The seminar presented by Mulugeta Abeneh at Addis Ababa University focuses on neonatal hypoglycemia, discussing its definitions, causes, symptoms, and management strategies. It outlines the risks associated with both transient and persistent hypoglycemia in newborns and emphasizes the importance of early identification and treatment. Additionally, the seminar highlights potential long-term effects on neurological development if hypoglycemia is not properly managed.

1. ADDIS ABABA UNIVERSITY COLLEGE OF HEALTH
SCIENCE DEPARTMENT OF NURSING AND
MIDWIFERY POST GRADUATE PROGRAM
SEMINAR PRESENTATION ABOUT
NEONATAL HYPOGLYCEMIA
BY: MULUGETA ABENEH
5/19/2024 1

2. 5/19/2024 2

3. Neonatal hypoglycemia
Objective
At the end of this session we will able to know:
 introduction an understanding of hypoglycemia in the
newborn.
 Identify neonates at risk for hypoglycemia during the
immediate newborn period.
 Describe the signs and symptoms of hypoglycemia in the
neonate.
 Identify the treatment for asymptomatic and symptomatic
hypoglycemia in the neonate.
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4. Neonatal hypoglycemia
Introduction:
• Hypoglycemia is a common metabolic problem in
NICUs.
• This is because of abrupt cease in glucose supply
following clamping of the umbilical cord at birth.
• Some neonates are symptomatic whereas most are
asymptomatic despite very low blood glucose levels
• Due to this lengthy debate has occurred among
investigators regarding the definition of
hypoglycemia.
• Attempts have been made to define hypoglycemia by
either a statistical approach or correlation of blood
glucose concentration with clinical signs and
symptoms
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5. NH….
Introduction…
 Hypoglycaemia could be defined as blood glucose
level less than 40mg/dl within the first 4 hours and
less than 45mg/dl within the 24 hours after birth
 The definition of hypoglycemia for preterm infants
should not be any different from that for full-term
infants.
 It should be described as transient or persistent, and
in either or both of these cases, as symptomatic or
asymptomatic.
 Overall incidence of symptomatic hypoglycemia is1–
3 per 1000 live births.
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6. NH….
Introduction …
• Transient hypoglycemia implies low glucose
values that last only a short time(within 48 hrs.)
which is the most common .
• Persistent and recurrent hypoglycemia implies a
form that requires prolonged management
(glucose infusions for several days at high rates of
infusion >12mg/kg/min) or Persisting beyond 48
hours of life
• Several of these hypoglycemia syndromes may
continue throughout infancy and childhood.
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7. NH
Introduction ….
• Because of clinical manifestations of
hypoglycemia are nonspecific and similar to
those of many disorders in newborn, careful
attention should be given to ensure that other
associated disorders (e.g., sepsis, asphyxia) are
not missed.
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8. Causes of the two types of neonatal
hypoglycemia
1. Transient hypoglycemia
 Associated with changes in maternal
metabolism
• Intrapartum administration of glucose
• Drug treatment(antidiabetic drugs tolbutamide
and chlorpropamide)
• Oral hypoglycemic agents
• Terbutaline, ritodrine, propranolol
• Diabetes in pregnancy: infant of diabetic mother
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9. Causes….
1. Transient hypoglycemia…
 Associated with neonatal problems
• Idiopathic condition or failure to adapt
• Intrauterine growth restriction
• Birth asphyxia
• Infection
• Hypothermia
• Erythroblastosis fetalis
• Congenital cardiac malformations
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10. Causes….
2. Persistent or recurrent hypoglycemia
 Hyperinsulinism
 Congenital hyperinsulinism
 Beckwith-Wiedemann syndrome
 Endocrine disorders
 Pituitary insufficiency
 Cortisol deficiency
 Congenital glucagon deficiency
 Epinephrine deficiency
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11. Causes.…
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2. Persistent or recurrent hypoglycemia
 Inborn errors of metabolism
 Carbohydrate metabolism
 Galactosemia
 Hepatic glycogen storage diseases
 Fructose intolerance
 Amino acid metabolism
 Maple syrup urine disease
 Hereditary tyrosinemia
 Ethylmalonic-adipic aciduria
 Fatty acid metabolism
 Defects in carnitine metabolism
 Acyl-coenzyme dehydrogenase defects

12. Who is at risk?
 Limited glycogen stores(rapid depletion of stored
glucose)
 Birth weight < 2 kg
 Small for gestational age (SGA)
 Intrauterine growth restriction (IURG)
 Premature birth prior to timing of glucose storage
during end of 3rd trimester
 Hyperinsulinemia( causes fetal insulin production)
Neonates of IDM(1:1000 pregnant women)
Mothers with GDM(~2% of pregnant women)
 Large for gestational age (LGA) > 4 kg
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13. At Risk…
 Who is at risk? By Increased glucose use are:
•Hypoxia/Perinatal Asphyxia
•Shock/Sepsis
•Respiratory distress
•Cardiac disease
•Hypothermia
Decreased glycogenolysis, gluconeogenesis, or
use of alternate fuels
• Inborn errors of metabolism
• Adrenal insufficiency
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14. Pathophysiology
Glucose
 Fetal storage of glucose occurs primarily in the 3rd
trimester in the form of glycogen ~ 70 – 80% of
maternal glucose levels can be seen in fetus during
pregnancy
After birth
Glycogen is broken down into glucose molecules which
are released back into the blood stream to be used as
energy
 Hormones which regulate glucose levels
 Insulin
 Glucagon
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15. Pathophysiology…
Insulin is secreted after food intake to increase
insulin levels
Insulin stimulates liver to store glucose as
glycogen
When muscle/liver cells are saturated with
glycogen extra glucose is stored as fat
When glucose levels fall
• Glycogen is secreted to increase glucose levels through
glycogenolysis
• Glycogenolysis releases glucose back into the blood
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16. Pathophysiology…
After birth
 Serum glucose levels decline during the 1st 3 hours after birth then
begin to stabilize
 Should reach nadir level ~ 1 hour after birth
 Glycogen stores in the liver rapidly deplete within 1st 12 hours of
life.
 Glucose starts to increase spontaneously after 3 hours of life.
 Gluconeogenesis accounts for ~10% of glucose usage by the
neonate by several hours of age.
 Glucose is the major fuel for brain functions/ metabolism
 which can lead to changes such as “brain
 cell softening swelling, necrosis,
 gyrus atrophy or white matter demyelination”
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17. Clinical symptoms and signs of
hypoglycemia
The clinical manifestations of neonatal hypoglycemia are non-
specific and they may be confused with other disorders of the
newborn
 Abnormal crying
• Irritability
• Apnea, cyanotic spells
• Jitteriness, tremors
• Feeding difficulty
• Lethargy or stupor
• Grunting, tachypnea
• Seizures
• Hypothermia
• Sweating
• Hypotonia
• limpness
• Tachycardia
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18. Cont.…
5/19/2024 18
Maternal
hyperglycemia
Fetal
hyperglycemia
Fetal
hyperinsulinemia
D/Lung
surfactant
Polycythemia
I/Fetal
substrate
uptake
Hypoxemia
?
Stillbirt
h
I/Oxygen
uptake
Respiratory
distress
Macrosomia
Erythropoietin

19. Cont.…
Diagnosis is based on
• Supportive perinatal history (risk factors).
• Signs and symptoms of hypoglycemia.
• Whole blood glucose less than 40 mg/dl.
NB :Newborns with persistent or recurrent
hypoglycemia need additional testing including
hormone analysis and imaging studies.
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20. Management of neonatal hypoglycemia
The overall management of neonatal
hypoglycemia should include:
1. Anticipation and prevention in those who are at
high risk.
2. Correction of hypoglycemia
3. Investigation and treatment of the cause of
hypoglycemia, when it is possible to identify the
cause.
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21. Management and treatment of NH…
A .Treatment of asymptomatic hypoglycemia
Feeding
 Feeding is the initial treatment in an
asymptomatic term infants,
• Immediately offer breast-feeding.
• Check blood glucose 30 minutes after feeding to
ensure normal glucose level before the next feeding.
• If repeated blood glucose is > 40mg/dl continue
to offer feedings at 2-3 hours interval.
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22. Management and treatment of NH…
Indications of IV infusions in asymptomatic
hypoglycemia (use same infusion as
symptomatic hypoglycemia)
• Blood glucose <25mg/dl.
• Blood glucose remains < 40mg/dl after one
attempt of feeding
• If infant becomes symptomatic
• If oral feeding is contraindicated
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23. CONT…
B . Treatment of symptomatic hypoglycemia
 Many neonates have asymptomatic (chemical)
hypoglycemia.
 The incidence of symptomatic hypoglycemia is highest in
small gestational age infants.
 The exact incidence of symptomatic hypoglycemia has
been difficult to establish because many of the symptoms in
neonates occur together with other conditions
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24. CONT…
 Immediate treatment
 Secure IV line, Give 2ml/kg of 10% glucose
IV bolus over one minute.
 10% dextrose for IV bolus can be prepared
using 40% dextrose, which is available in
our country
 Continuous therapy
 Put on 10% glucose infusion at glucose
infusion rate (GIR) of 6mg/kg/minutes
(~ 90ml/kg/day) as maintenance.
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25. Cont.…
 Recheck blood glucose after 30 minutes and if it
remains above 40 mg/dl frequency of checking
can be decreased to one hourly then every six
hourly.
 If blood glucose remains <40mg/dl, increase the
GIR by 2mg/kg/minutes every 30 minutes until
repeat values are above 40 mg/dl.
 Once the blood glucose values stabilize above
40mg/dl for 24 hours, the GIR can be tapered off
at 2 ml/kg/min every six hours with proportional
increment of oral feeds.
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26. Cont.
• If the neonate requires GIR > 12
mg/kg/minutes, persistent hypoglycemia
should be considered.
• Glucose infusion rate (GIR) can be calculated
using the following formula GIR in
mg/kg/min= dextrose % () × total fluid ml/kg/
day ÷144
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27. Outcomes :Short and Long Term
 It is not known at exactly what level or for how long
hypoglycemia must occur in order to affect the
neonate’s developing brain.
 However, risk of adverse neurologic damage increases with
severity and duration of hypoglycemia
 Infants are 2 – 3 times more likely to have issues with
planning, memory, attention, problem-solving, and visual-
motor coordination by 4 – 5 years of age
 Raising glucose levels too fast, too high has an even greater
risk of brain damage
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28. PROGNOSIS
Major long-term squeal include death and:
Neurologic damage
•Mental retardation
• Recurrent seizure activity, epilepsy
• Cerebral palsy
• Developmental delay
• Personality disorders
Cardiovascular impairment
• Myocardial ischemia
 Prolonged QT interval
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29. Reference
1.Ethiopian ministry of health NICU management
protocol 2024
2.Fanaroff and Martin’s neonatal perinatal Medicine
10th edition volume one
3. Dr. Sharon Fassino, DNP, RN, NNP-BC Texas
children hospital 2009 ppt.
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