologic matu-
of each group normal on 1- to 4-year follow-up. rity and the influence of pathology.
There was a significant (12%) increase in neuro-
logic abnormalities in symptomatic hypo- A recent metaanalysis (studies published
glycemic infants and a 50% incidence of neuro- 1986 to 1994) of low plasma glucose thresholds
logic abnormalities when seizures were present. in full-term normal newborns who were mostly
The compensatory provision of alternate fuels mixed-fed (formula and breastfeeding) or for-
constitutes a normal adaptive response to tran- mula-fed, presented recommended low thresh-
siently low nutrient intake during the establish- olds for plasma glucose based on hours after
ment of breastfeeding,2,12 resulting in breastfed birth (Table 1). The authors specifically noted
infants tolerating lower plasma glucose levels that given the lower plasma glucose levels in
without any significant clinical manifestations normal breastfed infants, the low thresholds for
or sequelae.12 Therefore, the monitoring of exclusively breastfed infants might even be
blood glucose concentrations in healthy, appro- lower.27 Recommendations based on this
priately grown neonates is unnecessary, and po- threshold approach are provided in Table 1.
tentially harmful to parental well-being and the Given this information, it is clear that the rou-
successful establishment of breastfeeding.4,6,13,14 tine monitoring of blood glucose in healthy term
infants is not only unnecessary, but is potentially
harmful to the establishment of a healthy
Definition of hypoglycemia
mother–infant relationship and successful breast-
The definition of hypoglycemia in the new- feeding patterns.6,13,14,28,29 This recommenda-
born infant has remained controversial because tion has been supported by the World Health
of a lack of significant correlation among plasma Organization,4 the AAP,30 and the National
glucose concentration, clinical symptoms, and Childbirth Trust of the United Kingdom.31 They
long-term sequelae.12,15,16 In addition, blood all conclude that early and exclusive breast-
glucose test results vary enormously with the feeding is safe to meet the nutritional needs of
source of the blood sample, the assay method, healthy term infants and that healthy, full-term
and whether whole blood, plasma, or serum glu- infants do not develop symptomatic hypo-
cose concentration is determined. Plasma or glycemia simply as a result of underfeeding.
serum glucose concentrations are 10% to 15%
higher than in whole blood.17 Testing methods
Breastfed, formula-fed, and mixed-fed in-
Bedside glucose testing strips are inexpen-
fants follow the same pattern of glucose values
sive and practical, but are not reliable with sig-
with an initial fall in glucose over the first 2
nificant variance from true blood glucose lev-
hours, followed by a gradual rise in glucose
els.14,26,32 Bedside glucose tests may be used for
over the next 96 hours, whether fed or not.1,18,19
screening, but laboratory levels must confirm
Breastfed infants tend to have slightly lower
results before a diagnosis of hypoglycemia can
glucose and higher ketone bodies than artifi-
be made, especially in asymptomatic in-
cially fed infants.2,18,20,21
fants.4,14,17,28
The incidence of “hypoglycemia” varies with
the definition.22 Many authors have suggested
numeric definitions of hypoglycemia, usually TABLE 1. RECOMMENDED LOW THRESHOLDS:
between 30 and 50 mg/dL (1.7 to 2.8 mmol/L) PLASMA GLUCOSE LEVEL
and varying by postnatal age.1,4,15,18,22–26 Corn-
Hour after birth 5th Percentile PGL (mg/dL)
blath et al.12 summarized the problem:
1–2 (nadir) 28 (1.6 mmol/L)
Significant hypoglycemia is not and can not 3–47 40 (2.2 mmol/L)
48–72 48 (2.7 mmol/L)
be defined as a single number that can be
applied universally to every individual pa- From Ref. 27.
3. 180 ABM PROTOCOLS
TABLE 2. AT-RISK INFANTS FOR WHOM ROUTINE neonatal problems. Even in the presence of an
MONITORING OF BLOOD GLUCOSE IS INDICATED arbitrary low glucose level, the physician must
Small for gestational age (SGA); 10th percentile for assess the general status of the infant by ob-
weight servation and physical examination to rule out
Large for gestational age (LGA); 90th percentile for other disease entities and processes that may
weight*
Discordant twin; weight 10% below larger twin need additional laboratory evaluation and
Infant of diabetic mother, especially if poorly treatment. Some common clinical signs are
controlled listed in Table 3.
Low birth weight ( 2500 g)
Perinatal stress; severe acidosis or hypoxia-ischemia
A diagnosis of hypoglycemia also requires
Cold stress that symptoms abate after normoglycemia is
Polycythemia (venous Hct 70%)/hyperviscosity restored. Transient, single, brief periods of hy-
Erythroblastosis fetalis poglycemia are unlikely to cause permanent
Beckwith-Wiedemann syndrome
Microphallus or midline defect neurologic damage.5,10,28
Suspected infection
Respiratory distress
Known or suspected inborn errors of metabolism or
endocrine disorders
Maternal drug treatment (e.g., terbutaline, propranolol, GENERAL MANAGEMENT
oral hypoglycemics) RECOMMENDATIONS (TABLE 4)
Infants displaying symptoms associated with
hypoglycemia (see Table 3) Early and exclusive breastfeeding meets the
*This remains controversial. Some recommend in un- nutritional and metabolic needs of healthy,
screened populations in whom LGA may represent un- term newborn infants. Healthy term infants do
diagnosed and untreated maternal diabetes. not develop symptomatic hypoglycemia sim-
From: Schaefer-Graf UM, Rossi R. Bührer C, et al. Rate
and risk factors of hypoglycemia in large-for-gestational- ply as a result of underfeeding.4,5,30
age newborn infants of non-diabetic mothers. Am J Obstet
Gynecol 2002;187:913–917; Cahill JB, Martin KL, Wagner 1. Routine supplementation of healthy, term in-
CL, Hulsey TC. Incidence of hypoglycemia in term large
for gestational age infants (LGA) as a function of feed- fants with water, glucose water or formula is
ing type. ABM News Views 2002;8:20. unnecessary and may interfere with estab-
lishing normal breastfeeding and normal
metabolic compensatory mechanisms.2,20,30,31
RISK FACTORS FOR HYPOGLYCEMIA
2. Healthy term infants should initiate breast-
Neonates at increased risk for developing feeding within 30 to 60 minutes of life and
neonatal hypoglycemia should be routinely continue on demand, recognizing that cry-
monitored for blood glucose levels irrespective ing is a very late sign of hunger.30,37 Early
of the mode of feeding. At risk neonates fall breastfeeding is not precluded just because
into two main categories: the infant meets the criteria for glucose mon-
itoring.
1. Excess use of glucose, which includes the
hyperinsulinemic states
TABLE 3. CLINICAL MANIFESTATIONS OF
2. Inadequate production or substrate deliv- POSSIBLE HYPOGLYCEMIA
ery33
Irritability, tremors, jitteriness
Exaggerated Moro reflex
The infant categories as shown in Table 2 are High-pitched cry
at increased risk for hypoglycemia.5,12,33–36 Seizures or myoclonic jerks
Lethargy, listlessness, limpness, hypotonia
Coma
Cyanosis
CLINICAL MANIFESTATIONS Apnea or irregular breathing
OF HYPOGLYCEMIA Tachypnea
Hypothermia; temperature instability
Vasomotor instability
The clinical manifestations of hypoglycemia Poor suck or refusal to feed
are nonspecific, occurring with a variety of other
4. ABM PROTOCOLS 181
TABLE 4. GENERAL MANAGEMENT RECOMMENDATIONS
Early and exclusive breastfeeding meets the nutritional and metabolic needs of healthy, term newborn infants.
1. Routine supplementation is unnecessary.
2. Initiate breastfeeding within 30 to 60 minutes of life and continue on demand.
3. Facilitate skin-to-skin contact of mother and infant.
4. Feedings should be frequent; 10 to 12 times per 24 hours in the first few days after birth.
Glucose screening is performed only on at-risk or symptomatic infants.
1. Routine monitoring of blood glucose in all term newborns is unnecessary and may be harmful.
2. An at-risk infant should be screened for hypoglycemia with a frequency and duration related to the specific
risk factors of the individual infant.
3. Monitoring continues until normal, preprandial levels are consistently obtained.
4. Bedside glucose screening tests must be confirmed by formal laboratory testing.
3. Initiation and establishment of breastfeed- related to the specific risk factors of the in-
ing is facilitated by skin-to-skin contact of dividual infant.5 It is suggested that moni-
mother and infant. Such practices will main- toring begin within 30 to 60 minutes for in-
tain normal infant body temperature and re- fants with suspected hyperinsulinemia, and
duce energy expenditure (thus enabling no later than 2 hours of age for infants in
maintenance of normal blood glucose) while other risk categories.
stimulating suckling and milk produc- 3. Monitoring should continue, until normal,
tion.21,30 preprandial levels are consistently ob-
4. Feedings should be frequent, 10 to 12 times tained.
per 24 hours in the first few days after 4. Bedside glucose screening tests must be con-
birth.30 firmed by formal laboratory testing.
Glucose screening should be performed only
on at-risk infants and those with clinical symp- MANAGEMENT OF DOCUMENTED
toms compatible with hypoglycemia. HYPOGLYCEMIA (TABLE 5)
1. Routine monitoring of blood glucose in Asymptomatic infant:
asymptomatic, term newborns is unneces-
sary and may be harmful.4,5,31,38,39 1. Continue breastfeeding (approximately
2. At-risk infants should be screened for hy- every 1 to 2 hours) or feed 3 to 5 mL/kg (up
poglycemia with a frequency and duration to 10 mL/kg)4 of expressed breast milk or
TABLE 5. MANAGEMENT OF DOCUMENTED HYPOGLYCEMIA
Asymptomatic infant
1. Continue breastfeeding (approximately every 1 to 2 hours) or feed 3 to 10 mL/kg of expressed breast milk
or substitute nutrition.
2. Recheck blood glucose concentration before subsequent feedings until the value is acceptable and stable.
3. Avoid forced feedings.
4. If glucose remains low despite feedings, begin intravenous glucose therapy.
5. Breastfeeding may continue during IV glucose therapy.
6. Carefully document response to treatment.
Symptomatic infant or infants with plasma glucose levels 20 to 25 mg/dL ( 1.1 to 1.4 mmol/L)
1. Initiate intravenous 10% glucose solution.
2. Do not rely on oral or intragastric feeding to correct extreme or symptomatic hypoglycemia.
3. The glucose concentration in symptomatic infants should be maintained 45 mg/dL ( 2.5 mmol/L).
4. Adjust intravenous rate by blood glucose concentration.
5. Encourage frequent breastfeeding.
6. Monitor glucose concentrations before feedings as the IV is weaned until values stabilize off intravenous
fluids.
7. Carefully document response to treatment
5. 182 ABM PROTOCOLS
substitute nutrition (pasteurized donor hu- SUPPORTING THE MOTHER
man milk, elemental formulas, partially hy-
drolyzed formulas, routine formulas). Having an infant who was thought to be
2. Recheck blood glucose concentration before normal and healthy and who develops hypo-
subsequent feedings until the value is ac- glycemia is both concerning to the mother and
ceptable and stable. family, and may jeopardize breastfeeding. Moth-
3. If the neonate is unable to suck or feedings ers should be reassured that there is nothing
are not tolerated, avoid forced feedings (e.g., wrong with their milk, and supplementation is
nasogastric tube) and begin intravenous (IV) usually temporary. Having the mother hand-ex-
therapy (see the following). Such an infant press or pump milk that is then fed to her infant
is not normal and requires a careful exami- can overcome feelings of maternal inadequacy as
nation and evaluation in addition to more well as help establish a full milk supply. It is im-
intensive therapy. portant to provide stimulation to the breasts by
4. If glucose remains low despite feedings, be- manual or mechanical expression with appro-
gin IV glucose therapy and adjust intra- priate frequency (eight times in 24 hours) until
venous rate by blood glucose concentration. her baby is latching and suckling well to protect
5. Breastfeeding may continue during IV glu- her milk supply. Keeping the infant at the breast,
cose therapy when the infant is interested or returning the infant to the breast as soon as
and will suckle. Wean IV glucose as serum possible is important. Skin-to-skin care is easily
glucose normalizes and feedings increase. done with an IV and may lessen the trauma of
6. Carefully document signs, physical exami- intervention, while also providing physiologic
nation, screening values, laboratory confir- thermoregulation, contributing to metabolic ho-
mation, treatment and changes in clinical meostasis.
condition (i.e., response to treatment).
Symptomatic infants or infants with plasma RECOMMENDATIONS FOR
glucose levels 20 to 25 mg/dL ( 1.1 to 1.4 FUTURE RESEARCH
mmol/L)
1. Well-planned, well-controlled studies are
1. Initiate intravenous 10% glucose solution. needed that look at plasma glucose concen-
2. Do not rely on oral or intragastric feeding to trations, clinical symptoms, and long-term
correct extreme or symptomatic hypo- sequelae so the levels of glucose necessary
glycemia. Such an infant is not normal, and for intervention can be better understood.
requires an immediate and careful exami- 2. The development of more reliable bedside
nation and evaluation in addition to IV glu- testing methods would increase the effi-
cose therapy. ciency of diagnosis and treatment of signif-
3. The glucose concentration in symptomatic icant glucose abnormalities.
infants should be maintained 45 mg/dL 3. A clearer understanding of the role of other
( 2.5 mmol/L). glucose-sparing fuels and methods to mea-
4. Adjust intravenous rate by blood glucose sure them in a clinically meaningful way
concentration. and time frame would aid in understanding
5. Encourage frequent breastfeeding after the which babies are truly at risk of neurologic
relief of symptoms. sequelae, and thus must be treated.
6. Monitor glucose concentrations before feed-
ings as the IV is weaned, until values are sta-
bilized off intravenous fluids. CONCLUSION
7. Carefully document signs, physical exami-
nation, screening values, laboratory confir- Healthy, full-term infants are programmed
mation, treatment, and changes in clinical to make the transition from their intrauterine
condition (i.e., response to treatment). constant flow of nutrients to their extrauterine
6. ABM PROTOCOLS 183
intermittent nutrient intake without the need opment after neonatal hypoglycemia: A systematic re-
for metabolic monitoring or interference with view and design of an optimal future study. Pediatrics
2006;117:2231–2243.
the natural breastfeeding process.3 Homeo-
11. Koivisto M, Blanco-Sequeiros M, Krause U. Neonatal
static mechanisms ensure adequate energy sub- symptomatic and asymptomatic hypoglycemia: A fol-
strate is provided to the brain and other organs, low-up study of 151 children. Dev Med Child Neurol
even when feedings are delayed. The normal 1972;14:603–614.
pattern of early, frequent, and exclusive breast- 12. Cornblath M, Hawdon JM, Williams AF, et al. Con-
feeding meets the needs of healthy full-term in- troversies regarding definition of neonatal hypo-
glycemia: Suggested operational thresholds. Pediatrics
fants. Routine screening or supplementation 2000;105:1141–1145.
are not necessary and may harm the normal es- 13. Hawdon JM. Neonatal hypoglycemia: The conse-
tablishment of breastfeeding. quences of admission to the special care nursery. Child
Health 1993;Feb:48–51.
14. Hawdon JM, Ward Platt MP, Aynsley-Green A.
Neonatal hypoglycemia: Blood glucose monitoring
ACKNOWLEDGMENT and infant feeding. Midwifery 1993;9:3–6.
15. Kalhan S, Peter-Wohl S. Hypoglycemia: What is it for
This work was supported in part by a grant the neonate? Am J Perinatol 2000;17:11–18.
from the Maternal and Child Health Bureau, 16. Sinclair JC. Approaches to the definition of neonatal
Department of Health and Human Services. hypoglycemia. Acta Paediatr Jpn 1997;39:S17–S20.
17. Cornblath M, Schwartz R. Disorders of Carbohydrate
Metabolism in Infancy, 3rd ed. Blackwell Scientific Pub-
lications, Boston, 1991.
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