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.
This document discusses hypoglycemia in neonates. It defines neonatal hypoglycemia as a plasma glucose level below 30 mg/dL in the first 24 hours of life or below 45 mg/dL thereafter. It identifies factors that increase hypoglycemia risk, such as low birth weight, prematurity, and maternal diabetes. Symptoms are nonspecific but include poor feeding, temperature instability, and central nervous system issues. Treatment involves glucose boluses and maintenance with intravenous dextrose infusions. Resistant or persistent hypoglycemia may require higher infusion rates, hydrocortisone, glucagon, or other drugs. Careful glucose monitoring is important to prevent neurological complications.
This document discusses the approach to hypoglycemia in childhood. It begins by defining hypoglycemia and describing the importance of glucose for brain development. It then discusses the pathophysiology of hypoglycemia, focusing on how the body maintains blood glucose levels through glycogenolysis, gluconeogenesis, and lipolysis. The clinical features of hypoglycemia are presented, distinguishing between sympathetic overactivity and neuroglycopenic symptoms. Common etiologies like hyperinsulinism, metabolic disorders, and systemic illnesses are outlined. The document concludes with recommendations for investigating hypoglycemia, managing acute episodes, and treating underlying causes to prevent long-term neurological consequences.
This document discusses the approach to hypoglycemia in childhood. It begins by defining hypoglycemia and describing the importance of glucose for brain development. It then discusses the pathophysiology of hypoglycemia, focusing on how the body maintains blood glucose levels through glycogenolysis, gluconeogenesis, and lipolysis. The clinical features of hypoglycemia are presented, distinguishing between sympathetic overactivity and neuroglycopenic symptoms. Common etiologies like hyperinsulinism, metabolic disorders, and systemic illnesses are outlined. The document concludes with recommendations for investigating hypoglycemia, managing acute episodes, and treating underlying causes to prevent long-term neurological consequences.
Hypoglycemia in infants and children can have potentially devastating consequences if not properly managed. It is defined as a blood glucose level below 55 mg/dL. The brain relies heavily on glucose for energy in early life. Persistent hypoglycemia can impair brain growth and development. Causes include decreased glucose production, increased glucose utilization, infections, metabolic disorders, and others. Symptoms range from autonomic activation to neurological changes like seizures. Management involves identifying the cause, treating any underlying condition, monitoring blood glucose closely, and administering intravenous glucose to prevent hypoglycemia.
This document discusses neonatal hypoglycemia, including risks, symptoms, treatment, and monitoring. It notes that hypoglycemia can cause long-term neurological issues if not addressed. Key points include: glucose levels fall dangerously low in the first few days of life; low birth weight, prematurity, and other medical issues increase hypoglycemia risk; symptoms are non-specific; treatment involves glucose boluses and intravenous fluids to maintain normal blood glucose levels, which should be monitored frequently, especially in at-risk newborns. Resistant or persistent hypoglycemia may require additional drugs or referral to a specialist to investigate underlying causes.
This document provides an overview of the management of gestational diabetes mellitus (GDM). It defines GDM and discusses its prevalence and pathophysiology. It outlines maternal and fetal complications of GDM. The document discusses screening, diagnostic criteria, and treatment targets for GDM. It also covers preconception counseling, antenatal care including monitoring, medical nutrition therapy, exercise recommendations, and fetal surveillance in the management of GDM.
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.
This document discusses hypoglycemia in neonates. It defines neonatal hypoglycemia as a plasma glucose level below 30 mg/dL in the first 24 hours of life or below 45 mg/dL thereafter. It identifies factors that increase hypoglycemia risk, such as low birth weight, prematurity, and maternal diabetes. Symptoms are nonspecific but include poor feeding, temperature instability, and central nervous system issues. Treatment involves glucose boluses and maintenance with intravenous dextrose infusions. Resistant or persistent hypoglycemia may require higher infusion rates, hydrocortisone, glucagon, or other drugs. Careful glucose monitoring is important to prevent neurological complications.
This document discusses the approach to hypoglycemia in childhood. It begins by defining hypoglycemia and describing the importance of glucose for brain development. It then discusses the pathophysiology of hypoglycemia, focusing on how the body maintains blood glucose levels through glycogenolysis, gluconeogenesis, and lipolysis. The clinical features of hypoglycemia are presented, distinguishing between sympathetic overactivity and neuroglycopenic symptoms. Common etiologies like hyperinsulinism, metabolic disorders, and systemic illnesses are outlined. The document concludes with recommendations for investigating hypoglycemia, managing acute episodes, and treating underlying causes to prevent long-term neurological consequences.
This document discusses the approach to hypoglycemia in childhood. It begins by defining hypoglycemia and describing the importance of glucose for brain development. It then discusses the pathophysiology of hypoglycemia, focusing on how the body maintains blood glucose levels through glycogenolysis, gluconeogenesis, and lipolysis. The clinical features of hypoglycemia are presented, distinguishing between sympathetic overactivity and neuroglycopenic symptoms. Common etiologies like hyperinsulinism, metabolic disorders, and systemic illnesses are outlined. The document concludes with recommendations for investigating hypoglycemia, managing acute episodes, and treating underlying causes to prevent long-term neurological consequences.
Hypoglycemia in infants and children can have potentially devastating consequences if not properly managed. It is defined as a blood glucose level below 55 mg/dL. The brain relies heavily on glucose for energy in early life. Persistent hypoglycemia can impair brain growth and development. Causes include decreased glucose production, increased glucose utilization, infections, metabolic disorders, and others. Symptoms range from autonomic activation to neurological changes like seizures. Management involves identifying the cause, treating any underlying condition, monitoring blood glucose closely, and administering intravenous glucose to prevent hypoglycemia.
This document discusses neonatal hypoglycemia, including risks, symptoms, treatment, and monitoring. It notes that hypoglycemia can cause long-term neurological issues if not addressed. Key points include: glucose levels fall dangerously low in the first few days of life; low birth weight, prematurity, and other medical issues increase hypoglycemia risk; symptoms are non-specific; treatment involves glucose boluses and intravenous fluids to maintain normal blood glucose levels, which should be monitored frequently, especially in at-risk newborns. Resistant or persistent hypoglycemia may require additional drugs or referral to a specialist to investigate underlying causes.
This document provides an overview of the management of gestational diabetes mellitus (GDM). It defines GDM and discusses its prevalence and pathophysiology. It outlines maternal and fetal complications of GDM. The document discusses screening, diagnostic criteria, and treatment targets for GDM. It also covers preconception counseling, antenatal care including monitoring, medical nutrition therapy, exercise recommendations, and fetal surveillance in the management of GDM.
Hypoglycemia in the NICU is one of the most important conditions. This presentation will therefore help the healthcare provider to develop skills that will enable them to quickly identify and effectively manage this condition
Diabetes mellitus and thyroid diseases can impact pregnancy. The presentation discussed diabetes mellitus, its classification and effects during pregnancy. It can increase risks for the mother like hypertension and risks for the baby like macrosomia. Screening and care involve monitoring blood sugar via tests and working with a team. Gestational diabetes requires diet control or possibly insulin. Thyroid diseases like thyrotoxicosis also impact pregnancy and require treatment to control the condition and prevent risks. Care involves monitoring and treating any thyroid abnormalities in the mother or baby.
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 diabetes in pregnancy, including:
- Risks to the mother include acceleration of complications like eye and kidney disease, as well as risks of hypoglycemia, pre-eclampsia, and obstetric complications.
- Risks to the fetus include congenital malformations, macrosomia, stillbirth, neonatal death, and issues like hypoglycemia and jaundice after birth.
- Management involves tight glycemic control, aspirin, monitoring for complications, and delivery planning based on gestational age and fetal growth. Acute issues like hypoglycemia and diabetic ketoacidosis require prompt treatment.
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.
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 diabetes in pregnancy, including gestational diabetes and pre-existing diabetes. It defines the different types of diabetes in pregnancy and provides statistics on prevalence. Screening recommendations are outlined as well as management approaches, including maintaining good glycemic control through monitoring, medical nutrition therapy, and insulin when needed. Potential maternal and fetal/neonatal complications are described if glycemic control is not well managed.
1) Diabetes in pregnancy poses unique risks to both mother and fetus compared to diabetes in the general population due to hormonal changes that can worsen insulin resistance and blood sugar control.
2) Poorly managed diabetes in pregnancy can lead to complications like congenital malformations, macrosomia, preeclampsia, stillbirth, and infections for both mother and baby.
3) Strict preconception care, blood sugar monitoring during pregnancy, and fetal surveillance are needed to optimize outcomes for women with diabetes who become pregnant.
Some additional things to ask in the history:
- Family history of similar episodes or endocrine disorders
- Dietary history, including any changes in appetite/food intake
- Growth pattern and any slowing of growth
- Pubertal development
Some additional things to examine:
- Vital signs - check for signs of dehydration, shock
- Detailed physical exam looking for signs of other endocrine abnormalities
- Developmental assessment
- Nutritional status
Investigations to consider:
- Electrolytes, liver/renal function tests
- Cortisol, ACTH to check for primary adrenal insufficiency
- Thyroid function tests
- Growth hormone stimulation test
- Blood glucose curve/
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.
1. Tight glycemic control through medical nutrition therapy, exercise, blood glucose monitoring, and potentially insulin is important to manage diabetes in pregnancy.
2. Close fetal surveillance through growth scans and tests are needed to monitor for complications like macrosomia.
3. Delivery timing and type (vaginal vs c-section) depends on maternal and fetal status and risks like macrosomia.
4. Neonatal risks include hypoglycemia, jaundice, and respiratory distress which requires close monitoring after birth.
5. Counseling on future diabetes risk and appropriate contraception is important in postpartum care.
NCD Training Module 4.8 Hyperglycaemia in Pregnancy.pptCHRISTOPHERMKONO2
Hyperglycemia in pregnancy, also known as gestational diabetes, occurs when glucose tolerance is impaired during pregnancy. It is diagnosed through screening tests and affects 3-10% of pregnancies. Risk factors include obesity, family history of diabetes, and previous gestational diabetes. Treatment involves lifestyle modifications like diet, exercise, glucose monitoring as well as possible medication like insulin or metformin. High blood sugar levels during pregnancy can increase risks for complications in both mother and baby such as preeclampsia, preterm birth, and excessive fetal growth. Post-delivery, women with gestational diabetes have increased risk of developing type 2 diabetes.
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.
1. Infants born to mothers with diabetes are at risk for complications due to maternal hyperglycemia and fetal hyperinsulinemia. They commonly present with hypoglycemia, macrosomia, respiratory distress, and congenital anomalies.
2. Clinical evaluation of newborns of diabetic mothers should include monitoring blood sugars and checking for electrolyte abnormalities, polycythemia, hyperbilirubinemia, cardiac issues, and neurological or gastrointestinal complications. Treatment involves stabilization of blood sugars and repletion of any electrolyte or hematologic abnormalities.
Neonatal Hypoglycemia approach and Management .pptxAzad Haleem
Dr. Azad Haleem provides an overview of neonatal hypoglycemia. Key points include:
1) Neonates are susceptible to hypoglycemia due to their high brain glucose needs and immature defenses against low blood sugar. Transitional hypoglycemia is common in the first 48 hours while persistent low blood sugar beyond 48 hours requires investigation.
2) Causes of persistent hypoglycemia include hyperinsulinism, hypopituitarism, inborn errors of metabolism, and rarely other conditions. Diagnostic testing aims to identify the underlying etiology.
3) Management involves glucose supplementation, identifying and treating the cause, and careful feeding advancement. Specific treatments depend on the condition, such as diet modifications for
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.
1) Infants of diabetic mothers (IDM) are at risk for complications during pregnancy and birth due to maternal hyperglycemia and the fetus's resulting hyperinsulinemia. Complications for the fetus include increased birth weight, hypoglycemia, hypocalcemia, and respiratory distress.
2) The Pederson hypothesis explains that maternal hyperglycemia causes fetal hyperglycemia and hyperinsulinemia after 20 weeks of gestation as the fetal pancreas matures. This excess insulin promotes increased growth in the fetus.
3) Management of IDM focuses on stabilizing blood glucose with IV dextrose supplementation and feeding support, and treating electrolyte abnormalities like hypocalcemia and hypomagnesemia
Mr. G, a 47-year-old businessman, was admitted to the hospital on September 27th at 11:05pm for diabetes mellitus, ischemic heart disease, hyperlipidemia, and hypertension. His medical history includes hypertension, diabetes, ischemic heart disease in 2008, and peripheral vascular disease in 2010. On examination, he had dry skin, flaky skin on his lower legs and feet, and an IV in his left hand. Lab tests showed elevated glucose, cholesterol, and kidney function. Imaging found an old heart attack and brain infarct. The patient's diabetes is managed through diet, exercise, oral medications, and possibly insulin therapy depending on his ability to control blood sugar levels.
Gestational diabetes (GDM) accounts for 90% of diabetes in pregnancy and occurs when a woman without diabetes develops high blood glucose levels during pregnancy due to insufficient insulin production. Women with GDM are at risk of complications like macrosomia. GDM is managed through medical nutrition therapy, exercise, blood glucose monitoring, and sometimes insulin or oral medications. Strict glycemic control is important for reducing risks.
This document discusses oral hypoglycemic toxicity from sulfonylureas. It notes that sulfonylureas are commonly prescribed to treat type 2 diabetes but can cause hypoglycemia from overdose. Symptoms of hypoglycemia include confusion, dizziness, and seizures. Treatment involves glucose administration via IV or glucagon injection. Patients may require glucose for hours to days depending on the drug and dose. Activated charcoal may help if ingestion was within an hour but has limited benefit for 1-2 tablet ingestions.
Human embryology is the study of prenatal human development from fertilization through birth. There are three main periods of development - the pre-embryonic period from fertilization to 2 weeks, the embryonic period from 3-8 weeks, and the fetal period from 9 weeks until birth. Gametogenesis refers to the formation of male and female sex cells or gametes through processes of meiosis and mitosis in the ovaries and testes. Fertilization occurs when a sperm fuses with an egg to form a zygote, initiating the embryonic development process.
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Hypoglycemia in the NICU is one of the most important conditions. This presentation will therefore help the healthcare provider to develop skills that will enable them to quickly identify and effectively manage this condition
Diabetes mellitus and thyroid diseases can impact pregnancy. The presentation discussed diabetes mellitus, its classification and effects during pregnancy. It can increase risks for the mother like hypertension and risks for the baby like macrosomia. Screening and care involve monitoring blood sugar via tests and working with a team. Gestational diabetes requires diet control or possibly insulin. Thyroid diseases like thyrotoxicosis also impact pregnancy and require treatment to control the condition and prevent risks. Care involves monitoring and treating any thyroid abnormalities in the mother or baby.
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 diabetes in pregnancy, including:
- Risks to the mother include acceleration of complications like eye and kidney disease, as well as risks of hypoglycemia, pre-eclampsia, and obstetric complications.
- Risks to the fetus include congenital malformations, macrosomia, stillbirth, neonatal death, and issues like hypoglycemia and jaundice after birth.
- Management involves tight glycemic control, aspirin, monitoring for complications, and delivery planning based on gestational age and fetal growth. Acute issues like hypoglycemia and diabetic ketoacidosis require prompt treatment.
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.
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 diabetes in pregnancy, including gestational diabetes and pre-existing diabetes. It defines the different types of diabetes in pregnancy and provides statistics on prevalence. Screening recommendations are outlined as well as management approaches, including maintaining good glycemic control through monitoring, medical nutrition therapy, and insulin when needed. Potential maternal and fetal/neonatal complications are described if glycemic control is not well managed.
1) Diabetes in pregnancy poses unique risks to both mother and fetus compared to diabetes in the general population due to hormonal changes that can worsen insulin resistance and blood sugar control.
2) Poorly managed diabetes in pregnancy can lead to complications like congenital malformations, macrosomia, preeclampsia, stillbirth, and infections for both mother and baby.
3) Strict preconception care, blood sugar monitoring during pregnancy, and fetal surveillance are needed to optimize outcomes for women with diabetes who become pregnant.
Some additional things to ask in the history:
- Family history of similar episodes or endocrine disorders
- Dietary history, including any changes in appetite/food intake
- Growth pattern and any slowing of growth
- Pubertal development
Some additional things to examine:
- Vital signs - check for signs of dehydration, shock
- Detailed physical exam looking for signs of other endocrine abnormalities
- Developmental assessment
- Nutritional status
Investigations to consider:
- Electrolytes, liver/renal function tests
- Cortisol, ACTH to check for primary adrenal insufficiency
- Thyroid function tests
- Growth hormone stimulation test
- Blood glucose curve/
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.
1. Tight glycemic control through medical nutrition therapy, exercise, blood glucose monitoring, and potentially insulin is important to manage diabetes in pregnancy.
2. Close fetal surveillance through growth scans and tests are needed to monitor for complications like macrosomia.
3. Delivery timing and type (vaginal vs c-section) depends on maternal and fetal status and risks like macrosomia.
4. Neonatal risks include hypoglycemia, jaundice, and respiratory distress which requires close monitoring after birth.
5. Counseling on future diabetes risk and appropriate contraception is important in postpartum care.
NCD Training Module 4.8 Hyperglycaemia in Pregnancy.pptCHRISTOPHERMKONO2
Hyperglycemia in pregnancy, also known as gestational diabetes, occurs when glucose tolerance is impaired during pregnancy. It is diagnosed through screening tests and affects 3-10% of pregnancies. Risk factors include obesity, family history of diabetes, and previous gestational diabetes. Treatment involves lifestyle modifications like diet, exercise, glucose monitoring as well as possible medication like insulin or metformin. High blood sugar levels during pregnancy can increase risks for complications in both mother and baby such as preeclampsia, preterm birth, and excessive fetal growth. Post-delivery, women with gestational diabetes have increased risk of developing type 2 diabetes.
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.
1. Infants born to mothers with diabetes are at risk for complications due to maternal hyperglycemia and fetal hyperinsulinemia. They commonly present with hypoglycemia, macrosomia, respiratory distress, and congenital anomalies.
2. Clinical evaluation of newborns of diabetic mothers should include monitoring blood sugars and checking for electrolyte abnormalities, polycythemia, hyperbilirubinemia, cardiac issues, and neurological or gastrointestinal complications. Treatment involves stabilization of blood sugars and repletion of any electrolyte or hematologic abnormalities.
Neonatal Hypoglycemia approach and Management .pptxAzad Haleem
Dr. Azad Haleem provides an overview of neonatal hypoglycemia. Key points include:
1) Neonates are susceptible to hypoglycemia due to their high brain glucose needs and immature defenses against low blood sugar. Transitional hypoglycemia is common in the first 48 hours while persistent low blood sugar beyond 48 hours requires investigation.
2) Causes of persistent hypoglycemia include hyperinsulinism, hypopituitarism, inborn errors of metabolism, and rarely other conditions. Diagnostic testing aims to identify the underlying etiology.
3) Management involves glucose supplementation, identifying and treating the cause, and careful feeding advancement. Specific treatments depend on the condition, such as diet modifications for
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.
1) Infants of diabetic mothers (IDM) are at risk for complications during pregnancy and birth due to maternal hyperglycemia and the fetus's resulting hyperinsulinemia. Complications for the fetus include increased birth weight, hypoglycemia, hypocalcemia, and respiratory distress.
2) The Pederson hypothesis explains that maternal hyperglycemia causes fetal hyperglycemia and hyperinsulinemia after 20 weeks of gestation as the fetal pancreas matures. This excess insulin promotes increased growth in the fetus.
3) Management of IDM focuses on stabilizing blood glucose with IV dextrose supplementation and feeding support, and treating electrolyte abnormalities like hypocalcemia and hypomagnesemia
Mr. G, a 47-year-old businessman, was admitted to the hospital on September 27th at 11:05pm for diabetes mellitus, ischemic heart disease, hyperlipidemia, and hypertension. His medical history includes hypertension, diabetes, ischemic heart disease in 2008, and peripheral vascular disease in 2010. On examination, he had dry skin, flaky skin on his lower legs and feet, and an IV in his left hand. Lab tests showed elevated glucose, cholesterol, and kidney function. Imaging found an old heart attack and brain infarct. The patient's diabetes is managed through diet, exercise, oral medications, and possibly insulin therapy depending on his ability to control blood sugar levels.
Gestational diabetes (GDM) accounts for 90% of diabetes in pregnancy and occurs when a woman without diabetes develops high blood glucose levels during pregnancy due to insufficient insulin production. Women with GDM are at risk of complications like macrosomia. GDM is managed through medical nutrition therapy, exercise, blood glucose monitoring, and sometimes insulin or oral medications. Strict glycemic control is important for reducing risks.
This document discusses oral hypoglycemic toxicity from sulfonylureas. It notes that sulfonylureas are commonly prescribed to treat type 2 diabetes but can cause hypoglycemia from overdose. Symptoms of hypoglycemia include confusion, dizziness, and seizures. Treatment involves glucose administration via IV or glucagon injection. Patients may require glucose for hours to days depending on the drug and dose. Activated charcoal may help if ingestion was within an hour but has limited benefit for 1-2 tablet ingestions.
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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
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.
5/19/2024 3
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
5/19/2024 4
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.
5/19/2024 5
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.
5/19/2024 6
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.
5/19/2024 7
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
5/19/2024 8
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
5/19/2024 12
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
5/19/2024 13
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
5/19/2024 14
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
5/19/2024 15
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”
5/19/2024 16
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
5/19/2024 17
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.
5/19/2024 19
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.
5/19/2024 20
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.
5/19/2024 21
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
5/19/2024 22
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
5/19/2024 23
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.
5/19/2024 24
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.
5/19/2024 25
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
5/19/2024 26
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
5/19/2024 27
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.
5/19/2024 29
What happened?
•Increased utilization of glucose secondary to increased
metabolic rate
-What does that mean?
•Rapid depletion of adequate glucose stores
