Hypoglycemia in neonates can be a critical emergency, particularly affecting preterm and small for gestational age infants, with a variety of symptoms including jitteriness and lethargy. Treatment typically involves glucose administration, with monitoring and adjustments as necessary, particularly for infants at high risk. Prognosis for normal intellectual function is cautious, particularly for those with recurrent or severe hypoglycemia, as it can lead to neurological issues.

1. PAEDIATRICS AND CHILD HEALTH
• NEONATOLOGY
• Hypoglycaemia
Dr. Chongo Shapi (Bsc. HB, MBChB)
- Medical Doctor
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2. Introduction
• Hypoglycemia is an emergency
- Term babies: < 2.5 mmol/L
- Preterm babies: < 2.2 mmol/L
• Incidence varies with the category of fetal growth and the
nursery feeding protocols
• Early feeding decreases the incidence
• Factors that increase incidence are:
1. Prematurity
2. Hypothermia
3. Hypoxia
4. Maternal diabetes
5. Maternal glucose infusion in labor
6. Intrauterine growth restriction (IUGR)
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3. • Serum glucose levels decline after birth until 1–3 hr
of age, when levels spontaneously increase in
normal infants
• In healthy term infants, serum glucose values are:
- Rarely <35 mg/dL between 1 and 3 hr of life
- Rarely < 40 mg/dL from 3 to 24 hr
- Rarely <45 mg/dL (2.5 mmol/L) after 24 hr
• Both premature and full-term infants are at risk for
serious neurodevelopmental deficits from equally
low glucose levels
• This risk is related to the depth and duration of the
hypoglycemia
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4. Incidence of Hypoglycemia by BW, GA and Intrauterine Growth
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5. Clinical Manifestations
• In contrast to the frequency of chemical
hypoglycemia, the incidence of symptomatic
hypoglycemia is highest in small for gestational
age infants
• The incidence of symptomatic hypoglycemia
probably varies between 1 and 3 per 1,000 live
births and affects about 5–15% of growth-
restricted infants
• The onset of symptoms varies from a few hours
to a week after birth
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6. Symptoms:
- Jitteriness or tremors
- Apathy
- Episodes of cyanosis
- Convulsions
- Intermittent apneic
spells or tachypnea
- Weak or high-pitched
cry
- Limpness or lethargy
- Difficulty feeding
- Eye rolling
- Sweating
- Sudden pallor
- Hypothermia
- Cardiac arrest and failure
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7. • These clinical manifestations may result from
various causes
• It is critical therefore to measure serum glucose
levels and determine whether they disappear
with the administration of sufficient glucose to
raise the blood sugar to normal levels
• If they do not, other diagnoses must be
considered
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Dr. Chongo Shapi, BSc.HB, MBChB, CUZ.
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8. Treatment
• Symptoms other than seizures:
- IV bolus of 200 mg/kg (2 mL/kg) of 10% glucose
• Convulsions:
- 5 mL/kg of 10% glucose as a bolus injection
• After initial therapy, a glucose infusion should be
given at 8 mg/kg/min
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Dr. Chongo Shapi, BSc.HB, MBChB, CUZ.
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9. • If hypoglycemia recurs, increase the infusion rate
and concentration until 15–20% glucose is used
• If IV infusions of 20% glucose are inadequate to
eliminate symptoms and maintain constant
normal serum glucose concentrations,
hyperinsulinemia is probably present
- Administer diazoxide
• If the diazoxide is unsuccessful, give octreotide
• Infants with severe persistent hyperinsulinemic
hypoglycemia may eventually need to undergo
subtotal pancreatectomy
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10. • Measure serum glucose every 2 hr after initiating
therapy until several determinations are above 40
mg/dL
• Subsequently, measure every 4–6 hr and reduce
treatment gradually
• Finally discontinue when the serum glucose value
has been in the normal range and the baby
asymptomatic for 24–48 hr
• Treatment is usually necessary for a few days to a
week, rarely for several weeks
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Dr. Chongo Shapi, BSc.HB, MBChB, CUZ.
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11. • Measure serum glucose in infants at increased risk
for hypoglycemia:
- Within 1 hr of birth
- Every 1–2 hr for the 1st 6–8 hr
- Then every 4–6 hr until 24 hr of life
• Normoglycemic high-risk infants should receive oral
or gavage feeding with human milk or formula
started at 1–3 hr of age and continued at 2–3 hr
intervals for 24–48 hr
• An IV infusion of glucose at 4 mg/kg/min should be
provided if oral feedings are poorly tolerated or if
asymptomatic transient neonatal hypoglycemia
develops
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12. Prognosis
• Good in asymptomatic patients with
hypoglycemia of short duration
• Recurs in 10–15% of infants after adequate
treatment
• Recurrence is more common if IVFs are
extravasated or discontinued too rapidly before
oral feedings are well tolerated
• Children in whom ketotic hypoglycemia later
develops have an increased incidence of neonatal
hypoglycemia
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13. Prognosis
• The prognosis for normal intellectual function must
be guarded
• This is because prolonged, recurrent, and severe
symptomatic hypoglycemia is associated with
neurologic sequelae
• Symptomatic infants with hypoglycemia, have a
poorer prognosis for subsequent normal intellectual
development than asymptomatic infants do
• This is especially in:
- LBW infants
- Persistent hyperinsulinemic hypoglycemia, and
- Infants of diabetic mothers
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14. Thanks
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