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Similar to Neonatal hypoglycemia
Neonatal hypoglycemia
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- 2. Definition Blood glucoselevel <40mg/dl Plasma glucose level <45mg/dl
- 3. Causes of hypoglycemia 1.Inadequate substrate: Small for gestational age (<3rd percentile) Gestational age <35 weeks Birth weight <2000g Delayed onset feeding 2. Relative hyperinsulinemia: Infants of diabetic mother Large for date babies (>97th percentile) Rh isoimmunisation
- 4. 3. Sickness Hypothermia Sepsis Asphysia
- 5. Clinical features Maybe asymptomatic Some may present with: Stupor Tremor Jitteriness Seizures coma Lethargy apathy Poor or difficult feeding Abnormal cry Eye rolling Hypothermia Sweating Tachypnea Grunting Cyanosis Sudden pallor Hypotonia Irritability
- 6. Screening High riskbabies should be screened for hypoglycemia at 2,6,12,24,48 and 72 hours after birth with reagent strips (dextrostix) If the blood sugar value is <40mg/dl on reagent strip , should be treated after confirmation by lab test.
- 7. Operational threshold In2000, Cornblath recommended the use of “operational threshold”for blood sugar management in newborn infants. It is indication for action and is not diagnostic of disease or abnormality.
- 8. Operational threshold as suggestedby Cornblath et al. 1. Healthy term infant <24 hrs of age – 30-35mg/dl may be acceptable at one time but threshold is raised to 45mg/dl if it persists after feeding or reoccur in 1st 24 hrs After 24 hrs , threshold should be increased to 45- 50mg/dl 2. Infant with abnormal sign and symptoms – 45mg/dl
- 9. 3. Asymptomatic infantswith risk factors -36mg/dl 4. For any baby, if the glucose level is <20-25mg/dl ; I.V glucose is needed to raise the plasma glucose level to >45mg/dl
- 10. Management Prevention Asymptomaticbabies Symptomatic babies Medical management Surgical management
- 11. Prevention All highrisk baby should require proper breast feeding counselling and support Adequacy of breast feeding should be accessed Babies not able to suck effectively on breast should receive expressed breast milk by alternative methods
- 12. Asymptomatic babies If bloodsugar >20mg/dl Trial of oral feeds Blood sugar test after 30-45 min if >40mg/dl if<40mg/dl Frequent feeding with i.v glucose infusion 6 hrly monitoring for 48 hr If blood sugar <20mg/dl I.V glucose infusion
- 13. Symptomatic babies Bolus of2ml/kg of 10% dextrose given followed immediately by glucose infusion at an initial rate of 6mg/kg/min Blood sugar is checked after 30-45 minutes and then 6 hrly If hypoglycemia still persists increase in glucose infusion rate by 2mg/kg/min until a maximum of 12mg/kg/min
- 14. If 2 ormore consecutive values are > 50mg/dl after 24 hr of parenteral therapy Infusion is taperd off at the rate of 2mg/kg/min every 6 hr with glucose monitoring Tapering should be combined with increase in oral feed
- 15. Medical management Hydrocortisone5mg/kg/day in 2 divided doses Diazoxide 5-8mg/kg/day Octreotide 5-20mcg/kg/day Glucagon 0.025-0.2mg/kg Surgical management Subtotal pancreatectomy
- 16. If hypoglycemia ispersistent or needs prolonged treatment, one should consider the rarer causes and following tests must be carried out to determine the cause: Critical lab sample- Glucose Insulin Cortisol Beta-hydroxybutyrate and free fatty acid levels
- 17. Other additionaltests- Growth hormone ACTH Thyroxine and TSH Glucagon Plasma and urine amino acids Urine ketones Urine reducing substance Other special tests to diagnose inborn errors of metabolism
- 18. Follow up andoutcomes 1 month – eye evaluation 3,6,9,12 and 18 months – growth, neurodevelopment and vision and hearing loss
- 19. Differential Diagnosis i. Sepsis ii.CNS disease iii. Toxic exposure iv. Metabolic abnormalities : hypocalcemia, hypomagnesemia, hyponatremia or hypernatremia v. Adrenal insufficiency vi. Heart failure vii. Renal failure viii. Liver failure
- 20. References: Ghai Essentialpediatrics Manual of neonatal care
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