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

2. Introduction
• Glucose or dextrose is a vital source of nutrient energy and
is required continuously by the fetus.
• Neonate needs this as either intermittent oral feeds or
continuous IV fluids.
• Hypoglycemia can cause long term neurologic sequelae.
 The important steps in preventing and treating
hypoglycemia are
 to identify neonates at risk of developing hypoglycemia
 to recognize symptoms of hypoglycemia, early feeding and
 to initiate IV fluid therapy, where ever needed.

3. Neonates at risk of hypoglycemia
o Babies weighing less than 2.0 kg birth weight,
o preterm babies,
o LGA (large for gestational age) babies especially
those weighing more than 3.5 kg,
o infants of diabetic mothers,
o those with delayed cry at birth, any sick neonate
who is not sucking or accepting feeds are all at
risk of developing hypoglycemia.
o The other risk factors for hypoglycemia are RDS,
polycythemia, shock, and hypothermia

4. Definition of hypoglycemia
• Neonatal hypoglycemia, defined as a plasma
glucose level of less than 30 mg/dL (1.65
mmol/L) in the first 24 hours of life and less
than 45 mg/dL (2.5 mmol/L) thereafter,
• Neonatal hypoglycemia is the most common
metabolic problem in newborns.

5. Symptoms of hypoglycemia
• The symptoms of hypoglycemia are very nonspecific and
can mimic any illness.
• The common symptoms are:
• Not looking well
• Lethargic,
• Weak cry,
• Poor feeding,
• Temperature instability like hypothermia,
• Poor respiratory effort: shallow breathing, apnea or
cyanosis
• CNS symptoms like: excessive jitteriness, convulsions or
hypotonia.

6. Factors which increase the risk of
hypoglycemia
• Various factors which increase the risk of
hypoglycemia are hypothermia & cold Stress,
cold environment, wet baby and inadequate
feeding.

7. Etiology
• The causes of neonatal hypoglycemia include the following:
• Persistent hyperinsulinemic hypoglycemia of infancy (PHHI)
• Limited glycogen stores (eg, prematurity, intrauterine
growth retardation)
• Increased glucose use (eg, hyperthermia, polycythemia,
sepsis, growth hormone deficiency)
• Decreased glycogenolysis, gluconeogenesis, or use of
alternate fuels (eg, inborn errors of metabolism, adrenal
insufficiency)
• Depleted glycogen stores (eg, asphyxia-perinatal stress,
starvation)

8. hypoglycemia ketotic and nonketotic

9. Treatment
• To raise the blood sugar value to normal range,
give 200 mg/kg of dextrose i.e. 2 ml /kg of 10%
dextrose as bolus slowly over 3-5 minutes and
start maintenance fluids with a dextrose infusion
rate (DIR) of 6 – 8 mg/kg/min.
• The maximum strength of dextrose that can be
given through a peripheral vein is 12.5%.
• Repeat Dextrostix after 15-30 minutes, if still low,
repeat bolus and increase (DIR) by 1 – 2
mg/kg/min or the maintenance fluids by 10 – 20
ml/kg/day.

10. • For example in a low birth weight baby on first day of life
give 80ml/kg/ day i.e. 80 x wt of the baby
• e.g. 1.8 kg i.e. 144 ml/day. Divide by 24 to obtain fluid per
hour (144 / 24 = 6 ml/hr).
• Take a measured volume set, fill 1/4th or 6 hrs fluid i.e. 24
ml and deliver at a rate of 6 micro drops/min (number of
drops per minute is equal to rate of fluid/hour).
• The dextrose infusion rate can be calculated by the
following formula:
 Fluid rate (ml/kg/day) x % of Dextrose to be used x 0.007 =
DIR (mg/kg/min).
o e.g. If a baby is on 100 ml/kg/day of 10% dextrose, the DIR
is 7 mg/kg/min. You may also use the reference charts to
calculate the DIR.

11. How to monitor blood glucose in
hypoglycemia
• In asymptomatic babies measure blood glucose within 2 hrs of
birth, preferably before feeds.
• Frequency & duration depends on clinical features and glucose
value, initial frequency may be 2 hrly, and later 4 hrly and finally 8 -
12 hrly.
• Monitoring is usually done for 72 hrs after birth in at risk newborns
or till glucose levels remain normal for 48 – 72 hrs.
• Symptomatic babies: may require more frequent monitoring.
• Maintain the same DIR till the blood glucose is stable for at least 6 –
8hrs and then decrease the DIR by not greater than 1 – 2
mg/kg/min every 2 hours with adequate monitoring.

12. Resistant or Persistent Hypoglycemia:
• Resistant or Persistent Hypoglycemia:
• Requirement of a dextrose infusion rate or more than
12 mg/ kg/min suggests resistant hypoglycemia.
• Any hypoglycemia persisting beyond one week despite
adequate management suggests persistent
hypoglycemia.
• One should rule out hyperinsulinemic state or inborn
errors of metabolism.
• Increase the DIR to 12–15 mg/kg/min, keeping in mind
that more than 12.5% dextrose should not be given
through a peripheral vein and a central venous
catheterization is required.

13. • In resistant or persistent hypoglycemia the
following drugs should be considered: –
• Hydrocortisone: 10 mg/kg/day in two divided
doses intravenously
• Glucagon: 100 – 300 ug/kg/dose IM to a
maximum of 3 doses in babies with adequate
glycogen stores
• Diazoxide: 2 – 5 mg/kg/dose every 8 hrly orally
• Octreotide : Synthetic somatostatin in a dose of
2–10 ug/kg/day subcutaneously q 8 -12 hourly
• Babies with persistent or resistant hypoglycemia
should be REFERRED to a specialize center for
farther investigations

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