neonatal hypoglycæmi, naturlig forebyggelse...controversies regarding definition of neonatal...
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Neonatal Hypoglycaeligmi naturlig forebyggelse
Bruges Best Practice til nyfoslashdte i Danmark
Bente Thorup Dalsgaard
Sygeplejerske IBCLC
Barselsafsnit 11
2016
Amning
hjaeliglpestoffer
naeligringsstoffer
tegn paring god sutteteknik
mors observationer
sundhedsprofessionelle observationer og
vurderinger
Hud kontakt
rdquohud mod hudrdquo
feedbackmekanismer mellem mor og barn
non farmakologiske
faktorer til forebyggelse af hypoglycaeligmi
Nyfoslashdte af moslashdre
med GDM
Tilfoslashjet slide efter oplaeligg
bull Lokalaftalen er at ligger hud mod hud de foslashrste to timer
og at barnet dier inden overflytning til barselsafdeling
bull Hvis barnet ikke evner at sutte hjaeliglpes mor med
haringndudmalkning og barnet faringr maeliglken med det samme
bull Hvis barnet ikke har suttet inden overflytning bevares hud
mod hud kontakten i overflytningen evt som kaelignguro
opbundet Paring afdelingen hjaeliglpes parret igen med at
etablere amning Hvis barnet ikke sutter udmalkes mindst
hver 3 time og barnet faringr maeliglken med det samme
bull Der opfordres til kontinuerlig hud mod hud
BD 12516
GDM kvalitetsstudie 2009-14
Samlet vurdering de foslashrste 4 timer
bull Kun 11 har bs lt 25
mmoll mod 23 foslashr
bull Blodsukker 1tpp fra de
retrospektive forloslashb er
IKKE medtaget da vi ved
at dette blodsukker er
fysiologisk lavt og derfor
ikke goslashr andet i dette
tilfaeliglde end at oslashge
antallet af boslashrn med
hypoglycaeligmi foslashr til 38
Grundlag Retrospektivt 141 boslashrn
Prospektivt 417 boslashrn
Amning
bull En oslashgning paring 77
flere amninger paring de
foslashrste 6 timer er en
signifikant forbedring
bull Dermed har boslashrnene
formentlig indtaget
vaeligsentlig mere raringmaeliglk
end boslashrnene foslashr
aeligndringen
Amning de foslashrste to timer efter foslashdslen
Neonatal Hypoglycaeligmi
Oplaeliggget er baseret paring viden om
nyfoslashdte ge 35deg Praeligmature derunder har
jeg ingen forudsaeligtninger for at tale om
Det vides ikke
hvor kort eller
lang en
tidsperiode med et
lavere blodsukker
skal vaeligre foslashr det
giver foslashlger
Det vides ikke
hvilket
blodsukkerniveau
der er mest sikkert
Det vides ikke
hvor graelignsen
garingr mellem
skade ikke-
skade
Vi er alle
bange for at et
barn faringr
senfoslashlger efter
hypoglycaeligmi
Burns Patterns of cerebral injury and
neurodevelopmental outcomes after symptomatic neonatal
hypoglycemia Pediatrics 2008
bull Alle var symptomatiske ge 37deg 61 havde kramper
bull Median bs paring 10 mmoll 86 havde
bs le15 mmoll 1 el flere gange flest 1 doslashgn
bull Alle havde neurologisk dysfunktion indenfor 1 uge
bull 40 IUGR (flest asymmetriske)
bull Overvaeliggt af moslashdre med DM eller hypertension
bull Akut sectio pga barnet
18 mdr boslashrn med forbigaringende tidlig hypoglycaeligmi eller ingen kramper udviklede
sig normalt trods WM-skade undtaget 1 barn
Win Tin 2014 566 praeligmature 47 laeligngerevarende svaeligr hypoglycaeligmi
bull Samme udvikling som parrede kontrolboslashrn hhv 2 og 15 aringr efter
Hypoglykaeligmi kohorte
bull 404 boslashrn i risiko for hypoglykaeligmi foslashlges i 2 aringr 53
havde bs lt 26 mmoll
bull Standard glucosemaringling og kontinuerlig skjult glucose
maringling i de foslashrste 48 timer eller til stabilt blodsukker
bull Overraskende var der 23 der havde lavt blodsukker
uden at det blev opdaget
Udvikling ved 24 maringneder
bull Ingen signifikant forskel i neurologisk udvikling eller
problemloslashsningsevne
bull Det ses dog at boslashrn der laring hoslashjt i bs (gt4) de foslashrste 12 timer
efter et bs-fald fik laveste score i neurologisk udvikling
bull Det tyder paring at et stabilt middel blodsukker er maringletMcKinlay 2015
Normale boslashrn
bull Glucose er eacuten af mange energikilder
for det nyfoslashdte barn
bull Hoseth 2000 laveste blodsukker 14
mmoll 1 time efter foslashdslen median 31
mmol l (14 til 53)
bull Hapo studiet 2010 Mean 32 mmol plusmn
09
Normale hjaeliglpesystemer
bull Ketogenese Normale nyfoslashdte har en
optil 40 x kapacitet af en voksen til at
starte ketogenese som skaffer energi
til barnet
bull Laktat betragtes som rdquoskurkrdquo men er
ogsaring en stor energi kilde da 2 x lactat
= glucose
Processer og tilfoslashrsel via colostrum
bull Glycogenolyse = omdannelse af glycogen
bull Gluconeogenese = nydannelse af glucose
bull Lipolyse = omdannelse af fedt til frie fedtsyrer
bull Ketogenese = udnyttelse af frie fedtsyrer til energi
Colostrum indeholder
bull Oligosaccharider Laktat laktose
bull Fedtsyrer monoumaeligttet fedt fedtmolekyler er store
energitaeligtte og medbringer selv lipase
bull Aminosyrer og proteiner
bull Vaeligkstfaktorer til hurtig transport af naeligringsstoffer
HYPOGLYCAEligMI
Alternative tilgange
bull Neonatal Hypoglycaeligmi er ikke en egentlig diagnose men en
beskrivelse af en tilstand
bull En tilstand hvor barnets metaboliske tilpasningsevne er reduceret og
DERFOR faringr hypoglycaeligmi
bull Alle nyfoslashdte har en back-up plan i form af alternative energikilder nogle boslashrn dog i
reduceret grad og DE er i risiko for hypoglycaeligmiCornblathM HawdonJM
Controversies regarding definition of neonatal hypoglycemia
suggested operational thresholds Pediatrics 2000 105 5 1141-1145
Der sker rigtig meget lige nu paring det laeliggefaglige omraringde (Win Tin 2014) Nye
forslag er at
bull asymptomatiske boslashrn er hypoglycaeligmiske med et bs lt 20 ogsaring ved naeligste
maringling altsaring over laeligngere tid og ikke kun eacuten vaeligrdi
bull Der maring kun vaeligre eacuten maringling lt 10 behandles straks
bull Ved symptomer skal der ogsaring reageres med det samme v bslt 25
Deacutet er laeliggefaglige beslutninger som vi maringske faringr at se
Hvem er Risikoboslashrn
Halvdelen af boslashrnene i Sugar Baby study
udaf 514 risikoboslashrn havde
51 bs lt 26 20 lt 20
Fordelingen i grupperne er helt ens
bull 79 var asymptomatiske
bull 15 var for traeligtte til at sutte
bull 7 sitrede
Incidence of Neonatal Hypoglycemia in Babies Identified as at Risk
Deborah L Harris
2012 J of Pediatrics
Burde vi taelignke Hvad
er dette barns
specifikke evne til
metabolisk tilpasning
efter foslashdslen og
hvordan stoslashtter vi
barnet bedst paring
naturlig vis i denne
proces og stadig
forebygger skade
Saeligrlige risikoboslashrn
bull IUGR boslashrn kan vaeligre meget uforudsigelige Deres
pancreas kan vaeligre overaktiv og dermed udsende for
meget insulin og pancreas kan vaeligre haeligmmet
bull Saeligrlig de boslashrn der er asymmetriske i deres vaeligkst
Soslashgning af litteratur
En hurtig PubMed soslashgning giver foslashlgende
1Neonatal hypoglycemia 2404
2Breastfeeding 36873
3Colostrum 7435
1+2 70
1+3 3
Early feeding
bull Der er ingen enighed om definition paring Early Feeding
bull Hawdon rdquofoslashrhen sendte boslashrnene hurtigt maeliglken tilbage til den velmenende
afsenderrdquo
bull Early Feeding kan vaeligre tidlig hyppig amning sukkervand modermaeliglk
erstatning dextrosegel Maeligngde
bull Udover amning er der mange modeller og ingen af dem er evidensbaserede
bull I 2015-16 kommer der stadig artikler om neonatal hypoglycaeligmi der ikke
skriver om ernaeligring overhovedet
Modermaeliglkserstatning og hjaeliglpestoffer
De Rooyrsquos studie fra 2002 viser
bull I et prospektivt studie med i alt 165 boslashrn blev boslashrnenes ketogenese
undersoslashgt
bull Deacuten gruppe der er taeligttest paring en af vores maringlgrupper GDM er Large
for Gestational Age boslashrnene Her paringvises det med signifikant forskel
at amning oslashger ketogenesen og at amning + modermaeliglkserstatning
ikke har saring god respons
bull Flaskeboslashrn danner stort set ikke ketonstoffer i starten foslashrst efter 12
timer
Det kan antyde at mme reducerer barnets evne til
modregulering og selvhjaeliglp
At mme har bivirkningersideeffekter der bestemt ikke
er hensigtsmaeligssige naringr vi taler om forebyggelse
Guidelines hvor er vi
Unicef 2013
bull Alle hud mod hud lige efter foslashdslen
bull Amning indenfor den foslashrste time
bull Foslashrste bs tidligst efter 2 timer og foslashr andet maringltid
bull Ved lavt bs (graelignse 26 el 20) ammes igen eller udmalket maeliglk Ved
fortsat lavt bs efter 1 time gives mme i de maeligngder vi kender
Survey af neonatale hypoglykaeligmi guidelines i Australien og New
Zealand vha Unicef(Sundercombe 2014)
bull Kun 9 ud af 22 naeligvner hud mod hud lige efter foslashdslen
bull Kun enkelte naeligvner hjaeliglp til effektiv amning og information om tegn
paring spiselyst
bull Mere end halvdelen anbefaler supplering med mors udmalkede maeliglk
bull Kun 8 ud af 22 sikrer sig samtykke foslashr mme og info til foraeligldre om
aringrsag til suppleringen
Unicef hypoglycemia 2013
Forebyggelse i ammeperspektiv og Baby Friendly
Normoglycaeligmisk tilstand boslashr opnaringes med mindst mulig intervention
Konventionel tilgang
bull 60 mlkgdoslashgn mm el mme oslashges med
20 mlkgdoslashgn x 8(-12)
bull Vallecasein 4060 mme = nedsat
ventrikeltoslashmning
bull Vi maringler stadig 1 t bs
bull Ved lav bs oslashges til 125 eller 150
af maeligngden
bull Glucose-infusion
bull Adskillelse af mor og barn
Individuel tilgangABM Protocol 2014
bull 1-3 mlkg (optil 5 mlkg) gerne hver 2 time
(3-5 mlkg i 2006-udgaven)
bull Hurtig passage af mm alle hjaeliglpestoffer er
med Vallecasein 9010
Bergmann
bull mavesaeligkkens stoslashrrelse lige foslashr foslashdslen
drikker barnet ca 10 ml gang Refererer til
studier der angiver ventiklen til hhv 10 12
15 20 ml
bull Anbefaler smaring hyppige amninger
suppleringer saring barnet ikke stresses og
bruger mere glucose end det tilfoslashres
bull Ward-Platt Laktat er rdquothe good guyrdquo og et
veloxideret velcirkuleret barn har alle
muligheder for at kompensere
bull Antenatal udmalkning af raringmaeliglk til DM-
boslashrn
Forskellen i et forloslashb
DPS
3000 gram
bull 180 ml 1 doslashgn
(60kgdoslashgn)
bull bsdarr oslashges til 225 ml 24
timer
Svaeligrt at faring udmalket dette
som ekstra
ABM
3000 gram
bull 36 ml foslashrste doslashgn
1 mlkg maringltid = 3 x 12
bull 108 ml v 3 ml kgmaringltid
(reduktion paring 40 )
Opnaringeligt at udmalke dette
som ekstra
Mon der er forskel paring
antal amninger
Haringndudmalkning korrektinkorrekt
bull httpswwwyoutubecomwatchv=k6V9xTZAWq0
24
Hvordan forholder vi os til dette
bull Vi kan ikke aeligndre instrukser for hypoglycaeligmi haringndtering det
er en laeliggefaglig opgave kan vi alligevel goslashre en forskel i
profylaktisk oslashjemed
bull Har vi et ansvar for at vaeligre kritiske overfor gamle strategier
ndash og dermed assistere paeligdiatere i forebyggelsesarbejdet
bull Hvordan kan vi balancere forebyggelse og ikke-skade
princippet naringr det ogsaring drejer sig om naturlig ernaeligring mor-
barn kontakt og medicinske interventioner
bull Kan vi med vores viden om colostrum og naturlige
processers effekt aeligndre praksis for disse boslashrn
bull Hvordan kan vi som sundhedsprofessionelle oslashge antallet af
risikoboslashrn der tidligt faringr mors maeliglk selv om det ikke sutter
bull Hvordan vil det aeligndre vores praksisarbejde
bull Hvordan klaeligdes novicen og vi paring til en rdquoWatch and Waitrdquo
tilgang til hypoglycaeligmiforebyggelse
bull POCT eller lab-svar
Mon ikke hypoglycaeligmi forebyggelse kvalitativt kan
komme videre end i 2014
Tak fordi I lyttede
referencerbull CHERTOK IR RAZ I SHOHAM I HADDAD H and WIZNITZER A 2009 Journal of human
nutrition and dietetics the official journal of the British Dietetic Association 22(2) pp 166-169
bull CHRISTESEN HT and ESBERG G 2014-last update Hypoglykaeligmi flowcharts DPS Available
httpvipregionhdkVIPRedaktoer151637nsfvLookupUploadATTACH-RHAP-
9K2D8Y$FILEHypoglykC3A6mi20-20neonatal20Flowcharts20Maj202014pdf [0916
2014]
bull CORDERO L TREUER SH LANDON MB and GABBE SG 1998 Management of infants of
diabetic mothers Archives of Pediatrics amp Adolescent Medicine 152(3) pp 249-254
bull CORNBLATH M HAWDON JM WILLIAMS AF AYNSLEY-GREEN A WARD-PLATT MP
SCHWARTZ R and KALHAN SC 2000 Controversies regarding definition of neonatal
hypoglycemia suggested operational thresholds Pediatrics 105(5) pp 1141-1145
bull CSONT GL GROTH S HOPKINS P and GUILLET R 2014 An evidence-based approach to
breastfeeding neonates at risk for hypoglycemia Journal of obstetric gynecologic and neonatal
nursing JOGNN NAACOG 43(1) pp 71-81
bull DE ROOY L and HAWDON J 2002 Nutritional factors that affect the postnatal metabolic
adaptation of full-term small- and large-for-gestational-age infants Pediatrics 109(3) pp E42
bull DOBSON LZ VIBEKE 2011 God blodsukkerregulering kun for barnets skyld 25(nr 4) pp 36--
47
bull FLORES-LE ROUX JA SAGARRA E BENAIGES D HERNANDEZ-RIVAS E CHILLARON
JJ PUIG DE DOU J MUR A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2012 A
prospective evaluation of neonatal hypoglycaemia in infants of women with gestational diabetes
mellitus Diabetes research and clinical practice 97(2) pp 217-222
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull HARRIS DL WESTON PJ SIGNAL M CHASE JG and HARDING JE 2013 Dextrose gel for neonatal
hypoglycaemia (the Sugar Babies Study) a randomised double-blind placebo-controlled trial Lancet (London
England) 382(9910) pp 2077-2083
bull HERNANDEZ-RIVAS E FLORES-LE ROUX JA BENAIGES D SAGARRA E CHILLARON JJ PAYA A
PUIG-DE DOU J GODAY A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2013 Gestational diabetes in a
multiethnic population of Spain clinical characteristics and perinatal outcomes Diabetes research and clinical
practice 100(2) pp 215-221
bull HOSETH E JOERGENSEN A EBBESEN F and MOELLER M 2000 Blood glucose levels in a population of
healthy breast fed term infants of appropriate size for gestational age Archives of disease in childhoodFetal and
neonatal edition 83(2) pp F117-9
bull JENSEN DM SORENSEN B FEILBERG-JORGENSEN N WESTERGAARD JG and BECK-NIELSEN H
2000 Maternal and perinatal outcomes in 143 Danish women with gestational diabetes mellitus and 143 controls with
a similar risk profile Diabetic medicine a journal of the British Diabetic Association 17(4) pp 281-286
bull MAAYAN-METZGER A LUBIN D and KUINT J 2009 Hypoglycemia rates in the first days of life among term
infants born to diabetic mothers Neonatology 96(2) pp 80-85
bull MAAYAN-METZGER A SCHUSHAN-EISEN I LUBIN D MORAN O KUINT J and MAZKERETH R 2014
Delivery room breastfeeding for prevention of hypoglycaemia in infants of diabetic mothers Fetal and pediatric
pathology 33(1) pp 23-28
bull MCKINLAY CEA 2015 neonatal hypoglycemia and neurodevelopment outcomes at 2 years N Engl J Med(373)
pp 1507-18
bull METZGER BE PERSSON B LOWE LP DYER AR CRUICKSHANK JK DEEROCHANAWONG C
HALLIDAY HL HENNIS AJ LILEY H NG PC COUSTAN DR HADDEN DR HOD M OATS JJ
TRIMBLE ER and HAPO STUDY COOPERATIVE RESEARCH GROUP 2010 Hyperglycemia and adverse
pregnancy outcome study neonatal glycemia Pediatrics 126(6) pp e1545-52
bull ROZANCE PJ and HAY WWJR 2012 Neonatal hypoglycemia--answers but more questions The Journal of
pediatrics 161(5) pp 775-776
bull SARKAR S WATMAN J SEIGEL WM and SCHAEFFER HA 2003 A prospective controlled study of neonatal
morbidities in infants born at 36 weeks or more gestation to Women with diet-controlled gestational diabetes (GDM-
class Al) Journal of perinatology official journal of the California Perinatal Association 23(3) pp 223-228
bull SOLTANI H DICKINSON FM KALK J and PAYNE K 2008 Breast feeding
practices and views among diabetic women a retrospective cohort study Midwifery
24(4) pp 471-479
bull TOZIER P 2013 Colostrum Versus Formula Supplentation for Glucose Stabilization in
Newborns of Diabetic Mothers 42(JOGNN The association of Womens Health
Obstetric and Neonatal Nurses) pp 619-628
bull VAN HOWE RS and STORMS MR 2008 Blood glucose determinations in large for
gestational age infants American Journal of Perinatology 25(5) pp 283-289
bull WIGHT N MARINELLI KA and ACADEMY OF BREASTFEEDING MEDICINE
PROTOCOL COMMITTEE 2006 ABM clinical protocol 1 guidelines for glucose
monitoring and treatment of hypoglycemia in breastfed neonates Breastfeeding
medicine the official journal of the Academy of Breastfeeding Medicine 1(3) pp 178-
184
bull VANHALTREN K and MALHOTRA A 2013 Characteristics of infants at risk of
hypoglycaemia secondary to being infant of a diabetic mother Journal of pediatric
endocrinology amp metabolism JPEM 26(9-10) pp 861-865
bull WIGHT NE 2014 Hypoglycemia in breastfed neonates Breastfeeding medicine the
official journal of the Academy of Breastfeeding Medicine 9(4) pp 173-179
bull DALSGAARD B and ECK K 2013-last update Klinisk retningslinje for
nonfarmakologisk forebyggelse af neonatal hypoglycaeligmi og energitab hos nyfoslashdte af
moslashdre med diaeligtbehandlet gestationel diabetes Available
httpwwwkliniskeretningslinjerdkimages88_gdm_godkendt_010713pdf [0917 2014]
hypoglycaeligmibull
bull BRAGG JJ GREEN R and HOLZMAN IR 2013 Does early enteral feeding prevent
hypoglycemia in small for gestational age neonates Journal of neonatal-perinatal medicine 6(2)
pp 131-135
bull HARRIS DL WESTON PJ and HARDING JE 2014 Lactate rather than ketones may provide
alternative cerebral fuel in hypoglycaemic newborns Archives of disease in childhoodFetal and
neonatal edition
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull LANG TF and HUSSAIN K 2014 Pediatric hypoglycemia Advances in Clinical Chemistry 63
pp 211-245
bull MITANCHEZ D BURGUET A and SIMEONI U 2014 Infants born to mothers with gestational
diabetes mellitus mild neonatal effects a long-term threat to global health The Journal of pediatrics
164(3) pp 445-450
bull SUNDERCOMBE SL RAYNES-GREENOW CH TURNER RM and JEFFERY HE 2014 Do
neonatal hypoglycaemia guidelines in Australia and New Zealand facilitate breast feeding
Midwifery 30(12) pp 1179-1186
bull TAM EW HAEUSSLEIN LA BONIFACIO SL GLASS HC ROGERS EE JEREMY RJ
BARKOVICH AJ and FERRIERO DM 2012 Hypoglycemia is associated with increased risk for
brain injury and adverse neurodevelopmental outcome in neonates at risk for encephalopathy The
Journal of pediatrics 161(1) pp 88-93
bull UNICEF 2013 hypoglycaemia guidance july 2013 UNICEF
Kilder tilfoslashjet 2016
bull AGHDAS K TALAT K and SEPIDEH B 2014 Effect of immediate and continuous mother-infant
skin-to-skin contact on breastfeeding self-efficacy of primiparous women a randomised control trial
Women and birth journal of the Australian College of Midwives 27(1) pp 37-40
bull BEIRANVAND S VALIZADEH F HOSSEINABADI R and POURNIA Y 2014 The Effects of
Skin-to-Skin Contact on Temperature and Breastfeeding Successfulness in Full-Term Newborns
after Cesarean Delivery International journal of pediatrics 2014 pp 846486
bull FENGER-GRON J FENGER-GRON M BLUNCK CH SCHONEMANN-RIGEL H and
WIELANDT HB 2015 Low breastfeeding rates and body mass index in Danish children of women
with gestational diabetes mellitus International breastfeeding journal 10 pp 26-015-0051-8
eCollection 2015
bull JAGIELLO KP and AZULAY CHERTOK IR 2015 Womens Experiences With Early
Breastfeeding After Gestational Diabetes Journal of obstetric gynecologic and neonatal nursing
JOGNN NAACOG 44(4) pp 500-509
bull SAMAYAM P RANGANATHAN PK KOTARI UD and BALASUNDARAM R 2015 Study of
Asymptomatic Hypoglycemia in Full Term Exclusively Breastfed Neonates in First 48 Hours of Life
Journal of clinical and diagnostic research JCDR 9(9) pp SC07-10
bull SOBREVIA L SALSOSO R SAEZ T SANHUEZA C PARDO F and LEIVA A 2015 Insulin
therapy and fetoplacental vascular function in gestational diabetes mellitus Experimental physiology
100(3) pp 231-238
bull STEWART CE SAGE EL and REYNOLDS P 2015 Supporting Baby Friendly a quality
improvement initiative for the management of transitional neonatal hypoglycaemia Archives of
disease in childhoodFetal and neonatal edition
bull
Amning
hjaeliglpestoffer
naeligringsstoffer
tegn paring god sutteteknik
mors observationer
sundhedsprofessionelle observationer og
vurderinger
Hud kontakt
rdquohud mod hudrdquo
feedbackmekanismer mellem mor og barn
non farmakologiske
faktorer til forebyggelse af hypoglycaeligmi
Nyfoslashdte af moslashdre
med GDM
Tilfoslashjet slide efter oplaeligg
bull Lokalaftalen er at ligger hud mod hud de foslashrste to timer
og at barnet dier inden overflytning til barselsafdeling
bull Hvis barnet ikke evner at sutte hjaeliglpes mor med
haringndudmalkning og barnet faringr maeliglken med det samme
bull Hvis barnet ikke har suttet inden overflytning bevares hud
mod hud kontakten i overflytningen evt som kaelignguro
opbundet Paring afdelingen hjaeliglpes parret igen med at
etablere amning Hvis barnet ikke sutter udmalkes mindst
hver 3 time og barnet faringr maeliglken med det samme
bull Der opfordres til kontinuerlig hud mod hud
BD 12516
GDM kvalitetsstudie 2009-14
Samlet vurdering de foslashrste 4 timer
bull Kun 11 har bs lt 25
mmoll mod 23 foslashr
bull Blodsukker 1tpp fra de
retrospektive forloslashb er
IKKE medtaget da vi ved
at dette blodsukker er
fysiologisk lavt og derfor
ikke goslashr andet i dette
tilfaeliglde end at oslashge
antallet af boslashrn med
hypoglycaeligmi foslashr til 38
Grundlag Retrospektivt 141 boslashrn
Prospektivt 417 boslashrn
Amning
bull En oslashgning paring 77
flere amninger paring de
foslashrste 6 timer er en
signifikant forbedring
bull Dermed har boslashrnene
formentlig indtaget
vaeligsentlig mere raringmaeliglk
end boslashrnene foslashr
aeligndringen
Amning de foslashrste to timer efter foslashdslen
Neonatal Hypoglycaeligmi
Oplaeliggget er baseret paring viden om
nyfoslashdte ge 35deg Praeligmature derunder har
jeg ingen forudsaeligtninger for at tale om
Det vides ikke
hvor kort eller
lang en
tidsperiode med et
lavere blodsukker
skal vaeligre foslashr det
giver foslashlger
Det vides ikke
hvilket
blodsukkerniveau
der er mest sikkert
Det vides ikke
hvor graelignsen
garingr mellem
skade ikke-
skade
Vi er alle
bange for at et
barn faringr
senfoslashlger efter
hypoglycaeligmi
Burns Patterns of cerebral injury and
neurodevelopmental outcomes after symptomatic neonatal
hypoglycemia Pediatrics 2008
bull Alle var symptomatiske ge 37deg 61 havde kramper
bull Median bs paring 10 mmoll 86 havde
bs le15 mmoll 1 el flere gange flest 1 doslashgn
bull Alle havde neurologisk dysfunktion indenfor 1 uge
bull 40 IUGR (flest asymmetriske)
bull Overvaeliggt af moslashdre med DM eller hypertension
bull Akut sectio pga barnet
18 mdr boslashrn med forbigaringende tidlig hypoglycaeligmi eller ingen kramper udviklede
sig normalt trods WM-skade undtaget 1 barn
Win Tin 2014 566 praeligmature 47 laeligngerevarende svaeligr hypoglycaeligmi
bull Samme udvikling som parrede kontrolboslashrn hhv 2 og 15 aringr efter
Hypoglykaeligmi kohorte
bull 404 boslashrn i risiko for hypoglykaeligmi foslashlges i 2 aringr 53
havde bs lt 26 mmoll
bull Standard glucosemaringling og kontinuerlig skjult glucose
maringling i de foslashrste 48 timer eller til stabilt blodsukker
bull Overraskende var der 23 der havde lavt blodsukker
uden at det blev opdaget
Udvikling ved 24 maringneder
bull Ingen signifikant forskel i neurologisk udvikling eller
problemloslashsningsevne
bull Det ses dog at boslashrn der laring hoslashjt i bs (gt4) de foslashrste 12 timer
efter et bs-fald fik laveste score i neurologisk udvikling
bull Det tyder paring at et stabilt middel blodsukker er maringletMcKinlay 2015
Normale boslashrn
bull Glucose er eacuten af mange energikilder
for det nyfoslashdte barn
bull Hoseth 2000 laveste blodsukker 14
mmoll 1 time efter foslashdslen median 31
mmol l (14 til 53)
bull Hapo studiet 2010 Mean 32 mmol plusmn
09
Normale hjaeliglpesystemer
bull Ketogenese Normale nyfoslashdte har en
optil 40 x kapacitet af en voksen til at
starte ketogenese som skaffer energi
til barnet
bull Laktat betragtes som rdquoskurkrdquo men er
ogsaring en stor energi kilde da 2 x lactat
= glucose
Processer og tilfoslashrsel via colostrum
bull Glycogenolyse = omdannelse af glycogen
bull Gluconeogenese = nydannelse af glucose
bull Lipolyse = omdannelse af fedt til frie fedtsyrer
bull Ketogenese = udnyttelse af frie fedtsyrer til energi
Colostrum indeholder
bull Oligosaccharider Laktat laktose
bull Fedtsyrer monoumaeligttet fedt fedtmolekyler er store
energitaeligtte og medbringer selv lipase
bull Aminosyrer og proteiner
bull Vaeligkstfaktorer til hurtig transport af naeligringsstoffer
HYPOGLYCAEligMI
Alternative tilgange
bull Neonatal Hypoglycaeligmi er ikke en egentlig diagnose men en
beskrivelse af en tilstand
bull En tilstand hvor barnets metaboliske tilpasningsevne er reduceret og
DERFOR faringr hypoglycaeligmi
bull Alle nyfoslashdte har en back-up plan i form af alternative energikilder nogle boslashrn dog i
reduceret grad og DE er i risiko for hypoglycaeligmiCornblathM HawdonJM
Controversies regarding definition of neonatal hypoglycemia
suggested operational thresholds Pediatrics 2000 105 5 1141-1145
Der sker rigtig meget lige nu paring det laeliggefaglige omraringde (Win Tin 2014) Nye
forslag er at
bull asymptomatiske boslashrn er hypoglycaeligmiske med et bs lt 20 ogsaring ved naeligste
maringling altsaring over laeligngere tid og ikke kun eacuten vaeligrdi
bull Der maring kun vaeligre eacuten maringling lt 10 behandles straks
bull Ved symptomer skal der ogsaring reageres med det samme v bslt 25
Deacutet er laeliggefaglige beslutninger som vi maringske faringr at se
Hvem er Risikoboslashrn
Halvdelen af boslashrnene i Sugar Baby study
udaf 514 risikoboslashrn havde
51 bs lt 26 20 lt 20
Fordelingen i grupperne er helt ens
bull 79 var asymptomatiske
bull 15 var for traeligtte til at sutte
bull 7 sitrede
Incidence of Neonatal Hypoglycemia in Babies Identified as at Risk
Deborah L Harris
2012 J of Pediatrics
Burde vi taelignke Hvad
er dette barns
specifikke evne til
metabolisk tilpasning
efter foslashdslen og
hvordan stoslashtter vi
barnet bedst paring
naturlig vis i denne
proces og stadig
forebygger skade
Saeligrlige risikoboslashrn
bull IUGR boslashrn kan vaeligre meget uforudsigelige Deres
pancreas kan vaeligre overaktiv og dermed udsende for
meget insulin og pancreas kan vaeligre haeligmmet
bull Saeligrlig de boslashrn der er asymmetriske i deres vaeligkst
Soslashgning af litteratur
En hurtig PubMed soslashgning giver foslashlgende
1Neonatal hypoglycemia 2404
2Breastfeeding 36873
3Colostrum 7435
1+2 70
1+3 3
Early feeding
bull Der er ingen enighed om definition paring Early Feeding
bull Hawdon rdquofoslashrhen sendte boslashrnene hurtigt maeliglken tilbage til den velmenende
afsenderrdquo
bull Early Feeding kan vaeligre tidlig hyppig amning sukkervand modermaeliglk
erstatning dextrosegel Maeligngde
bull Udover amning er der mange modeller og ingen af dem er evidensbaserede
bull I 2015-16 kommer der stadig artikler om neonatal hypoglycaeligmi der ikke
skriver om ernaeligring overhovedet
Modermaeliglkserstatning og hjaeliglpestoffer
De Rooyrsquos studie fra 2002 viser
bull I et prospektivt studie med i alt 165 boslashrn blev boslashrnenes ketogenese
undersoslashgt
bull Deacuten gruppe der er taeligttest paring en af vores maringlgrupper GDM er Large
for Gestational Age boslashrnene Her paringvises det med signifikant forskel
at amning oslashger ketogenesen og at amning + modermaeliglkserstatning
ikke har saring god respons
bull Flaskeboslashrn danner stort set ikke ketonstoffer i starten foslashrst efter 12
timer
Det kan antyde at mme reducerer barnets evne til
modregulering og selvhjaeliglp
At mme har bivirkningersideeffekter der bestemt ikke
er hensigtsmaeligssige naringr vi taler om forebyggelse
Guidelines hvor er vi
Unicef 2013
bull Alle hud mod hud lige efter foslashdslen
bull Amning indenfor den foslashrste time
bull Foslashrste bs tidligst efter 2 timer og foslashr andet maringltid
bull Ved lavt bs (graelignse 26 el 20) ammes igen eller udmalket maeliglk Ved
fortsat lavt bs efter 1 time gives mme i de maeligngder vi kender
Survey af neonatale hypoglykaeligmi guidelines i Australien og New
Zealand vha Unicef(Sundercombe 2014)
bull Kun 9 ud af 22 naeligvner hud mod hud lige efter foslashdslen
bull Kun enkelte naeligvner hjaeliglp til effektiv amning og information om tegn
paring spiselyst
bull Mere end halvdelen anbefaler supplering med mors udmalkede maeliglk
bull Kun 8 ud af 22 sikrer sig samtykke foslashr mme og info til foraeligldre om
aringrsag til suppleringen
Unicef hypoglycemia 2013
Forebyggelse i ammeperspektiv og Baby Friendly
Normoglycaeligmisk tilstand boslashr opnaringes med mindst mulig intervention
Konventionel tilgang
bull 60 mlkgdoslashgn mm el mme oslashges med
20 mlkgdoslashgn x 8(-12)
bull Vallecasein 4060 mme = nedsat
ventrikeltoslashmning
bull Vi maringler stadig 1 t bs
bull Ved lav bs oslashges til 125 eller 150
af maeligngden
bull Glucose-infusion
bull Adskillelse af mor og barn
Individuel tilgangABM Protocol 2014
bull 1-3 mlkg (optil 5 mlkg) gerne hver 2 time
(3-5 mlkg i 2006-udgaven)
bull Hurtig passage af mm alle hjaeliglpestoffer er
med Vallecasein 9010
Bergmann
bull mavesaeligkkens stoslashrrelse lige foslashr foslashdslen
drikker barnet ca 10 ml gang Refererer til
studier der angiver ventiklen til hhv 10 12
15 20 ml
bull Anbefaler smaring hyppige amninger
suppleringer saring barnet ikke stresses og
bruger mere glucose end det tilfoslashres
bull Ward-Platt Laktat er rdquothe good guyrdquo og et
veloxideret velcirkuleret barn har alle
muligheder for at kompensere
bull Antenatal udmalkning af raringmaeliglk til DM-
boslashrn
Forskellen i et forloslashb
DPS
3000 gram
bull 180 ml 1 doslashgn
(60kgdoslashgn)
bull bsdarr oslashges til 225 ml 24
timer
Svaeligrt at faring udmalket dette
som ekstra
ABM
3000 gram
bull 36 ml foslashrste doslashgn
1 mlkg maringltid = 3 x 12
bull 108 ml v 3 ml kgmaringltid
(reduktion paring 40 )
Opnaringeligt at udmalke dette
som ekstra
Mon der er forskel paring
antal amninger
Haringndudmalkning korrektinkorrekt
bull httpswwwyoutubecomwatchv=k6V9xTZAWq0
24
Hvordan forholder vi os til dette
bull Vi kan ikke aeligndre instrukser for hypoglycaeligmi haringndtering det
er en laeliggefaglig opgave kan vi alligevel goslashre en forskel i
profylaktisk oslashjemed
bull Har vi et ansvar for at vaeligre kritiske overfor gamle strategier
ndash og dermed assistere paeligdiatere i forebyggelsesarbejdet
bull Hvordan kan vi balancere forebyggelse og ikke-skade
princippet naringr det ogsaring drejer sig om naturlig ernaeligring mor-
barn kontakt og medicinske interventioner
bull Kan vi med vores viden om colostrum og naturlige
processers effekt aeligndre praksis for disse boslashrn
bull Hvordan kan vi som sundhedsprofessionelle oslashge antallet af
risikoboslashrn der tidligt faringr mors maeliglk selv om det ikke sutter
bull Hvordan vil det aeligndre vores praksisarbejde
bull Hvordan klaeligdes novicen og vi paring til en rdquoWatch and Waitrdquo
tilgang til hypoglycaeligmiforebyggelse
bull POCT eller lab-svar
Mon ikke hypoglycaeligmi forebyggelse kvalitativt kan
komme videre end i 2014
Tak fordi I lyttede
referencerbull CHERTOK IR RAZ I SHOHAM I HADDAD H and WIZNITZER A 2009 Journal of human
nutrition and dietetics the official journal of the British Dietetic Association 22(2) pp 166-169
bull CHRISTESEN HT and ESBERG G 2014-last update Hypoglykaeligmi flowcharts DPS Available
httpvipregionhdkVIPRedaktoer151637nsfvLookupUploadATTACH-RHAP-
9K2D8Y$FILEHypoglykC3A6mi20-20neonatal20Flowcharts20Maj202014pdf [0916
2014]
bull CORDERO L TREUER SH LANDON MB and GABBE SG 1998 Management of infants of
diabetic mothers Archives of Pediatrics amp Adolescent Medicine 152(3) pp 249-254
bull CORNBLATH M HAWDON JM WILLIAMS AF AYNSLEY-GREEN A WARD-PLATT MP
SCHWARTZ R and KALHAN SC 2000 Controversies regarding definition of neonatal
hypoglycemia suggested operational thresholds Pediatrics 105(5) pp 1141-1145
bull CSONT GL GROTH S HOPKINS P and GUILLET R 2014 An evidence-based approach to
breastfeeding neonates at risk for hypoglycemia Journal of obstetric gynecologic and neonatal
nursing JOGNN NAACOG 43(1) pp 71-81
bull DE ROOY L and HAWDON J 2002 Nutritional factors that affect the postnatal metabolic
adaptation of full-term small- and large-for-gestational-age infants Pediatrics 109(3) pp E42
bull DOBSON LZ VIBEKE 2011 God blodsukkerregulering kun for barnets skyld 25(nr 4) pp 36--
47
bull FLORES-LE ROUX JA SAGARRA E BENAIGES D HERNANDEZ-RIVAS E CHILLARON
JJ PUIG DE DOU J MUR A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2012 A
prospective evaluation of neonatal hypoglycaemia in infants of women with gestational diabetes
mellitus Diabetes research and clinical practice 97(2) pp 217-222
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull HARRIS DL WESTON PJ SIGNAL M CHASE JG and HARDING JE 2013 Dextrose gel for neonatal
hypoglycaemia (the Sugar Babies Study) a randomised double-blind placebo-controlled trial Lancet (London
England) 382(9910) pp 2077-2083
bull HERNANDEZ-RIVAS E FLORES-LE ROUX JA BENAIGES D SAGARRA E CHILLARON JJ PAYA A
PUIG-DE DOU J GODAY A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2013 Gestational diabetes in a
multiethnic population of Spain clinical characteristics and perinatal outcomes Diabetes research and clinical
practice 100(2) pp 215-221
bull HOSETH E JOERGENSEN A EBBESEN F and MOELLER M 2000 Blood glucose levels in a population of
healthy breast fed term infants of appropriate size for gestational age Archives of disease in childhoodFetal and
neonatal edition 83(2) pp F117-9
bull JENSEN DM SORENSEN B FEILBERG-JORGENSEN N WESTERGAARD JG and BECK-NIELSEN H
2000 Maternal and perinatal outcomes in 143 Danish women with gestational diabetes mellitus and 143 controls with
a similar risk profile Diabetic medicine a journal of the British Diabetic Association 17(4) pp 281-286
bull MAAYAN-METZGER A LUBIN D and KUINT J 2009 Hypoglycemia rates in the first days of life among term
infants born to diabetic mothers Neonatology 96(2) pp 80-85
bull MAAYAN-METZGER A SCHUSHAN-EISEN I LUBIN D MORAN O KUINT J and MAZKERETH R 2014
Delivery room breastfeeding for prevention of hypoglycaemia in infants of diabetic mothers Fetal and pediatric
pathology 33(1) pp 23-28
bull MCKINLAY CEA 2015 neonatal hypoglycemia and neurodevelopment outcomes at 2 years N Engl J Med(373)
pp 1507-18
bull METZGER BE PERSSON B LOWE LP DYER AR CRUICKSHANK JK DEEROCHANAWONG C
HALLIDAY HL HENNIS AJ LILEY H NG PC COUSTAN DR HADDEN DR HOD M OATS JJ
TRIMBLE ER and HAPO STUDY COOPERATIVE RESEARCH GROUP 2010 Hyperglycemia and adverse
pregnancy outcome study neonatal glycemia Pediatrics 126(6) pp e1545-52
bull ROZANCE PJ and HAY WWJR 2012 Neonatal hypoglycemia--answers but more questions The Journal of
pediatrics 161(5) pp 775-776
bull SARKAR S WATMAN J SEIGEL WM and SCHAEFFER HA 2003 A prospective controlled study of neonatal
morbidities in infants born at 36 weeks or more gestation to Women with diet-controlled gestational diabetes (GDM-
class Al) Journal of perinatology official journal of the California Perinatal Association 23(3) pp 223-228
bull SOLTANI H DICKINSON FM KALK J and PAYNE K 2008 Breast feeding
practices and views among diabetic women a retrospective cohort study Midwifery
24(4) pp 471-479
bull TOZIER P 2013 Colostrum Versus Formula Supplentation for Glucose Stabilization in
Newborns of Diabetic Mothers 42(JOGNN The association of Womens Health
Obstetric and Neonatal Nurses) pp 619-628
bull VAN HOWE RS and STORMS MR 2008 Blood glucose determinations in large for
gestational age infants American Journal of Perinatology 25(5) pp 283-289
bull WIGHT N MARINELLI KA and ACADEMY OF BREASTFEEDING MEDICINE
PROTOCOL COMMITTEE 2006 ABM clinical protocol 1 guidelines for glucose
monitoring and treatment of hypoglycemia in breastfed neonates Breastfeeding
medicine the official journal of the Academy of Breastfeeding Medicine 1(3) pp 178-
184
bull VANHALTREN K and MALHOTRA A 2013 Characteristics of infants at risk of
hypoglycaemia secondary to being infant of a diabetic mother Journal of pediatric
endocrinology amp metabolism JPEM 26(9-10) pp 861-865
bull WIGHT NE 2014 Hypoglycemia in breastfed neonates Breastfeeding medicine the
official journal of the Academy of Breastfeeding Medicine 9(4) pp 173-179
bull DALSGAARD B and ECK K 2013-last update Klinisk retningslinje for
nonfarmakologisk forebyggelse af neonatal hypoglycaeligmi og energitab hos nyfoslashdte af
moslashdre med diaeligtbehandlet gestationel diabetes Available
httpwwwkliniskeretningslinjerdkimages88_gdm_godkendt_010713pdf [0917 2014]
hypoglycaeligmibull
bull BRAGG JJ GREEN R and HOLZMAN IR 2013 Does early enteral feeding prevent
hypoglycemia in small for gestational age neonates Journal of neonatal-perinatal medicine 6(2)
pp 131-135
bull HARRIS DL WESTON PJ and HARDING JE 2014 Lactate rather than ketones may provide
alternative cerebral fuel in hypoglycaemic newborns Archives of disease in childhoodFetal and
neonatal edition
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull LANG TF and HUSSAIN K 2014 Pediatric hypoglycemia Advances in Clinical Chemistry 63
pp 211-245
bull MITANCHEZ D BURGUET A and SIMEONI U 2014 Infants born to mothers with gestational
diabetes mellitus mild neonatal effects a long-term threat to global health The Journal of pediatrics
164(3) pp 445-450
bull SUNDERCOMBE SL RAYNES-GREENOW CH TURNER RM and JEFFERY HE 2014 Do
neonatal hypoglycaemia guidelines in Australia and New Zealand facilitate breast feeding
Midwifery 30(12) pp 1179-1186
bull TAM EW HAEUSSLEIN LA BONIFACIO SL GLASS HC ROGERS EE JEREMY RJ
BARKOVICH AJ and FERRIERO DM 2012 Hypoglycemia is associated with increased risk for
brain injury and adverse neurodevelopmental outcome in neonates at risk for encephalopathy The
Journal of pediatrics 161(1) pp 88-93
bull UNICEF 2013 hypoglycaemia guidance july 2013 UNICEF
Kilder tilfoslashjet 2016
bull AGHDAS K TALAT K and SEPIDEH B 2014 Effect of immediate and continuous mother-infant
skin-to-skin contact on breastfeeding self-efficacy of primiparous women a randomised control trial
Women and birth journal of the Australian College of Midwives 27(1) pp 37-40
bull BEIRANVAND S VALIZADEH F HOSSEINABADI R and POURNIA Y 2014 The Effects of
Skin-to-Skin Contact on Temperature and Breastfeeding Successfulness in Full-Term Newborns
after Cesarean Delivery International journal of pediatrics 2014 pp 846486
bull FENGER-GRON J FENGER-GRON M BLUNCK CH SCHONEMANN-RIGEL H and
WIELANDT HB 2015 Low breastfeeding rates and body mass index in Danish children of women
with gestational diabetes mellitus International breastfeeding journal 10 pp 26-015-0051-8
eCollection 2015
bull JAGIELLO KP and AZULAY CHERTOK IR 2015 Womens Experiences With Early
Breastfeeding After Gestational Diabetes Journal of obstetric gynecologic and neonatal nursing
JOGNN NAACOG 44(4) pp 500-509
bull SAMAYAM P RANGANATHAN PK KOTARI UD and BALASUNDARAM R 2015 Study of
Asymptomatic Hypoglycemia in Full Term Exclusively Breastfed Neonates in First 48 Hours of Life
Journal of clinical and diagnostic research JCDR 9(9) pp SC07-10
bull SOBREVIA L SALSOSO R SAEZ T SANHUEZA C PARDO F and LEIVA A 2015 Insulin
therapy and fetoplacental vascular function in gestational diabetes mellitus Experimental physiology
100(3) pp 231-238
bull STEWART CE SAGE EL and REYNOLDS P 2015 Supporting Baby Friendly a quality
improvement initiative for the management of transitional neonatal hypoglycaemia Archives of
disease in childhoodFetal and neonatal edition
bull
Tilfoslashjet slide efter oplaeligg
bull Lokalaftalen er at ligger hud mod hud de foslashrste to timer
og at barnet dier inden overflytning til barselsafdeling
bull Hvis barnet ikke evner at sutte hjaeliglpes mor med
haringndudmalkning og barnet faringr maeliglken med det samme
bull Hvis barnet ikke har suttet inden overflytning bevares hud
mod hud kontakten i overflytningen evt som kaelignguro
opbundet Paring afdelingen hjaeliglpes parret igen med at
etablere amning Hvis barnet ikke sutter udmalkes mindst
hver 3 time og barnet faringr maeliglken med det samme
bull Der opfordres til kontinuerlig hud mod hud
BD 12516
GDM kvalitetsstudie 2009-14
Samlet vurdering de foslashrste 4 timer
bull Kun 11 har bs lt 25
mmoll mod 23 foslashr
bull Blodsukker 1tpp fra de
retrospektive forloslashb er
IKKE medtaget da vi ved
at dette blodsukker er
fysiologisk lavt og derfor
ikke goslashr andet i dette
tilfaeliglde end at oslashge
antallet af boslashrn med
hypoglycaeligmi foslashr til 38
Grundlag Retrospektivt 141 boslashrn
Prospektivt 417 boslashrn
Amning
bull En oslashgning paring 77
flere amninger paring de
foslashrste 6 timer er en
signifikant forbedring
bull Dermed har boslashrnene
formentlig indtaget
vaeligsentlig mere raringmaeliglk
end boslashrnene foslashr
aeligndringen
Amning de foslashrste to timer efter foslashdslen
Neonatal Hypoglycaeligmi
Oplaeliggget er baseret paring viden om
nyfoslashdte ge 35deg Praeligmature derunder har
jeg ingen forudsaeligtninger for at tale om
Det vides ikke
hvor kort eller
lang en
tidsperiode med et
lavere blodsukker
skal vaeligre foslashr det
giver foslashlger
Det vides ikke
hvilket
blodsukkerniveau
der er mest sikkert
Det vides ikke
hvor graelignsen
garingr mellem
skade ikke-
skade
Vi er alle
bange for at et
barn faringr
senfoslashlger efter
hypoglycaeligmi
Burns Patterns of cerebral injury and
neurodevelopmental outcomes after symptomatic neonatal
hypoglycemia Pediatrics 2008
bull Alle var symptomatiske ge 37deg 61 havde kramper
bull Median bs paring 10 mmoll 86 havde
bs le15 mmoll 1 el flere gange flest 1 doslashgn
bull Alle havde neurologisk dysfunktion indenfor 1 uge
bull 40 IUGR (flest asymmetriske)
bull Overvaeliggt af moslashdre med DM eller hypertension
bull Akut sectio pga barnet
18 mdr boslashrn med forbigaringende tidlig hypoglycaeligmi eller ingen kramper udviklede
sig normalt trods WM-skade undtaget 1 barn
Win Tin 2014 566 praeligmature 47 laeligngerevarende svaeligr hypoglycaeligmi
bull Samme udvikling som parrede kontrolboslashrn hhv 2 og 15 aringr efter
Hypoglykaeligmi kohorte
bull 404 boslashrn i risiko for hypoglykaeligmi foslashlges i 2 aringr 53
havde bs lt 26 mmoll
bull Standard glucosemaringling og kontinuerlig skjult glucose
maringling i de foslashrste 48 timer eller til stabilt blodsukker
bull Overraskende var der 23 der havde lavt blodsukker
uden at det blev opdaget
Udvikling ved 24 maringneder
bull Ingen signifikant forskel i neurologisk udvikling eller
problemloslashsningsevne
bull Det ses dog at boslashrn der laring hoslashjt i bs (gt4) de foslashrste 12 timer
efter et bs-fald fik laveste score i neurologisk udvikling
bull Det tyder paring at et stabilt middel blodsukker er maringletMcKinlay 2015
Normale boslashrn
bull Glucose er eacuten af mange energikilder
for det nyfoslashdte barn
bull Hoseth 2000 laveste blodsukker 14
mmoll 1 time efter foslashdslen median 31
mmol l (14 til 53)
bull Hapo studiet 2010 Mean 32 mmol plusmn
09
Normale hjaeliglpesystemer
bull Ketogenese Normale nyfoslashdte har en
optil 40 x kapacitet af en voksen til at
starte ketogenese som skaffer energi
til barnet
bull Laktat betragtes som rdquoskurkrdquo men er
ogsaring en stor energi kilde da 2 x lactat
= glucose
Processer og tilfoslashrsel via colostrum
bull Glycogenolyse = omdannelse af glycogen
bull Gluconeogenese = nydannelse af glucose
bull Lipolyse = omdannelse af fedt til frie fedtsyrer
bull Ketogenese = udnyttelse af frie fedtsyrer til energi
Colostrum indeholder
bull Oligosaccharider Laktat laktose
bull Fedtsyrer monoumaeligttet fedt fedtmolekyler er store
energitaeligtte og medbringer selv lipase
bull Aminosyrer og proteiner
bull Vaeligkstfaktorer til hurtig transport af naeligringsstoffer
HYPOGLYCAEligMI
Alternative tilgange
bull Neonatal Hypoglycaeligmi er ikke en egentlig diagnose men en
beskrivelse af en tilstand
bull En tilstand hvor barnets metaboliske tilpasningsevne er reduceret og
DERFOR faringr hypoglycaeligmi
bull Alle nyfoslashdte har en back-up plan i form af alternative energikilder nogle boslashrn dog i
reduceret grad og DE er i risiko for hypoglycaeligmiCornblathM HawdonJM
Controversies regarding definition of neonatal hypoglycemia
suggested operational thresholds Pediatrics 2000 105 5 1141-1145
Der sker rigtig meget lige nu paring det laeliggefaglige omraringde (Win Tin 2014) Nye
forslag er at
bull asymptomatiske boslashrn er hypoglycaeligmiske med et bs lt 20 ogsaring ved naeligste
maringling altsaring over laeligngere tid og ikke kun eacuten vaeligrdi
bull Der maring kun vaeligre eacuten maringling lt 10 behandles straks
bull Ved symptomer skal der ogsaring reageres med det samme v bslt 25
Deacutet er laeliggefaglige beslutninger som vi maringske faringr at se
Hvem er Risikoboslashrn
Halvdelen af boslashrnene i Sugar Baby study
udaf 514 risikoboslashrn havde
51 bs lt 26 20 lt 20
Fordelingen i grupperne er helt ens
bull 79 var asymptomatiske
bull 15 var for traeligtte til at sutte
bull 7 sitrede
Incidence of Neonatal Hypoglycemia in Babies Identified as at Risk
Deborah L Harris
2012 J of Pediatrics
Burde vi taelignke Hvad
er dette barns
specifikke evne til
metabolisk tilpasning
efter foslashdslen og
hvordan stoslashtter vi
barnet bedst paring
naturlig vis i denne
proces og stadig
forebygger skade
Saeligrlige risikoboslashrn
bull IUGR boslashrn kan vaeligre meget uforudsigelige Deres
pancreas kan vaeligre overaktiv og dermed udsende for
meget insulin og pancreas kan vaeligre haeligmmet
bull Saeligrlig de boslashrn der er asymmetriske i deres vaeligkst
Soslashgning af litteratur
En hurtig PubMed soslashgning giver foslashlgende
1Neonatal hypoglycemia 2404
2Breastfeeding 36873
3Colostrum 7435
1+2 70
1+3 3
Early feeding
bull Der er ingen enighed om definition paring Early Feeding
bull Hawdon rdquofoslashrhen sendte boslashrnene hurtigt maeliglken tilbage til den velmenende
afsenderrdquo
bull Early Feeding kan vaeligre tidlig hyppig amning sukkervand modermaeliglk
erstatning dextrosegel Maeligngde
bull Udover amning er der mange modeller og ingen af dem er evidensbaserede
bull I 2015-16 kommer der stadig artikler om neonatal hypoglycaeligmi der ikke
skriver om ernaeligring overhovedet
Modermaeliglkserstatning og hjaeliglpestoffer
De Rooyrsquos studie fra 2002 viser
bull I et prospektivt studie med i alt 165 boslashrn blev boslashrnenes ketogenese
undersoslashgt
bull Deacuten gruppe der er taeligttest paring en af vores maringlgrupper GDM er Large
for Gestational Age boslashrnene Her paringvises det med signifikant forskel
at amning oslashger ketogenesen og at amning + modermaeliglkserstatning
ikke har saring god respons
bull Flaskeboslashrn danner stort set ikke ketonstoffer i starten foslashrst efter 12
timer
Det kan antyde at mme reducerer barnets evne til
modregulering og selvhjaeliglp
At mme har bivirkningersideeffekter der bestemt ikke
er hensigtsmaeligssige naringr vi taler om forebyggelse
Guidelines hvor er vi
Unicef 2013
bull Alle hud mod hud lige efter foslashdslen
bull Amning indenfor den foslashrste time
bull Foslashrste bs tidligst efter 2 timer og foslashr andet maringltid
bull Ved lavt bs (graelignse 26 el 20) ammes igen eller udmalket maeliglk Ved
fortsat lavt bs efter 1 time gives mme i de maeligngder vi kender
Survey af neonatale hypoglykaeligmi guidelines i Australien og New
Zealand vha Unicef(Sundercombe 2014)
bull Kun 9 ud af 22 naeligvner hud mod hud lige efter foslashdslen
bull Kun enkelte naeligvner hjaeliglp til effektiv amning og information om tegn
paring spiselyst
bull Mere end halvdelen anbefaler supplering med mors udmalkede maeliglk
bull Kun 8 ud af 22 sikrer sig samtykke foslashr mme og info til foraeligldre om
aringrsag til suppleringen
Unicef hypoglycemia 2013
Forebyggelse i ammeperspektiv og Baby Friendly
Normoglycaeligmisk tilstand boslashr opnaringes med mindst mulig intervention
Konventionel tilgang
bull 60 mlkgdoslashgn mm el mme oslashges med
20 mlkgdoslashgn x 8(-12)
bull Vallecasein 4060 mme = nedsat
ventrikeltoslashmning
bull Vi maringler stadig 1 t bs
bull Ved lav bs oslashges til 125 eller 150
af maeligngden
bull Glucose-infusion
bull Adskillelse af mor og barn
Individuel tilgangABM Protocol 2014
bull 1-3 mlkg (optil 5 mlkg) gerne hver 2 time
(3-5 mlkg i 2006-udgaven)
bull Hurtig passage af mm alle hjaeliglpestoffer er
med Vallecasein 9010
Bergmann
bull mavesaeligkkens stoslashrrelse lige foslashr foslashdslen
drikker barnet ca 10 ml gang Refererer til
studier der angiver ventiklen til hhv 10 12
15 20 ml
bull Anbefaler smaring hyppige amninger
suppleringer saring barnet ikke stresses og
bruger mere glucose end det tilfoslashres
bull Ward-Platt Laktat er rdquothe good guyrdquo og et
veloxideret velcirkuleret barn har alle
muligheder for at kompensere
bull Antenatal udmalkning af raringmaeliglk til DM-
boslashrn
Forskellen i et forloslashb
DPS
3000 gram
bull 180 ml 1 doslashgn
(60kgdoslashgn)
bull bsdarr oslashges til 225 ml 24
timer
Svaeligrt at faring udmalket dette
som ekstra
ABM
3000 gram
bull 36 ml foslashrste doslashgn
1 mlkg maringltid = 3 x 12
bull 108 ml v 3 ml kgmaringltid
(reduktion paring 40 )
Opnaringeligt at udmalke dette
som ekstra
Mon der er forskel paring
antal amninger
Haringndudmalkning korrektinkorrekt
bull httpswwwyoutubecomwatchv=k6V9xTZAWq0
24
Hvordan forholder vi os til dette
bull Vi kan ikke aeligndre instrukser for hypoglycaeligmi haringndtering det
er en laeliggefaglig opgave kan vi alligevel goslashre en forskel i
profylaktisk oslashjemed
bull Har vi et ansvar for at vaeligre kritiske overfor gamle strategier
ndash og dermed assistere paeligdiatere i forebyggelsesarbejdet
bull Hvordan kan vi balancere forebyggelse og ikke-skade
princippet naringr det ogsaring drejer sig om naturlig ernaeligring mor-
barn kontakt og medicinske interventioner
bull Kan vi med vores viden om colostrum og naturlige
processers effekt aeligndre praksis for disse boslashrn
bull Hvordan kan vi som sundhedsprofessionelle oslashge antallet af
risikoboslashrn der tidligt faringr mors maeliglk selv om det ikke sutter
bull Hvordan vil det aeligndre vores praksisarbejde
bull Hvordan klaeligdes novicen og vi paring til en rdquoWatch and Waitrdquo
tilgang til hypoglycaeligmiforebyggelse
bull POCT eller lab-svar
Mon ikke hypoglycaeligmi forebyggelse kvalitativt kan
komme videre end i 2014
Tak fordi I lyttede
referencerbull CHERTOK IR RAZ I SHOHAM I HADDAD H and WIZNITZER A 2009 Journal of human
nutrition and dietetics the official journal of the British Dietetic Association 22(2) pp 166-169
bull CHRISTESEN HT and ESBERG G 2014-last update Hypoglykaeligmi flowcharts DPS Available
httpvipregionhdkVIPRedaktoer151637nsfvLookupUploadATTACH-RHAP-
9K2D8Y$FILEHypoglykC3A6mi20-20neonatal20Flowcharts20Maj202014pdf [0916
2014]
bull CORDERO L TREUER SH LANDON MB and GABBE SG 1998 Management of infants of
diabetic mothers Archives of Pediatrics amp Adolescent Medicine 152(3) pp 249-254
bull CORNBLATH M HAWDON JM WILLIAMS AF AYNSLEY-GREEN A WARD-PLATT MP
SCHWARTZ R and KALHAN SC 2000 Controversies regarding definition of neonatal
hypoglycemia suggested operational thresholds Pediatrics 105(5) pp 1141-1145
bull CSONT GL GROTH S HOPKINS P and GUILLET R 2014 An evidence-based approach to
breastfeeding neonates at risk for hypoglycemia Journal of obstetric gynecologic and neonatal
nursing JOGNN NAACOG 43(1) pp 71-81
bull DE ROOY L and HAWDON J 2002 Nutritional factors that affect the postnatal metabolic
adaptation of full-term small- and large-for-gestational-age infants Pediatrics 109(3) pp E42
bull DOBSON LZ VIBEKE 2011 God blodsukkerregulering kun for barnets skyld 25(nr 4) pp 36--
47
bull FLORES-LE ROUX JA SAGARRA E BENAIGES D HERNANDEZ-RIVAS E CHILLARON
JJ PUIG DE DOU J MUR A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2012 A
prospective evaluation of neonatal hypoglycaemia in infants of women with gestational diabetes
mellitus Diabetes research and clinical practice 97(2) pp 217-222
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull HARRIS DL WESTON PJ SIGNAL M CHASE JG and HARDING JE 2013 Dextrose gel for neonatal
hypoglycaemia (the Sugar Babies Study) a randomised double-blind placebo-controlled trial Lancet (London
England) 382(9910) pp 2077-2083
bull HERNANDEZ-RIVAS E FLORES-LE ROUX JA BENAIGES D SAGARRA E CHILLARON JJ PAYA A
PUIG-DE DOU J GODAY A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2013 Gestational diabetes in a
multiethnic population of Spain clinical characteristics and perinatal outcomes Diabetes research and clinical
practice 100(2) pp 215-221
bull HOSETH E JOERGENSEN A EBBESEN F and MOELLER M 2000 Blood glucose levels in a population of
healthy breast fed term infants of appropriate size for gestational age Archives of disease in childhoodFetal and
neonatal edition 83(2) pp F117-9
bull JENSEN DM SORENSEN B FEILBERG-JORGENSEN N WESTERGAARD JG and BECK-NIELSEN H
2000 Maternal and perinatal outcomes in 143 Danish women with gestational diabetes mellitus and 143 controls with
a similar risk profile Diabetic medicine a journal of the British Diabetic Association 17(4) pp 281-286
bull MAAYAN-METZGER A LUBIN D and KUINT J 2009 Hypoglycemia rates in the first days of life among term
infants born to diabetic mothers Neonatology 96(2) pp 80-85
bull MAAYAN-METZGER A SCHUSHAN-EISEN I LUBIN D MORAN O KUINT J and MAZKERETH R 2014
Delivery room breastfeeding for prevention of hypoglycaemia in infants of diabetic mothers Fetal and pediatric
pathology 33(1) pp 23-28
bull MCKINLAY CEA 2015 neonatal hypoglycemia and neurodevelopment outcomes at 2 years N Engl J Med(373)
pp 1507-18
bull METZGER BE PERSSON B LOWE LP DYER AR CRUICKSHANK JK DEEROCHANAWONG C
HALLIDAY HL HENNIS AJ LILEY H NG PC COUSTAN DR HADDEN DR HOD M OATS JJ
TRIMBLE ER and HAPO STUDY COOPERATIVE RESEARCH GROUP 2010 Hyperglycemia and adverse
pregnancy outcome study neonatal glycemia Pediatrics 126(6) pp e1545-52
bull ROZANCE PJ and HAY WWJR 2012 Neonatal hypoglycemia--answers but more questions The Journal of
pediatrics 161(5) pp 775-776
bull SARKAR S WATMAN J SEIGEL WM and SCHAEFFER HA 2003 A prospective controlled study of neonatal
morbidities in infants born at 36 weeks or more gestation to Women with diet-controlled gestational diabetes (GDM-
class Al) Journal of perinatology official journal of the California Perinatal Association 23(3) pp 223-228
bull SOLTANI H DICKINSON FM KALK J and PAYNE K 2008 Breast feeding
practices and views among diabetic women a retrospective cohort study Midwifery
24(4) pp 471-479
bull TOZIER P 2013 Colostrum Versus Formula Supplentation for Glucose Stabilization in
Newborns of Diabetic Mothers 42(JOGNN The association of Womens Health
Obstetric and Neonatal Nurses) pp 619-628
bull VAN HOWE RS and STORMS MR 2008 Blood glucose determinations in large for
gestational age infants American Journal of Perinatology 25(5) pp 283-289
bull WIGHT N MARINELLI KA and ACADEMY OF BREASTFEEDING MEDICINE
PROTOCOL COMMITTEE 2006 ABM clinical protocol 1 guidelines for glucose
monitoring and treatment of hypoglycemia in breastfed neonates Breastfeeding
medicine the official journal of the Academy of Breastfeeding Medicine 1(3) pp 178-
184
bull VANHALTREN K and MALHOTRA A 2013 Characteristics of infants at risk of
hypoglycaemia secondary to being infant of a diabetic mother Journal of pediatric
endocrinology amp metabolism JPEM 26(9-10) pp 861-865
bull WIGHT NE 2014 Hypoglycemia in breastfed neonates Breastfeeding medicine the
official journal of the Academy of Breastfeeding Medicine 9(4) pp 173-179
bull DALSGAARD B and ECK K 2013-last update Klinisk retningslinje for
nonfarmakologisk forebyggelse af neonatal hypoglycaeligmi og energitab hos nyfoslashdte af
moslashdre med diaeligtbehandlet gestationel diabetes Available
httpwwwkliniskeretningslinjerdkimages88_gdm_godkendt_010713pdf [0917 2014]
hypoglycaeligmibull
bull BRAGG JJ GREEN R and HOLZMAN IR 2013 Does early enteral feeding prevent
hypoglycemia in small for gestational age neonates Journal of neonatal-perinatal medicine 6(2)
pp 131-135
bull HARRIS DL WESTON PJ and HARDING JE 2014 Lactate rather than ketones may provide
alternative cerebral fuel in hypoglycaemic newborns Archives of disease in childhoodFetal and
neonatal edition
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull LANG TF and HUSSAIN K 2014 Pediatric hypoglycemia Advances in Clinical Chemistry 63
pp 211-245
bull MITANCHEZ D BURGUET A and SIMEONI U 2014 Infants born to mothers with gestational
diabetes mellitus mild neonatal effects a long-term threat to global health The Journal of pediatrics
164(3) pp 445-450
bull SUNDERCOMBE SL RAYNES-GREENOW CH TURNER RM and JEFFERY HE 2014 Do
neonatal hypoglycaemia guidelines in Australia and New Zealand facilitate breast feeding
Midwifery 30(12) pp 1179-1186
bull TAM EW HAEUSSLEIN LA BONIFACIO SL GLASS HC ROGERS EE JEREMY RJ
BARKOVICH AJ and FERRIERO DM 2012 Hypoglycemia is associated with increased risk for
brain injury and adverse neurodevelopmental outcome in neonates at risk for encephalopathy The
Journal of pediatrics 161(1) pp 88-93
bull UNICEF 2013 hypoglycaemia guidance july 2013 UNICEF
Kilder tilfoslashjet 2016
bull AGHDAS K TALAT K and SEPIDEH B 2014 Effect of immediate and continuous mother-infant
skin-to-skin contact on breastfeeding self-efficacy of primiparous women a randomised control trial
Women and birth journal of the Australian College of Midwives 27(1) pp 37-40
bull BEIRANVAND S VALIZADEH F HOSSEINABADI R and POURNIA Y 2014 The Effects of
Skin-to-Skin Contact on Temperature and Breastfeeding Successfulness in Full-Term Newborns
after Cesarean Delivery International journal of pediatrics 2014 pp 846486
bull FENGER-GRON J FENGER-GRON M BLUNCK CH SCHONEMANN-RIGEL H and
WIELANDT HB 2015 Low breastfeeding rates and body mass index in Danish children of women
with gestational diabetes mellitus International breastfeeding journal 10 pp 26-015-0051-8
eCollection 2015
bull JAGIELLO KP and AZULAY CHERTOK IR 2015 Womens Experiences With Early
Breastfeeding After Gestational Diabetes Journal of obstetric gynecologic and neonatal nursing
JOGNN NAACOG 44(4) pp 500-509
bull SAMAYAM P RANGANATHAN PK KOTARI UD and BALASUNDARAM R 2015 Study of
Asymptomatic Hypoglycemia in Full Term Exclusively Breastfed Neonates in First 48 Hours of Life
Journal of clinical and diagnostic research JCDR 9(9) pp SC07-10
bull SOBREVIA L SALSOSO R SAEZ T SANHUEZA C PARDO F and LEIVA A 2015 Insulin
therapy and fetoplacental vascular function in gestational diabetes mellitus Experimental physiology
100(3) pp 231-238
bull STEWART CE SAGE EL and REYNOLDS P 2015 Supporting Baby Friendly a quality
improvement initiative for the management of transitional neonatal hypoglycaemia Archives of
disease in childhoodFetal and neonatal edition
bull
GDM kvalitetsstudie 2009-14
Samlet vurdering de foslashrste 4 timer
bull Kun 11 har bs lt 25
mmoll mod 23 foslashr
bull Blodsukker 1tpp fra de
retrospektive forloslashb er
IKKE medtaget da vi ved
at dette blodsukker er
fysiologisk lavt og derfor
ikke goslashr andet i dette
tilfaeliglde end at oslashge
antallet af boslashrn med
hypoglycaeligmi foslashr til 38
Grundlag Retrospektivt 141 boslashrn
Prospektivt 417 boslashrn
Amning
bull En oslashgning paring 77
flere amninger paring de
foslashrste 6 timer er en
signifikant forbedring
bull Dermed har boslashrnene
formentlig indtaget
vaeligsentlig mere raringmaeliglk
end boslashrnene foslashr
aeligndringen
Amning de foslashrste to timer efter foslashdslen
Neonatal Hypoglycaeligmi
Oplaeliggget er baseret paring viden om
nyfoslashdte ge 35deg Praeligmature derunder har
jeg ingen forudsaeligtninger for at tale om
Det vides ikke
hvor kort eller
lang en
tidsperiode med et
lavere blodsukker
skal vaeligre foslashr det
giver foslashlger
Det vides ikke
hvilket
blodsukkerniveau
der er mest sikkert
Det vides ikke
hvor graelignsen
garingr mellem
skade ikke-
skade
Vi er alle
bange for at et
barn faringr
senfoslashlger efter
hypoglycaeligmi
Burns Patterns of cerebral injury and
neurodevelopmental outcomes after symptomatic neonatal
hypoglycemia Pediatrics 2008
bull Alle var symptomatiske ge 37deg 61 havde kramper
bull Median bs paring 10 mmoll 86 havde
bs le15 mmoll 1 el flere gange flest 1 doslashgn
bull Alle havde neurologisk dysfunktion indenfor 1 uge
bull 40 IUGR (flest asymmetriske)
bull Overvaeliggt af moslashdre med DM eller hypertension
bull Akut sectio pga barnet
18 mdr boslashrn med forbigaringende tidlig hypoglycaeligmi eller ingen kramper udviklede
sig normalt trods WM-skade undtaget 1 barn
Win Tin 2014 566 praeligmature 47 laeligngerevarende svaeligr hypoglycaeligmi
bull Samme udvikling som parrede kontrolboslashrn hhv 2 og 15 aringr efter
Hypoglykaeligmi kohorte
bull 404 boslashrn i risiko for hypoglykaeligmi foslashlges i 2 aringr 53
havde bs lt 26 mmoll
bull Standard glucosemaringling og kontinuerlig skjult glucose
maringling i de foslashrste 48 timer eller til stabilt blodsukker
bull Overraskende var der 23 der havde lavt blodsukker
uden at det blev opdaget
Udvikling ved 24 maringneder
bull Ingen signifikant forskel i neurologisk udvikling eller
problemloslashsningsevne
bull Det ses dog at boslashrn der laring hoslashjt i bs (gt4) de foslashrste 12 timer
efter et bs-fald fik laveste score i neurologisk udvikling
bull Det tyder paring at et stabilt middel blodsukker er maringletMcKinlay 2015
Normale boslashrn
bull Glucose er eacuten af mange energikilder
for det nyfoslashdte barn
bull Hoseth 2000 laveste blodsukker 14
mmoll 1 time efter foslashdslen median 31
mmol l (14 til 53)
bull Hapo studiet 2010 Mean 32 mmol plusmn
09
Normale hjaeliglpesystemer
bull Ketogenese Normale nyfoslashdte har en
optil 40 x kapacitet af en voksen til at
starte ketogenese som skaffer energi
til barnet
bull Laktat betragtes som rdquoskurkrdquo men er
ogsaring en stor energi kilde da 2 x lactat
= glucose
Processer og tilfoslashrsel via colostrum
bull Glycogenolyse = omdannelse af glycogen
bull Gluconeogenese = nydannelse af glucose
bull Lipolyse = omdannelse af fedt til frie fedtsyrer
bull Ketogenese = udnyttelse af frie fedtsyrer til energi
Colostrum indeholder
bull Oligosaccharider Laktat laktose
bull Fedtsyrer monoumaeligttet fedt fedtmolekyler er store
energitaeligtte og medbringer selv lipase
bull Aminosyrer og proteiner
bull Vaeligkstfaktorer til hurtig transport af naeligringsstoffer
HYPOGLYCAEligMI
Alternative tilgange
bull Neonatal Hypoglycaeligmi er ikke en egentlig diagnose men en
beskrivelse af en tilstand
bull En tilstand hvor barnets metaboliske tilpasningsevne er reduceret og
DERFOR faringr hypoglycaeligmi
bull Alle nyfoslashdte har en back-up plan i form af alternative energikilder nogle boslashrn dog i
reduceret grad og DE er i risiko for hypoglycaeligmiCornblathM HawdonJM
Controversies regarding definition of neonatal hypoglycemia
suggested operational thresholds Pediatrics 2000 105 5 1141-1145
Der sker rigtig meget lige nu paring det laeliggefaglige omraringde (Win Tin 2014) Nye
forslag er at
bull asymptomatiske boslashrn er hypoglycaeligmiske med et bs lt 20 ogsaring ved naeligste
maringling altsaring over laeligngere tid og ikke kun eacuten vaeligrdi
bull Der maring kun vaeligre eacuten maringling lt 10 behandles straks
bull Ved symptomer skal der ogsaring reageres med det samme v bslt 25
Deacutet er laeliggefaglige beslutninger som vi maringske faringr at se
Hvem er Risikoboslashrn
Halvdelen af boslashrnene i Sugar Baby study
udaf 514 risikoboslashrn havde
51 bs lt 26 20 lt 20
Fordelingen i grupperne er helt ens
bull 79 var asymptomatiske
bull 15 var for traeligtte til at sutte
bull 7 sitrede
Incidence of Neonatal Hypoglycemia in Babies Identified as at Risk
Deborah L Harris
2012 J of Pediatrics
Burde vi taelignke Hvad
er dette barns
specifikke evne til
metabolisk tilpasning
efter foslashdslen og
hvordan stoslashtter vi
barnet bedst paring
naturlig vis i denne
proces og stadig
forebygger skade
Saeligrlige risikoboslashrn
bull IUGR boslashrn kan vaeligre meget uforudsigelige Deres
pancreas kan vaeligre overaktiv og dermed udsende for
meget insulin og pancreas kan vaeligre haeligmmet
bull Saeligrlig de boslashrn der er asymmetriske i deres vaeligkst
Soslashgning af litteratur
En hurtig PubMed soslashgning giver foslashlgende
1Neonatal hypoglycemia 2404
2Breastfeeding 36873
3Colostrum 7435
1+2 70
1+3 3
Early feeding
bull Der er ingen enighed om definition paring Early Feeding
bull Hawdon rdquofoslashrhen sendte boslashrnene hurtigt maeliglken tilbage til den velmenende
afsenderrdquo
bull Early Feeding kan vaeligre tidlig hyppig amning sukkervand modermaeliglk
erstatning dextrosegel Maeligngde
bull Udover amning er der mange modeller og ingen af dem er evidensbaserede
bull I 2015-16 kommer der stadig artikler om neonatal hypoglycaeligmi der ikke
skriver om ernaeligring overhovedet
Modermaeliglkserstatning og hjaeliglpestoffer
De Rooyrsquos studie fra 2002 viser
bull I et prospektivt studie med i alt 165 boslashrn blev boslashrnenes ketogenese
undersoslashgt
bull Deacuten gruppe der er taeligttest paring en af vores maringlgrupper GDM er Large
for Gestational Age boslashrnene Her paringvises det med signifikant forskel
at amning oslashger ketogenesen og at amning + modermaeliglkserstatning
ikke har saring god respons
bull Flaskeboslashrn danner stort set ikke ketonstoffer i starten foslashrst efter 12
timer
Det kan antyde at mme reducerer barnets evne til
modregulering og selvhjaeliglp
At mme har bivirkningersideeffekter der bestemt ikke
er hensigtsmaeligssige naringr vi taler om forebyggelse
Guidelines hvor er vi
Unicef 2013
bull Alle hud mod hud lige efter foslashdslen
bull Amning indenfor den foslashrste time
bull Foslashrste bs tidligst efter 2 timer og foslashr andet maringltid
bull Ved lavt bs (graelignse 26 el 20) ammes igen eller udmalket maeliglk Ved
fortsat lavt bs efter 1 time gives mme i de maeligngder vi kender
Survey af neonatale hypoglykaeligmi guidelines i Australien og New
Zealand vha Unicef(Sundercombe 2014)
bull Kun 9 ud af 22 naeligvner hud mod hud lige efter foslashdslen
bull Kun enkelte naeligvner hjaeliglp til effektiv amning og information om tegn
paring spiselyst
bull Mere end halvdelen anbefaler supplering med mors udmalkede maeliglk
bull Kun 8 ud af 22 sikrer sig samtykke foslashr mme og info til foraeligldre om
aringrsag til suppleringen
Unicef hypoglycemia 2013
Forebyggelse i ammeperspektiv og Baby Friendly
Normoglycaeligmisk tilstand boslashr opnaringes med mindst mulig intervention
Konventionel tilgang
bull 60 mlkgdoslashgn mm el mme oslashges med
20 mlkgdoslashgn x 8(-12)
bull Vallecasein 4060 mme = nedsat
ventrikeltoslashmning
bull Vi maringler stadig 1 t bs
bull Ved lav bs oslashges til 125 eller 150
af maeligngden
bull Glucose-infusion
bull Adskillelse af mor og barn
Individuel tilgangABM Protocol 2014
bull 1-3 mlkg (optil 5 mlkg) gerne hver 2 time
(3-5 mlkg i 2006-udgaven)
bull Hurtig passage af mm alle hjaeliglpestoffer er
med Vallecasein 9010
Bergmann
bull mavesaeligkkens stoslashrrelse lige foslashr foslashdslen
drikker barnet ca 10 ml gang Refererer til
studier der angiver ventiklen til hhv 10 12
15 20 ml
bull Anbefaler smaring hyppige amninger
suppleringer saring barnet ikke stresses og
bruger mere glucose end det tilfoslashres
bull Ward-Platt Laktat er rdquothe good guyrdquo og et
veloxideret velcirkuleret barn har alle
muligheder for at kompensere
bull Antenatal udmalkning af raringmaeliglk til DM-
boslashrn
Forskellen i et forloslashb
DPS
3000 gram
bull 180 ml 1 doslashgn
(60kgdoslashgn)
bull bsdarr oslashges til 225 ml 24
timer
Svaeligrt at faring udmalket dette
som ekstra
ABM
3000 gram
bull 36 ml foslashrste doslashgn
1 mlkg maringltid = 3 x 12
bull 108 ml v 3 ml kgmaringltid
(reduktion paring 40 )
Opnaringeligt at udmalke dette
som ekstra
Mon der er forskel paring
antal amninger
Haringndudmalkning korrektinkorrekt
bull httpswwwyoutubecomwatchv=k6V9xTZAWq0
24
Hvordan forholder vi os til dette
bull Vi kan ikke aeligndre instrukser for hypoglycaeligmi haringndtering det
er en laeliggefaglig opgave kan vi alligevel goslashre en forskel i
profylaktisk oslashjemed
bull Har vi et ansvar for at vaeligre kritiske overfor gamle strategier
ndash og dermed assistere paeligdiatere i forebyggelsesarbejdet
bull Hvordan kan vi balancere forebyggelse og ikke-skade
princippet naringr det ogsaring drejer sig om naturlig ernaeligring mor-
barn kontakt og medicinske interventioner
bull Kan vi med vores viden om colostrum og naturlige
processers effekt aeligndre praksis for disse boslashrn
bull Hvordan kan vi som sundhedsprofessionelle oslashge antallet af
risikoboslashrn der tidligt faringr mors maeliglk selv om det ikke sutter
bull Hvordan vil det aeligndre vores praksisarbejde
bull Hvordan klaeligdes novicen og vi paring til en rdquoWatch and Waitrdquo
tilgang til hypoglycaeligmiforebyggelse
bull POCT eller lab-svar
Mon ikke hypoglycaeligmi forebyggelse kvalitativt kan
komme videre end i 2014
Tak fordi I lyttede
referencerbull CHERTOK IR RAZ I SHOHAM I HADDAD H and WIZNITZER A 2009 Journal of human
nutrition and dietetics the official journal of the British Dietetic Association 22(2) pp 166-169
bull CHRISTESEN HT and ESBERG G 2014-last update Hypoglykaeligmi flowcharts DPS Available
httpvipregionhdkVIPRedaktoer151637nsfvLookupUploadATTACH-RHAP-
9K2D8Y$FILEHypoglykC3A6mi20-20neonatal20Flowcharts20Maj202014pdf [0916
2014]
bull CORDERO L TREUER SH LANDON MB and GABBE SG 1998 Management of infants of
diabetic mothers Archives of Pediatrics amp Adolescent Medicine 152(3) pp 249-254
bull CORNBLATH M HAWDON JM WILLIAMS AF AYNSLEY-GREEN A WARD-PLATT MP
SCHWARTZ R and KALHAN SC 2000 Controversies regarding definition of neonatal
hypoglycemia suggested operational thresholds Pediatrics 105(5) pp 1141-1145
bull CSONT GL GROTH S HOPKINS P and GUILLET R 2014 An evidence-based approach to
breastfeeding neonates at risk for hypoglycemia Journal of obstetric gynecologic and neonatal
nursing JOGNN NAACOG 43(1) pp 71-81
bull DE ROOY L and HAWDON J 2002 Nutritional factors that affect the postnatal metabolic
adaptation of full-term small- and large-for-gestational-age infants Pediatrics 109(3) pp E42
bull DOBSON LZ VIBEKE 2011 God blodsukkerregulering kun for barnets skyld 25(nr 4) pp 36--
47
bull FLORES-LE ROUX JA SAGARRA E BENAIGES D HERNANDEZ-RIVAS E CHILLARON
JJ PUIG DE DOU J MUR A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2012 A
prospective evaluation of neonatal hypoglycaemia in infants of women with gestational diabetes
mellitus Diabetes research and clinical practice 97(2) pp 217-222
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull HARRIS DL WESTON PJ SIGNAL M CHASE JG and HARDING JE 2013 Dextrose gel for neonatal
hypoglycaemia (the Sugar Babies Study) a randomised double-blind placebo-controlled trial Lancet (London
England) 382(9910) pp 2077-2083
bull HERNANDEZ-RIVAS E FLORES-LE ROUX JA BENAIGES D SAGARRA E CHILLARON JJ PAYA A
PUIG-DE DOU J GODAY A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2013 Gestational diabetes in a
multiethnic population of Spain clinical characteristics and perinatal outcomes Diabetes research and clinical
practice 100(2) pp 215-221
bull HOSETH E JOERGENSEN A EBBESEN F and MOELLER M 2000 Blood glucose levels in a population of
healthy breast fed term infants of appropriate size for gestational age Archives of disease in childhoodFetal and
neonatal edition 83(2) pp F117-9
bull JENSEN DM SORENSEN B FEILBERG-JORGENSEN N WESTERGAARD JG and BECK-NIELSEN H
2000 Maternal and perinatal outcomes in 143 Danish women with gestational diabetes mellitus and 143 controls with
a similar risk profile Diabetic medicine a journal of the British Diabetic Association 17(4) pp 281-286
bull MAAYAN-METZGER A LUBIN D and KUINT J 2009 Hypoglycemia rates in the first days of life among term
infants born to diabetic mothers Neonatology 96(2) pp 80-85
bull MAAYAN-METZGER A SCHUSHAN-EISEN I LUBIN D MORAN O KUINT J and MAZKERETH R 2014
Delivery room breastfeeding for prevention of hypoglycaemia in infants of diabetic mothers Fetal and pediatric
pathology 33(1) pp 23-28
bull MCKINLAY CEA 2015 neonatal hypoglycemia and neurodevelopment outcomes at 2 years N Engl J Med(373)
pp 1507-18
bull METZGER BE PERSSON B LOWE LP DYER AR CRUICKSHANK JK DEEROCHANAWONG C
HALLIDAY HL HENNIS AJ LILEY H NG PC COUSTAN DR HADDEN DR HOD M OATS JJ
TRIMBLE ER and HAPO STUDY COOPERATIVE RESEARCH GROUP 2010 Hyperglycemia and adverse
pregnancy outcome study neonatal glycemia Pediatrics 126(6) pp e1545-52
bull ROZANCE PJ and HAY WWJR 2012 Neonatal hypoglycemia--answers but more questions The Journal of
pediatrics 161(5) pp 775-776
bull SARKAR S WATMAN J SEIGEL WM and SCHAEFFER HA 2003 A prospective controlled study of neonatal
morbidities in infants born at 36 weeks or more gestation to Women with diet-controlled gestational diabetes (GDM-
class Al) Journal of perinatology official journal of the California Perinatal Association 23(3) pp 223-228
bull SOLTANI H DICKINSON FM KALK J and PAYNE K 2008 Breast feeding
practices and views among diabetic women a retrospective cohort study Midwifery
24(4) pp 471-479
bull TOZIER P 2013 Colostrum Versus Formula Supplentation for Glucose Stabilization in
Newborns of Diabetic Mothers 42(JOGNN The association of Womens Health
Obstetric and Neonatal Nurses) pp 619-628
bull VAN HOWE RS and STORMS MR 2008 Blood glucose determinations in large for
gestational age infants American Journal of Perinatology 25(5) pp 283-289
bull WIGHT N MARINELLI KA and ACADEMY OF BREASTFEEDING MEDICINE
PROTOCOL COMMITTEE 2006 ABM clinical protocol 1 guidelines for glucose
monitoring and treatment of hypoglycemia in breastfed neonates Breastfeeding
medicine the official journal of the Academy of Breastfeeding Medicine 1(3) pp 178-
184
bull VANHALTREN K and MALHOTRA A 2013 Characteristics of infants at risk of
hypoglycaemia secondary to being infant of a diabetic mother Journal of pediatric
endocrinology amp metabolism JPEM 26(9-10) pp 861-865
bull WIGHT NE 2014 Hypoglycemia in breastfed neonates Breastfeeding medicine the
official journal of the Academy of Breastfeeding Medicine 9(4) pp 173-179
bull DALSGAARD B and ECK K 2013-last update Klinisk retningslinje for
nonfarmakologisk forebyggelse af neonatal hypoglycaeligmi og energitab hos nyfoslashdte af
moslashdre med diaeligtbehandlet gestationel diabetes Available
httpwwwkliniskeretningslinjerdkimages88_gdm_godkendt_010713pdf [0917 2014]
hypoglycaeligmibull
bull BRAGG JJ GREEN R and HOLZMAN IR 2013 Does early enteral feeding prevent
hypoglycemia in small for gestational age neonates Journal of neonatal-perinatal medicine 6(2)
pp 131-135
bull HARRIS DL WESTON PJ and HARDING JE 2014 Lactate rather than ketones may provide
alternative cerebral fuel in hypoglycaemic newborns Archives of disease in childhoodFetal and
neonatal edition
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull LANG TF and HUSSAIN K 2014 Pediatric hypoglycemia Advances in Clinical Chemistry 63
pp 211-245
bull MITANCHEZ D BURGUET A and SIMEONI U 2014 Infants born to mothers with gestational
diabetes mellitus mild neonatal effects a long-term threat to global health The Journal of pediatrics
164(3) pp 445-450
bull SUNDERCOMBE SL RAYNES-GREENOW CH TURNER RM and JEFFERY HE 2014 Do
neonatal hypoglycaemia guidelines in Australia and New Zealand facilitate breast feeding
Midwifery 30(12) pp 1179-1186
bull TAM EW HAEUSSLEIN LA BONIFACIO SL GLASS HC ROGERS EE JEREMY RJ
BARKOVICH AJ and FERRIERO DM 2012 Hypoglycemia is associated with increased risk for
brain injury and adverse neurodevelopmental outcome in neonates at risk for encephalopathy The
Journal of pediatrics 161(1) pp 88-93
bull UNICEF 2013 hypoglycaemia guidance july 2013 UNICEF
Kilder tilfoslashjet 2016
bull AGHDAS K TALAT K and SEPIDEH B 2014 Effect of immediate and continuous mother-infant
skin-to-skin contact on breastfeeding self-efficacy of primiparous women a randomised control trial
Women and birth journal of the Australian College of Midwives 27(1) pp 37-40
bull BEIRANVAND S VALIZADEH F HOSSEINABADI R and POURNIA Y 2014 The Effects of
Skin-to-Skin Contact on Temperature and Breastfeeding Successfulness in Full-Term Newborns
after Cesarean Delivery International journal of pediatrics 2014 pp 846486
bull FENGER-GRON J FENGER-GRON M BLUNCK CH SCHONEMANN-RIGEL H and
WIELANDT HB 2015 Low breastfeeding rates and body mass index in Danish children of women
with gestational diabetes mellitus International breastfeeding journal 10 pp 26-015-0051-8
eCollection 2015
bull JAGIELLO KP and AZULAY CHERTOK IR 2015 Womens Experiences With Early
Breastfeeding After Gestational Diabetes Journal of obstetric gynecologic and neonatal nursing
JOGNN NAACOG 44(4) pp 500-509
bull SAMAYAM P RANGANATHAN PK KOTARI UD and BALASUNDARAM R 2015 Study of
Asymptomatic Hypoglycemia in Full Term Exclusively Breastfed Neonates in First 48 Hours of Life
Journal of clinical and diagnostic research JCDR 9(9) pp SC07-10
bull SOBREVIA L SALSOSO R SAEZ T SANHUEZA C PARDO F and LEIVA A 2015 Insulin
therapy and fetoplacental vascular function in gestational diabetes mellitus Experimental physiology
100(3) pp 231-238
bull STEWART CE SAGE EL and REYNOLDS P 2015 Supporting Baby Friendly a quality
improvement initiative for the management of transitional neonatal hypoglycaemia Archives of
disease in childhoodFetal and neonatal edition
bull
Amning
bull En oslashgning paring 77
flere amninger paring de
foslashrste 6 timer er en
signifikant forbedring
bull Dermed har boslashrnene
formentlig indtaget
vaeligsentlig mere raringmaeliglk
end boslashrnene foslashr
aeligndringen
Amning de foslashrste to timer efter foslashdslen
Neonatal Hypoglycaeligmi
Oplaeliggget er baseret paring viden om
nyfoslashdte ge 35deg Praeligmature derunder har
jeg ingen forudsaeligtninger for at tale om
Det vides ikke
hvor kort eller
lang en
tidsperiode med et
lavere blodsukker
skal vaeligre foslashr det
giver foslashlger
Det vides ikke
hvilket
blodsukkerniveau
der er mest sikkert
Det vides ikke
hvor graelignsen
garingr mellem
skade ikke-
skade
Vi er alle
bange for at et
barn faringr
senfoslashlger efter
hypoglycaeligmi
Burns Patterns of cerebral injury and
neurodevelopmental outcomes after symptomatic neonatal
hypoglycemia Pediatrics 2008
bull Alle var symptomatiske ge 37deg 61 havde kramper
bull Median bs paring 10 mmoll 86 havde
bs le15 mmoll 1 el flere gange flest 1 doslashgn
bull Alle havde neurologisk dysfunktion indenfor 1 uge
bull 40 IUGR (flest asymmetriske)
bull Overvaeliggt af moslashdre med DM eller hypertension
bull Akut sectio pga barnet
18 mdr boslashrn med forbigaringende tidlig hypoglycaeligmi eller ingen kramper udviklede
sig normalt trods WM-skade undtaget 1 barn
Win Tin 2014 566 praeligmature 47 laeligngerevarende svaeligr hypoglycaeligmi
bull Samme udvikling som parrede kontrolboslashrn hhv 2 og 15 aringr efter
Hypoglykaeligmi kohorte
bull 404 boslashrn i risiko for hypoglykaeligmi foslashlges i 2 aringr 53
havde bs lt 26 mmoll
bull Standard glucosemaringling og kontinuerlig skjult glucose
maringling i de foslashrste 48 timer eller til stabilt blodsukker
bull Overraskende var der 23 der havde lavt blodsukker
uden at det blev opdaget
Udvikling ved 24 maringneder
bull Ingen signifikant forskel i neurologisk udvikling eller
problemloslashsningsevne
bull Det ses dog at boslashrn der laring hoslashjt i bs (gt4) de foslashrste 12 timer
efter et bs-fald fik laveste score i neurologisk udvikling
bull Det tyder paring at et stabilt middel blodsukker er maringletMcKinlay 2015
Normale boslashrn
bull Glucose er eacuten af mange energikilder
for det nyfoslashdte barn
bull Hoseth 2000 laveste blodsukker 14
mmoll 1 time efter foslashdslen median 31
mmol l (14 til 53)
bull Hapo studiet 2010 Mean 32 mmol plusmn
09
Normale hjaeliglpesystemer
bull Ketogenese Normale nyfoslashdte har en
optil 40 x kapacitet af en voksen til at
starte ketogenese som skaffer energi
til barnet
bull Laktat betragtes som rdquoskurkrdquo men er
ogsaring en stor energi kilde da 2 x lactat
= glucose
Processer og tilfoslashrsel via colostrum
bull Glycogenolyse = omdannelse af glycogen
bull Gluconeogenese = nydannelse af glucose
bull Lipolyse = omdannelse af fedt til frie fedtsyrer
bull Ketogenese = udnyttelse af frie fedtsyrer til energi
Colostrum indeholder
bull Oligosaccharider Laktat laktose
bull Fedtsyrer monoumaeligttet fedt fedtmolekyler er store
energitaeligtte og medbringer selv lipase
bull Aminosyrer og proteiner
bull Vaeligkstfaktorer til hurtig transport af naeligringsstoffer
HYPOGLYCAEligMI
Alternative tilgange
bull Neonatal Hypoglycaeligmi er ikke en egentlig diagnose men en
beskrivelse af en tilstand
bull En tilstand hvor barnets metaboliske tilpasningsevne er reduceret og
DERFOR faringr hypoglycaeligmi
bull Alle nyfoslashdte har en back-up plan i form af alternative energikilder nogle boslashrn dog i
reduceret grad og DE er i risiko for hypoglycaeligmiCornblathM HawdonJM
Controversies regarding definition of neonatal hypoglycemia
suggested operational thresholds Pediatrics 2000 105 5 1141-1145
Der sker rigtig meget lige nu paring det laeliggefaglige omraringde (Win Tin 2014) Nye
forslag er at
bull asymptomatiske boslashrn er hypoglycaeligmiske med et bs lt 20 ogsaring ved naeligste
maringling altsaring over laeligngere tid og ikke kun eacuten vaeligrdi
bull Der maring kun vaeligre eacuten maringling lt 10 behandles straks
bull Ved symptomer skal der ogsaring reageres med det samme v bslt 25
Deacutet er laeliggefaglige beslutninger som vi maringske faringr at se
Hvem er Risikoboslashrn
Halvdelen af boslashrnene i Sugar Baby study
udaf 514 risikoboslashrn havde
51 bs lt 26 20 lt 20
Fordelingen i grupperne er helt ens
bull 79 var asymptomatiske
bull 15 var for traeligtte til at sutte
bull 7 sitrede
Incidence of Neonatal Hypoglycemia in Babies Identified as at Risk
Deborah L Harris
2012 J of Pediatrics
Burde vi taelignke Hvad
er dette barns
specifikke evne til
metabolisk tilpasning
efter foslashdslen og
hvordan stoslashtter vi
barnet bedst paring
naturlig vis i denne
proces og stadig
forebygger skade
Saeligrlige risikoboslashrn
bull IUGR boslashrn kan vaeligre meget uforudsigelige Deres
pancreas kan vaeligre overaktiv og dermed udsende for
meget insulin og pancreas kan vaeligre haeligmmet
bull Saeligrlig de boslashrn der er asymmetriske i deres vaeligkst
Soslashgning af litteratur
En hurtig PubMed soslashgning giver foslashlgende
1Neonatal hypoglycemia 2404
2Breastfeeding 36873
3Colostrum 7435
1+2 70
1+3 3
Early feeding
bull Der er ingen enighed om definition paring Early Feeding
bull Hawdon rdquofoslashrhen sendte boslashrnene hurtigt maeliglken tilbage til den velmenende
afsenderrdquo
bull Early Feeding kan vaeligre tidlig hyppig amning sukkervand modermaeliglk
erstatning dextrosegel Maeligngde
bull Udover amning er der mange modeller og ingen af dem er evidensbaserede
bull I 2015-16 kommer der stadig artikler om neonatal hypoglycaeligmi der ikke
skriver om ernaeligring overhovedet
Modermaeliglkserstatning og hjaeliglpestoffer
De Rooyrsquos studie fra 2002 viser
bull I et prospektivt studie med i alt 165 boslashrn blev boslashrnenes ketogenese
undersoslashgt
bull Deacuten gruppe der er taeligttest paring en af vores maringlgrupper GDM er Large
for Gestational Age boslashrnene Her paringvises det med signifikant forskel
at amning oslashger ketogenesen og at amning + modermaeliglkserstatning
ikke har saring god respons
bull Flaskeboslashrn danner stort set ikke ketonstoffer i starten foslashrst efter 12
timer
Det kan antyde at mme reducerer barnets evne til
modregulering og selvhjaeliglp
At mme har bivirkningersideeffekter der bestemt ikke
er hensigtsmaeligssige naringr vi taler om forebyggelse
Guidelines hvor er vi
Unicef 2013
bull Alle hud mod hud lige efter foslashdslen
bull Amning indenfor den foslashrste time
bull Foslashrste bs tidligst efter 2 timer og foslashr andet maringltid
bull Ved lavt bs (graelignse 26 el 20) ammes igen eller udmalket maeliglk Ved
fortsat lavt bs efter 1 time gives mme i de maeligngder vi kender
Survey af neonatale hypoglykaeligmi guidelines i Australien og New
Zealand vha Unicef(Sundercombe 2014)
bull Kun 9 ud af 22 naeligvner hud mod hud lige efter foslashdslen
bull Kun enkelte naeligvner hjaeliglp til effektiv amning og information om tegn
paring spiselyst
bull Mere end halvdelen anbefaler supplering med mors udmalkede maeliglk
bull Kun 8 ud af 22 sikrer sig samtykke foslashr mme og info til foraeligldre om
aringrsag til suppleringen
Unicef hypoglycemia 2013
Forebyggelse i ammeperspektiv og Baby Friendly
Normoglycaeligmisk tilstand boslashr opnaringes med mindst mulig intervention
Konventionel tilgang
bull 60 mlkgdoslashgn mm el mme oslashges med
20 mlkgdoslashgn x 8(-12)
bull Vallecasein 4060 mme = nedsat
ventrikeltoslashmning
bull Vi maringler stadig 1 t bs
bull Ved lav bs oslashges til 125 eller 150
af maeligngden
bull Glucose-infusion
bull Adskillelse af mor og barn
Individuel tilgangABM Protocol 2014
bull 1-3 mlkg (optil 5 mlkg) gerne hver 2 time
(3-5 mlkg i 2006-udgaven)
bull Hurtig passage af mm alle hjaeliglpestoffer er
med Vallecasein 9010
Bergmann
bull mavesaeligkkens stoslashrrelse lige foslashr foslashdslen
drikker barnet ca 10 ml gang Refererer til
studier der angiver ventiklen til hhv 10 12
15 20 ml
bull Anbefaler smaring hyppige amninger
suppleringer saring barnet ikke stresses og
bruger mere glucose end det tilfoslashres
bull Ward-Platt Laktat er rdquothe good guyrdquo og et
veloxideret velcirkuleret barn har alle
muligheder for at kompensere
bull Antenatal udmalkning af raringmaeliglk til DM-
boslashrn
Forskellen i et forloslashb
DPS
3000 gram
bull 180 ml 1 doslashgn
(60kgdoslashgn)
bull bsdarr oslashges til 225 ml 24
timer
Svaeligrt at faring udmalket dette
som ekstra
ABM
3000 gram
bull 36 ml foslashrste doslashgn
1 mlkg maringltid = 3 x 12
bull 108 ml v 3 ml kgmaringltid
(reduktion paring 40 )
Opnaringeligt at udmalke dette
som ekstra
Mon der er forskel paring
antal amninger
Haringndudmalkning korrektinkorrekt
bull httpswwwyoutubecomwatchv=k6V9xTZAWq0
24
Hvordan forholder vi os til dette
bull Vi kan ikke aeligndre instrukser for hypoglycaeligmi haringndtering det
er en laeliggefaglig opgave kan vi alligevel goslashre en forskel i
profylaktisk oslashjemed
bull Har vi et ansvar for at vaeligre kritiske overfor gamle strategier
ndash og dermed assistere paeligdiatere i forebyggelsesarbejdet
bull Hvordan kan vi balancere forebyggelse og ikke-skade
princippet naringr det ogsaring drejer sig om naturlig ernaeligring mor-
barn kontakt og medicinske interventioner
bull Kan vi med vores viden om colostrum og naturlige
processers effekt aeligndre praksis for disse boslashrn
bull Hvordan kan vi som sundhedsprofessionelle oslashge antallet af
risikoboslashrn der tidligt faringr mors maeliglk selv om det ikke sutter
bull Hvordan vil det aeligndre vores praksisarbejde
bull Hvordan klaeligdes novicen og vi paring til en rdquoWatch and Waitrdquo
tilgang til hypoglycaeligmiforebyggelse
bull POCT eller lab-svar
Mon ikke hypoglycaeligmi forebyggelse kvalitativt kan
komme videre end i 2014
Tak fordi I lyttede
referencerbull CHERTOK IR RAZ I SHOHAM I HADDAD H and WIZNITZER A 2009 Journal of human
nutrition and dietetics the official journal of the British Dietetic Association 22(2) pp 166-169
bull CHRISTESEN HT and ESBERG G 2014-last update Hypoglykaeligmi flowcharts DPS Available
httpvipregionhdkVIPRedaktoer151637nsfvLookupUploadATTACH-RHAP-
9K2D8Y$FILEHypoglykC3A6mi20-20neonatal20Flowcharts20Maj202014pdf [0916
2014]
bull CORDERO L TREUER SH LANDON MB and GABBE SG 1998 Management of infants of
diabetic mothers Archives of Pediatrics amp Adolescent Medicine 152(3) pp 249-254
bull CORNBLATH M HAWDON JM WILLIAMS AF AYNSLEY-GREEN A WARD-PLATT MP
SCHWARTZ R and KALHAN SC 2000 Controversies regarding definition of neonatal
hypoglycemia suggested operational thresholds Pediatrics 105(5) pp 1141-1145
bull CSONT GL GROTH S HOPKINS P and GUILLET R 2014 An evidence-based approach to
breastfeeding neonates at risk for hypoglycemia Journal of obstetric gynecologic and neonatal
nursing JOGNN NAACOG 43(1) pp 71-81
bull DE ROOY L and HAWDON J 2002 Nutritional factors that affect the postnatal metabolic
adaptation of full-term small- and large-for-gestational-age infants Pediatrics 109(3) pp E42
bull DOBSON LZ VIBEKE 2011 God blodsukkerregulering kun for barnets skyld 25(nr 4) pp 36--
47
bull FLORES-LE ROUX JA SAGARRA E BENAIGES D HERNANDEZ-RIVAS E CHILLARON
JJ PUIG DE DOU J MUR A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2012 A
prospective evaluation of neonatal hypoglycaemia in infants of women with gestational diabetes
mellitus Diabetes research and clinical practice 97(2) pp 217-222
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull HARRIS DL WESTON PJ SIGNAL M CHASE JG and HARDING JE 2013 Dextrose gel for neonatal
hypoglycaemia (the Sugar Babies Study) a randomised double-blind placebo-controlled trial Lancet (London
England) 382(9910) pp 2077-2083
bull HERNANDEZ-RIVAS E FLORES-LE ROUX JA BENAIGES D SAGARRA E CHILLARON JJ PAYA A
PUIG-DE DOU J GODAY A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2013 Gestational diabetes in a
multiethnic population of Spain clinical characteristics and perinatal outcomes Diabetes research and clinical
practice 100(2) pp 215-221
bull HOSETH E JOERGENSEN A EBBESEN F and MOELLER M 2000 Blood glucose levels in a population of
healthy breast fed term infants of appropriate size for gestational age Archives of disease in childhoodFetal and
neonatal edition 83(2) pp F117-9
bull JENSEN DM SORENSEN B FEILBERG-JORGENSEN N WESTERGAARD JG and BECK-NIELSEN H
2000 Maternal and perinatal outcomes in 143 Danish women with gestational diabetes mellitus and 143 controls with
a similar risk profile Diabetic medicine a journal of the British Diabetic Association 17(4) pp 281-286
bull MAAYAN-METZGER A LUBIN D and KUINT J 2009 Hypoglycemia rates in the first days of life among term
infants born to diabetic mothers Neonatology 96(2) pp 80-85
bull MAAYAN-METZGER A SCHUSHAN-EISEN I LUBIN D MORAN O KUINT J and MAZKERETH R 2014
Delivery room breastfeeding for prevention of hypoglycaemia in infants of diabetic mothers Fetal and pediatric
pathology 33(1) pp 23-28
bull MCKINLAY CEA 2015 neonatal hypoglycemia and neurodevelopment outcomes at 2 years N Engl J Med(373)
pp 1507-18
bull METZGER BE PERSSON B LOWE LP DYER AR CRUICKSHANK JK DEEROCHANAWONG C
HALLIDAY HL HENNIS AJ LILEY H NG PC COUSTAN DR HADDEN DR HOD M OATS JJ
TRIMBLE ER and HAPO STUDY COOPERATIVE RESEARCH GROUP 2010 Hyperglycemia and adverse
pregnancy outcome study neonatal glycemia Pediatrics 126(6) pp e1545-52
bull ROZANCE PJ and HAY WWJR 2012 Neonatal hypoglycemia--answers but more questions The Journal of
pediatrics 161(5) pp 775-776
bull SARKAR S WATMAN J SEIGEL WM and SCHAEFFER HA 2003 A prospective controlled study of neonatal
morbidities in infants born at 36 weeks or more gestation to Women with diet-controlled gestational diabetes (GDM-
class Al) Journal of perinatology official journal of the California Perinatal Association 23(3) pp 223-228
bull SOLTANI H DICKINSON FM KALK J and PAYNE K 2008 Breast feeding
practices and views among diabetic women a retrospective cohort study Midwifery
24(4) pp 471-479
bull TOZIER P 2013 Colostrum Versus Formula Supplentation for Glucose Stabilization in
Newborns of Diabetic Mothers 42(JOGNN The association of Womens Health
Obstetric and Neonatal Nurses) pp 619-628
bull VAN HOWE RS and STORMS MR 2008 Blood glucose determinations in large for
gestational age infants American Journal of Perinatology 25(5) pp 283-289
bull WIGHT N MARINELLI KA and ACADEMY OF BREASTFEEDING MEDICINE
PROTOCOL COMMITTEE 2006 ABM clinical protocol 1 guidelines for glucose
monitoring and treatment of hypoglycemia in breastfed neonates Breastfeeding
medicine the official journal of the Academy of Breastfeeding Medicine 1(3) pp 178-
184
bull VANHALTREN K and MALHOTRA A 2013 Characteristics of infants at risk of
hypoglycaemia secondary to being infant of a diabetic mother Journal of pediatric
endocrinology amp metabolism JPEM 26(9-10) pp 861-865
bull WIGHT NE 2014 Hypoglycemia in breastfed neonates Breastfeeding medicine the
official journal of the Academy of Breastfeeding Medicine 9(4) pp 173-179
bull DALSGAARD B and ECK K 2013-last update Klinisk retningslinje for
nonfarmakologisk forebyggelse af neonatal hypoglycaeligmi og energitab hos nyfoslashdte af
moslashdre med diaeligtbehandlet gestationel diabetes Available
httpwwwkliniskeretningslinjerdkimages88_gdm_godkendt_010713pdf [0917 2014]
hypoglycaeligmibull
bull BRAGG JJ GREEN R and HOLZMAN IR 2013 Does early enteral feeding prevent
hypoglycemia in small for gestational age neonates Journal of neonatal-perinatal medicine 6(2)
pp 131-135
bull HARRIS DL WESTON PJ and HARDING JE 2014 Lactate rather than ketones may provide
alternative cerebral fuel in hypoglycaemic newborns Archives of disease in childhoodFetal and
neonatal edition
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull LANG TF and HUSSAIN K 2014 Pediatric hypoglycemia Advances in Clinical Chemistry 63
pp 211-245
bull MITANCHEZ D BURGUET A and SIMEONI U 2014 Infants born to mothers with gestational
diabetes mellitus mild neonatal effects a long-term threat to global health The Journal of pediatrics
164(3) pp 445-450
bull SUNDERCOMBE SL RAYNES-GREENOW CH TURNER RM and JEFFERY HE 2014 Do
neonatal hypoglycaemia guidelines in Australia and New Zealand facilitate breast feeding
Midwifery 30(12) pp 1179-1186
bull TAM EW HAEUSSLEIN LA BONIFACIO SL GLASS HC ROGERS EE JEREMY RJ
BARKOVICH AJ and FERRIERO DM 2012 Hypoglycemia is associated with increased risk for
brain injury and adverse neurodevelopmental outcome in neonates at risk for encephalopathy The
Journal of pediatrics 161(1) pp 88-93
bull UNICEF 2013 hypoglycaemia guidance july 2013 UNICEF
Kilder tilfoslashjet 2016
bull AGHDAS K TALAT K and SEPIDEH B 2014 Effect of immediate and continuous mother-infant
skin-to-skin contact on breastfeeding self-efficacy of primiparous women a randomised control trial
Women and birth journal of the Australian College of Midwives 27(1) pp 37-40
bull BEIRANVAND S VALIZADEH F HOSSEINABADI R and POURNIA Y 2014 The Effects of
Skin-to-Skin Contact on Temperature and Breastfeeding Successfulness in Full-Term Newborns
after Cesarean Delivery International journal of pediatrics 2014 pp 846486
bull FENGER-GRON J FENGER-GRON M BLUNCK CH SCHONEMANN-RIGEL H and
WIELANDT HB 2015 Low breastfeeding rates and body mass index in Danish children of women
with gestational diabetes mellitus International breastfeeding journal 10 pp 26-015-0051-8
eCollection 2015
bull JAGIELLO KP and AZULAY CHERTOK IR 2015 Womens Experiences With Early
Breastfeeding After Gestational Diabetes Journal of obstetric gynecologic and neonatal nursing
JOGNN NAACOG 44(4) pp 500-509
bull SAMAYAM P RANGANATHAN PK KOTARI UD and BALASUNDARAM R 2015 Study of
Asymptomatic Hypoglycemia in Full Term Exclusively Breastfed Neonates in First 48 Hours of Life
Journal of clinical and diagnostic research JCDR 9(9) pp SC07-10
bull SOBREVIA L SALSOSO R SAEZ T SANHUEZA C PARDO F and LEIVA A 2015 Insulin
therapy and fetoplacental vascular function in gestational diabetes mellitus Experimental physiology
100(3) pp 231-238
bull STEWART CE SAGE EL and REYNOLDS P 2015 Supporting Baby Friendly a quality
improvement initiative for the management of transitional neonatal hypoglycaemia Archives of
disease in childhoodFetal and neonatal edition
bull
Amning de foslashrste to timer efter foslashdslen
Neonatal Hypoglycaeligmi
Oplaeliggget er baseret paring viden om
nyfoslashdte ge 35deg Praeligmature derunder har
jeg ingen forudsaeligtninger for at tale om
Det vides ikke
hvor kort eller
lang en
tidsperiode med et
lavere blodsukker
skal vaeligre foslashr det
giver foslashlger
Det vides ikke
hvilket
blodsukkerniveau
der er mest sikkert
Det vides ikke
hvor graelignsen
garingr mellem
skade ikke-
skade
Vi er alle
bange for at et
barn faringr
senfoslashlger efter
hypoglycaeligmi
Burns Patterns of cerebral injury and
neurodevelopmental outcomes after symptomatic neonatal
hypoglycemia Pediatrics 2008
bull Alle var symptomatiske ge 37deg 61 havde kramper
bull Median bs paring 10 mmoll 86 havde
bs le15 mmoll 1 el flere gange flest 1 doslashgn
bull Alle havde neurologisk dysfunktion indenfor 1 uge
bull 40 IUGR (flest asymmetriske)
bull Overvaeliggt af moslashdre med DM eller hypertension
bull Akut sectio pga barnet
18 mdr boslashrn med forbigaringende tidlig hypoglycaeligmi eller ingen kramper udviklede
sig normalt trods WM-skade undtaget 1 barn
Win Tin 2014 566 praeligmature 47 laeligngerevarende svaeligr hypoglycaeligmi
bull Samme udvikling som parrede kontrolboslashrn hhv 2 og 15 aringr efter
Hypoglykaeligmi kohorte
bull 404 boslashrn i risiko for hypoglykaeligmi foslashlges i 2 aringr 53
havde bs lt 26 mmoll
bull Standard glucosemaringling og kontinuerlig skjult glucose
maringling i de foslashrste 48 timer eller til stabilt blodsukker
bull Overraskende var der 23 der havde lavt blodsukker
uden at det blev opdaget
Udvikling ved 24 maringneder
bull Ingen signifikant forskel i neurologisk udvikling eller
problemloslashsningsevne
bull Det ses dog at boslashrn der laring hoslashjt i bs (gt4) de foslashrste 12 timer
efter et bs-fald fik laveste score i neurologisk udvikling
bull Det tyder paring at et stabilt middel blodsukker er maringletMcKinlay 2015
Normale boslashrn
bull Glucose er eacuten af mange energikilder
for det nyfoslashdte barn
bull Hoseth 2000 laveste blodsukker 14
mmoll 1 time efter foslashdslen median 31
mmol l (14 til 53)
bull Hapo studiet 2010 Mean 32 mmol plusmn
09
Normale hjaeliglpesystemer
bull Ketogenese Normale nyfoslashdte har en
optil 40 x kapacitet af en voksen til at
starte ketogenese som skaffer energi
til barnet
bull Laktat betragtes som rdquoskurkrdquo men er
ogsaring en stor energi kilde da 2 x lactat
= glucose
Processer og tilfoslashrsel via colostrum
bull Glycogenolyse = omdannelse af glycogen
bull Gluconeogenese = nydannelse af glucose
bull Lipolyse = omdannelse af fedt til frie fedtsyrer
bull Ketogenese = udnyttelse af frie fedtsyrer til energi
Colostrum indeholder
bull Oligosaccharider Laktat laktose
bull Fedtsyrer monoumaeligttet fedt fedtmolekyler er store
energitaeligtte og medbringer selv lipase
bull Aminosyrer og proteiner
bull Vaeligkstfaktorer til hurtig transport af naeligringsstoffer
HYPOGLYCAEligMI
Alternative tilgange
bull Neonatal Hypoglycaeligmi er ikke en egentlig diagnose men en
beskrivelse af en tilstand
bull En tilstand hvor barnets metaboliske tilpasningsevne er reduceret og
DERFOR faringr hypoglycaeligmi
bull Alle nyfoslashdte har en back-up plan i form af alternative energikilder nogle boslashrn dog i
reduceret grad og DE er i risiko for hypoglycaeligmiCornblathM HawdonJM
Controversies regarding definition of neonatal hypoglycemia
suggested operational thresholds Pediatrics 2000 105 5 1141-1145
Der sker rigtig meget lige nu paring det laeliggefaglige omraringde (Win Tin 2014) Nye
forslag er at
bull asymptomatiske boslashrn er hypoglycaeligmiske med et bs lt 20 ogsaring ved naeligste
maringling altsaring over laeligngere tid og ikke kun eacuten vaeligrdi
bull Der maring kun vaeligre eacuten maringling lt 10 behandles straks
bull Ved symptomer skal der ogsaring reageres med det samme v bslt 25
Deacutet er laeliggefaglige beslutninger som vi maringske faringr at se
Hvem er Risikoboslashrn
Halvdelen af boslashrnene i Sugar Baby study
udaf 514 risikoboslashrn havde
51 bs lt 26 20 lt 20
Fordelingen i grupperne er helt ens
bull 79 var asymptomatiske
bull 15 var for traeligtte til at sutte
bull 7 sitrede
Incidence of Neonatal Hypoglycemia in Babies Identified as at Risk
Deborah L Harris
2012 J of Pediatrics
Burde vi taelignke Hvad
er dette barns
specifikke evne til
metabolisk tilpasning
efter foslashdslen og
hvordan stoslashtter vi
barnet bedst paring
naturlig vis i denne
proces og stadig
forebygger skade
Saeligrlige risikoboslashrn
bull IUGR boslashrn kan vaeligre meget uforudsigelige Deres
pancreas kan vaeligre overaktiv og dermed udsende for
meget insulin og pancreas kan vaeligre haeligmmet
bull Saeligrlig de boslashrn der er asymmetriske i deres vaeligkst
Soslashgning af litteratur
En hurtig PubMed soslashgning giver foslashlgende
1Neonatal hypoglycemia 2404
2Breastfeeding 36873
3Colostrum 7435
1+2 70
1+3 3
Early feeding
bull Der er ingen enighed om definition paring Early Feeding
bull Hawdon rdquofoslashrhen sendte boslashrnene hurtigt maeliglken tilbage til den velmenende
afsenderrdquo
bull Early Feeding kan vaeligre tidlig hyppig amning sukkervand modermaeliglk
erstatning dextrosegel Maeligngde
bull Udover amning er der mange modeller og ingen af dem er evidensbaserede
bull I 2015-16 kommer der stadig artikler om neonatal hypoglycaeligmi der ikke
skriver om ernaeligring overhovedet
Modermaeliglkserstatning og hjaeliglpestoffer
De Rooyrsquos studie fra 2002 viser
bull I et prospektivt studie med i alt 165 boslashrn blev boslashrnenes ketogenese
undersoslashgt
bull Deacuten gruppe der er taeligttest paring en af vores maringlgrupper GDM er Large
for Gestational Age boslashrnene Her paringvises det med signifikant forskel
at amning oslashger ketogenesen og at amning + modermaeliglkserstatning
ikke har saring god respons
bull Flaskeboslashrn danner stort set ikke ketonstoffer i starten foslashrst efter 12
timer
Det kan antyde at mme reducerer barnets evne til
modregulering og selvhjaeliglp
At mme har bivirkningersideeffekter der bestemt ikke
er hensigtsmaeligssige naringr vi taler om forebyggelse
Guidelines hvor er vi
Unicef 2013
bull Alle hud mod hud lige efter foslashdslen
bull Amning indenfor den foslashrste time
bull Foslashrste bs tidligst efter 2 timer og foslashr andet maringltid
bull Ved lavt bs (graelignse 26 el 20) ammes igen eller udmalket maeliglk Ved
fortsat lavt bs efter 1 time gives mme i de maeligngder vi kender
Survey af neonatale hypoglykaeligmi guidelines i Australien og New
Zealand vha Unicef(Sundercombe 2014)
bull Kun 9 ud af 22 naeligvner hud mod hud lige efter foslashdslen
bull Kun enkelte naeligvner hjaeliglp til effektiv amning og information om tegn
paring spiselyst
bull Mere end halvdelen anbefaler supplering med mors udmalkede maeliglk
bull Kun 8 ud af 22 sikrer sig samtykke foslashr mme og info til foraeligldre om
aringrsag til suppleringen
Unicef hypoglycemia 2013
Forebyggelse i ammeperspektiv og Baby Friendly
Normoglycaeligmisk tilstand boslashr opnaringes med mindst mulig intervention
Konventionel tilgang
bull 60 mlkgdoslashgn mm el mme oslashges med
20 mlkgdoslashgn x 8(-12)
bull Vallecasein 4060 mme = nedsat
ventrikeltoslashmning
bull Vi maringler stadig 1 t bs
bull Ved lav bs oslashges til 125 eller 150
af maeligngden
bull Glucose-infusion
bull Adskillelse af mor og barn
Individuel tilgangABM Protocol 2014
bull 1-3 mlkg (optil 5 mlkg) gerne hver 2 time
(3-5 mlkg i 2006-udgaven)
bull Hurtig passage af mm alle hjaeliglpestoffer er
med Vallecasein 9010
Bergmann
bull mavesaeligkkens stoslashrrelse lige foslashr foslashdslen
drikker barnet ca 10 ml gang Refererer til
studier der angiver ventiklen til hhv 10 12
15 20 ml
bull Anbefaler smaring hyppige amninger
suppleringer saring barnet ikke stresses og
bruger mere glucose end det tilfoslashres
bull Ward-Platt Laktat er rdquothe good guyrdquo og et
veloxideret velcirkuleret barn har alle
muligheder for at kompensere
bull Antenatal udmalkning af raringmaeliglk til DM-
boslashrn
Forskellen i et forloslashb
DPS
3000 gram
bull 180 ml 1 doslashgn
(60kgdoslashgn)
bull bsdarr oslashges til 225 ml 24
timer
Svaeligrt at faring udmalket dette
som ekstra
ABM
3000 gram
bull 36 ml foslashrste doslashgn
1 mlkg maringltid = 3 x 12
bull 108 ml v 3 ml kgmaringltid
(reduktion paring 40 )
Opnaringeligt at udmalke dette
som ekstra
Mon der er forskel paring
antal amninger
Haringndudmalkning korrektinkorrekt
bull httpswwwyoutubecomwatchv=k6V9xTZAWq0
24
Hvordan forholder vi os til dette
bull Vi kan ikke aeligndre instrukser for hypoglycaeligmi haringndtering det
er en laeliggefaglig opgave kan vi alligevel goslashre en forskel i
profylaktisk oslashjemed
bull Har vi et ansvar for at vaeligre kritiske overfor gamle strategier
ndash og dermed assistere paeligdiatere i forebyggelsesarbejdet
bull Hvordan kan vi balancere forebyggelse og ikke-skade
princippet naringr det ogsaring drejer sig om naturlig ernaeligring mor-
barn kontakt og medicinske interventioner
bull Kan vi med vores viden om colostrum og naturlige
processers effekt aeligndre praksis for disse boslashrn
bull Hvordan kan vi som sundhedsprofessionelle oslashge antallet af
risikoboslashrn der tidligt faringr mors maeliglk selv om det ikke sutter
bull Hvordan vil det aeligndre vores praksisarbejde
bull Hvordan klaeligdes novicen og vi paring til en rdquoWatch and Waitrdquo
tilgang til hypoglycaeligmiforebyggelse
bull POCT eller lab-svar
Mon ikke hypoglycaeligmi forebyggelse kvalitativt kan
komme videre end i 2014
Tak fordi I lyttede
referencerbull CHERTOK IR RAZ I SHOHAM I HADDAD H and WIZNITZER A 2009 Journal of human
nutrition and dietetics the official journal of the British Dietetic Association 22(2) pp 166-169
bull CHRISTESEN HT and ESBERG G 2014-last update Hypoglykaeligmi flowcharts DPS Available
httpvipregionhdkVIPRedaktoer151637nsfvLookupUploadATTACH-RHAP-
9K2D8Y$FILEHypoglykC3A6mi20-20neonatal20Flowcharts20Maj202014pdf [0916
2014]
bull CORDERO L TREUER SH LANDON MB and GABBE SG 1998 Management of infants of
diabetic mothers Archives of Pediatrics amp Adolescent Medicine 152(3) pp 249-254
bull CORNBLATH M HAWDON JM WILLIAMS AF AYNSLEY-GREEN A WARD-PLATT MP
SCHWARTZ R and KALHAN SC 2000 Controversies regarding definition of neonatal
hypoglycemia suggested operational thresholds Pediatrics 105(5) pp 1141-1145
bull CSONT GL GROTH S HOPKINS P and GUILLET R 2014 An evidence-based approach to
breastfeeding neonates at risk for hypoglycemia Journal of obstetric gynecologic and neonatal
nursing JOGNN NAACOG 43(1) pp 71-81
bull DE ROOY L and HAWDON J 2002 Nutritional factors that affect the postnatal metabolic
adaptation of full-term small- and large-for-gestational-age infants Pediatrics 109(3) pp E42
bull DOBSON LZ VIBEKE 2011 God blodsukkerregulering kun for barnets skyld 25(nr 4) pp 36--
47
bull FLORES-LE ROUX JA SAGARRA E BENAIGES D HERNANDEZ-RIVAS E CHILLARON
JJ PUIG DE DOU J MUR A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2012 A
prospective evaluation of neonatal hypoglycaemia in infants of women with gestational diabetes
mellitus Diabetes research and clinical practice 97(2) pp 217-222
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull HARRIS DL WESTON PJ SIGNAL M CHASE JG and HARDING JE 2013 Dextrose gel for neonatal
hypoglycaemia (the Sugar Babies Study) a randomised double-blind placebo-controlled trial Lancet (London
England) 382(9910) pp 2077-2083
bull HERNANDEZ-RIVAS E FLORES-LE ROUX JA BENAIGES D SAGARRA E CHILLARON JJ PAYA A
PUIG-DE DOU J GODAY A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2013 Gestational diabetes in a
multiethnic population of Spain clinical characteristics and perinatal outcomes Diabetes research and clinical
practice 100(2) pp 215-221
bull HOSETH E JOERGENSEN A EBBESEN F and MOELLER M 2000 Blood glucose levels in a population of
healthy breast fed term infants of appropriate size for gestational age Archives of disease in childhoodFetal and
neonatal edition 83(2) pp F117-9
bull JENSEN DM SORENSEN B FEILBERG-JORGENSEN N WESTERGAARD JG and BECK-NIELSEN H
2000 Maternal and perinatal outcomes in 143 Danish women with gestational diabetes mellitus and 143 controls with
a similar risk profile Diabetic medicine a journal of the British Diabetic Association 17(4) pp 281-286
bull MAAYAN-METZGER A LUBIN D and KUINT J 2009 Hypoglycemia rates in the first days of life among term
infants born to diabetic mothers Neonatology 96(2) pp 80-85
bull MAAYAN-METZGER A SCHUSHAN-EISEN I LUBIN D MORAN O KUINT J and MAZKERETH R 2014
Delivery room breastfeeding for prevention of hypoglycaemia in infants of diabetic mothers Fetal and pediatric
pathology 33(1) pp 23-28
bull MCKINLAY CEA 2015 neonatal hypoglycemia and neurodevelopment outcomes at 2 years N Engl J Med(373)
pp 1507-18
bull METZGER BE PERSSON B LOWE LP DYER AR CRUICKSHANK JK DEEROCHANAWONG C
HALLIDAY HL HENNIS AJ LILEY H NG PC COUSTAN DR HADDEN DR HOD M OATS JJ
TRIMBLE ER and HAPO STUDY COOPERATIVE RESEARCH GROUP 2010 Hyperglycemia and adverse
pregnancy outcome study neonatal glycemia Pediatrics 126(6) pp e1545-52
bull ROZANCE PJ and HAY WWJR 2012 Neonatal hypoglycemia--answers but more questions The Journal of
pediatrics 161(5) pp 775-776
bull SARKAR S WATMAN J SEIGEL WM and SCHAEFFER HA 2003 A prospective controlled study of neonatal
morbidities in infants born at 36 weeks or more gestation to Women with diet-controlled gestational diabetes (GDM-
class Al) Journal of perinatology official journal of the California Perinatal Association 23(3) pp 223-228
bull SOLTANI H DICKINSON FM KALK J and PAYNE K 2008 Breast feeding
practices and views among diabetic women a retrospective cohort study Midwifery
24(4) pp 471-479
bull TOZIER P 2013 Colostrum Versus Formula Supplentation for Glucose Stabilization in
Newborns of Diabetic Mothers 42(JOGNN The association of Womens Health
Obstetric and Neonatal Nurses) pp 619-628
bull VAN HOWE RS and STORMS MR 2008 Blood glucose determinations in large for
gestational age infants American Journal of Perinatology 25(5) pp 283-289
bull WIGHT N MARINELLI KA and ACADEMY OF BREASTFEEDING MEDICINE
PROTOCOL COMMITTEE 2006 ABM clinical protocol 1 guidelines for glucose
monitoring and treatment of hypoglycemia in breastfed neonates Breastfeeding
medicine the official journal of the Academy of Breastfeeding Medicine 1(3) pp 178-
184
bull VANHALTREN K and MALHOTRA A 2013 Characteristics of infants at risk of
hypoglycaemia secondary to being infant of a diabetic mother Journal of pediatric
endocrinology amp metabolism JPEM 26(9-10) pp 861-865
bull WIGHT NE 2014 Hypoglycemia in breastfed neonates Breastfeeding medicine the
official journal of the Academy of Breastfeeding Medicine 9(4) pp 173-179
bull DALSGAARD B and ECK K 2013-last update Klinisk retningslinje for
nonfarmakologisk forebyggelse af neonatal hypoglycaeligmi og energitab hos nyfoslashdte af
moslashdre med diaeligtbehandlet gestationel diabetes Available
httpwwwkliniskeretningslinjerdkimages88_gdm_godkendt_010713pdf [0917 2014]
hypoglycaeligmibull
bull BRAGG JJ GREEN R and HOLZMAN IR 2013 Does early enteral feeding prevent
hypoglycemia in small for gestational age neonates Journal of neonatal-perinatal medicine 6(2)
pp 131-135
bull HARRIS DL WESTON PJ and HARDING JE 2014 Lactate rather than ketones may provide
alternative cerebral fuel in hypoglycaemic newborns Archives of disease in childhoodFetal and
neonatal edition
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull LANG TF and HUSSAIN K 2014 Pediatric hypoglycemia Advances in Clinical Chemistry 63
pp 211-245
bull MITANCHEZ D BURGUET A and SIMEONI U 2014 Infants born to mothers with gestational
diabetes mellitus mild neonatal effects a long-term threat to global health The Journal of pediatrics
164(3) pp 445-450
bull SUNDERCOMBE SL RAYNES-GREENOW CH TURNER RM and JEFFERY HE 2014 Do
neonatal hypoglycaemia guidelines in Australia and New Zealand facilitate breast feeding
Midwifery 30(12) pp 1179-1186
bull TAM EW HAEUSSLEIN LA BONIFACIO SL GLASS HC ROGERS EE JEREMY RJ
BARKOVICH AJ and FERRIERO DM 2012 Hypoglycemia is associated with increased risk for
brain injury and adverse neurodevelopmental outcome in neonates at risk for encephalopathy The
Journal of pediatrics 161(1) pp 88-93
bull UNICEF 2013 hypoglycaemia guidance july 2013 UNICEF
Kilder tilfoslashjet 2016
bull AGHDAS K TALAT K and SEPIDEH B 2014 Effect of immediate and continuous mother-infant
skin-to-skin contact on breastfeeding self-efficacy of primiparous women a randomised control trial
Women and birth journal of the Australian College of Midwives 27(1) pp 37-40
bull BEIRANVAND S VALIZADEH F HOSSEINABADI R and POURNIA Y 2014 The Effects of
Skin-to-Skin Contact on Temperature and Breastfeeding Successfulness in Full-Term Newborns
after Cesarean Delivery International journal of pediatrics 2014 pp 846486
bull FENGER-GRON J FENGER-GRON M BLUNCK CH SCHONEMANN-RIGEL H and
WIELANDT HB 2015 Low breastfeeding rates and body mass index in Danish children of women
with gestational diabetes mellitus International breastfeeding journal 10 pp 26-015-0051-8
eCollection 2015
bull JAGIELLO KP and AZULAY CHERTOK IR 2015 Womens Experiences With Early
Breastfeeding After Gestational Diabetes Journal of obstetric gynecologic and neonatal nursing
JOGNN NAACOG 44(4) pp 500-509
bull SAMAYAM P RANGANATHAN PK KOTARI UD and BALASUNDARAM R 2015 Study of
Asymptomatic Hypoglycemia in Full Term Exclusively Breastfed Neonates in First 48 Hours of Life
Journal of clinical and diagnostic research JCDR 9(9) pp SC07-10
bull SOBREVIA L SALSOSO R SAEZ T SANHUEZA C PARDO F and LEIVA A 2015 Insulin
therapy and fetoplacental vascular function in gestational diabetes mellitus Experimental physiology
100(3) pp 231-238
bull STEWART CE SAGE EL and REYNOLDS P 2015 Supporting Baby Friendly a quality
improvement initiative for the management of transitional neonatal hypoglycaemia Archives of
disease in childhoodFetal and neonatal edition
bull
Neonatal Hypoglycaeligmi
Oplaeliggget er baseret paring viden om
nyfoslashdte ge 35deg Praeligmature derunder har
jeg ingen forudsaeligtninger for at tale om
Det vides ikke
hvor kort eller
lang en
tidsperiode med et
lavere blodsukker
skal vaeligre foslashr det
giver foslashlger
Det vides ikke
hvilket
blodsukkerniveau
der er mest sikkert
Det vides ikke
hvor graelignsen
garingr mellem
skade ikke-
skade
Vi er alle
bange for at et
barn faringr
senfoslashlger efter
hypoglycaeligmi
Burns Patterns of cerebral injury and
neurodevelopmental outcomes after symptomatic neonatal
hypoglycemia Pediatrics 2008
bull Alle var symptomatiske ge 37deg 61 havde kramper
bull Median bs paring 10 mmoll 86 havde
bs le15 mmoll 1 el flere gange flest 1 doslashgn
bull Alle havde neurologisk dysfunktion indenfor 1 uge
bull 40 IUGR (flest asymmetriske)
bull Overvaeliggt af moslashdre med DM eller hypertension
bull Akut sectio pga barnet
18 mdr boslashrn med forbigaringende tidlig hypoglycaeligmi eller ingen kramper udviklede
sig normalt trods WM-skade undtaget 1 barn
Win Tin 2014 566 praeligmature 47 laeligngerevarende svaeligr hypoglycaeligmi
bull Samme udvikling som parrede kontrolboslashrn hhv 2 og 15 aringr efter
Hypoglykaeligmi kohorte
bull 404 boslashrn i risiko for hypoglykaeligmi foslashlges i 2 aringr 53
havde bs lt 26 mmoll
bull Standard glucosemaringling og kontinuerlig skjult glucose
maringling i de foslashrste 48 timer eller til stabilt blodsukker
bull Overraskende var der 23 der havde lavt blodsukker
uden at det blev opdaget
Udvikling ved 24 maringneder
bull Ingen signifikant forskel i neurologisk udvikling eller
problemloslashsningsevne
bull Det ses dog at boslashrn der laring hoslashjt i bs (gt4) de foslashrste 12 timer
efter et bs-fald fik laveste score i neurologisk udvikling
bull Det tyder paring at et stabilt middel blodsukker er maringletMcKinlay 2015
Normale boslashrn
bull Glucose er eacuten af mange energikilder
for det nyfoslashdte barn
bull Hoseth 2000 laveste blodsukker 14
mmoll 1 time efter foslashdslen median 31
mmol l (14 til 53)
bull Hapo studiet 2010 Mean 32 mmol plusmn
09
Normale hjaeliglpesystemer
bull Ketogenese Normale nyfoslashdte har en
optil 40 x kapacitet af en voksen til at
starte ketogenese som skaffer energi
til barnet
bull Laktat betragtes som rdquoskurkrdquo men er
ogsaring en stor energi kilde da 2 x lactat
= glucose
Processer og tilfoslashrsel via colostrum
bull Glycogenolyse = omdannelse af glycogen
bull Gluconeogenese = nydannelse af glucose
bull Lipolyse = omdannelse af fedt til frie fedtsyrer
bull Ketogenese = udnyttelse af frie fedtsyrer til energi
Colostrum indeholder
bull Oligosaccharider Laktat laktose
bull Fedtsyrer monoumaeligttet fedt fedtmolekyler er store
energitaeligtte og medbringer selv lipase
bull Aminosyrer og proteiner
bull Vaeligkstfaktorer til hurtig transport af naeligringsstoffer
HYPOGLYCAEligMI
Alternative tilgange
bull Neonatal Hypoglycaeligmi er ikke en egentlig diagnose men en
beskrivelse af en tilstand
bull En tilstand hvor barnets metaboliske tilpasningsevne er reduceret og
DERFOR faringr hypoglycaeligmi
bull Alle nyfoslashdte har en back-up plan i form af alternative energikilder nogle boslashrn dog i
reduceret grad og DE er i risiko for hypoglycaeligmiCornblathM HawdonJM
Controversies regarding definition of neonatal hypoglycemia
suggested operational thresholds Pediatrics 2000 105 5 1141-1145
Der sker rigtig meget lige nu paring det laeliggefaglige omraringde (Win Tin 2014) Nye
forslag er at
bull asymptomatiske boslashrn er hypoglycaeligmiske med et bs lt 20 ogsaring ved naeligste
maringling altsaring over laeligngere tid og ikke kun eacuten vaeligrdi
bull Der maring kun vaeligre eacuten maringling lt 10 behandles straks
bull Ved symptomer skal der ogsaring reageres med det samme v bslt 25
Deacutet er laeliggefaglige beslutninger som vi maringske faringr at se
Hvem er Risikoboslashrn
Halvdelen af boslashrnene i Sugar Baby study
udaf 514 risikoboslashrn havde
51 bs lt 26 20 lt 20
Fordelingen i grupperne er helt ens
bull 79 var asymptomatiske
bull 15 var for traeligtte til at sutte
bull 7 sitrede
Incidence of Neonatal Hypoglycemia in Babies Identified as at Risk
Deborah L Harris
2012 J of Pediatrics
Burde vi taelignke Hvad
er dette barns
specifikke evne til
metabolisk tilpasning
efter foslashdslen og
hvordan stoslashtter vi
barnet bedst paring
naturlig vis i denne
proces og stadig
forebygger skade
Saeligrlige risikoboslashrn
bull IUGR boslashrn kan vaeligre meget uforudsigelige Deres
pancreas kan vaeligre overaktiv og dermed udsende for
meget insulin og pancreas kan vaeligre haeligmmet
bull Saeligrlig de boslashrn der er asymmetriske i deres vaeligkst
Soslashgning af litteratur
En hurtig PubMed soslashgning giver foslashlgende
1Neonatal hypoglycemia 2404
2Breastfeeding 36873
3Colostrum 7435
1+2 70
1+3 3
Early feeding
bull Der er ingen enighed om definition paring Early Feeding
bull Hawdon rdquofoslashrhen sendte boslashrnene hurtigt maeliglken tilbage til den velmenende
afsenderrdquo
bull Early Feeding kan vaeligre tidlig hyppig amning sukkervand modermaeliglk
erstatning dextrosegel Maeligngde
bull Udover amning er der mange modeller og ingen af dem er evidensbaserede
bull I 2015-16 kommer der stadig artikler om neonatal hypoglycaeligmi der ikke
skriver om ernaeligring overhovedet
Modermaeliglkserstatning og hjaeliglpestoffer
De Rooyrsquos studie fra 2002 viser
bull I et prospektivt studie med i alt 165 boslashrn blev boslashrnenes ketogenese
undersoslashgt
bull Deacuten gruppe der er taeligttest paring en af vores maringlgrupper GDM er Large
for Gestational Age boslashrnene Her paringvises det med signifikant forskel
at amning oslashger ketogenesen og at amning + modermaeliglkserstatning
ikke har saring god respons
bull Flaskeboslashrn danner stort set ikke ketonstoffer i starten foslashrst efter 12
timer
Det kan antyde at mme reducerer barnets evne til
modregulering og selvhjaeliglp
At mme har bivirkningersideeffekter der bestemt ikke
er hensigtsmaeligssige naringr vi taler om forebyggelse
Guidelines hvor er vi
Unicef 2013
bull Alle hud mod hud lige efter foslashdslen
bull Amning indenfor den foslashrste time
bull Foslashrste bs tidligst efter 2 timer og foslashr andet maringltid
bull Ved lavt bs (graelignse 26 el 20) ammes igen eller udmalket maeliglk Ved
fortsat lavt bs efter 1 time gives mme i de maeligngder vi kender
Survey af neonatale hypoglykaeligmi guidelines i Australien og New
Zealand vha Unicef(Sundercombe 2014)
bull Kun 9 ud af 22 naeligvner hud mod hud lige efter foslashdslen
bull Kun enkelte naeligvner hjaeliglp til effektiv amning og information om tegn
paring spiselyst
bull Mere end halvdelen anbefaler supplering med mors udmalkede maeliglk
bull Kun 8 ud af 22 sikrer sig samtykke foslashr mme og info til foraeligldre om
aringrsag til suppleringen
Unicef hypoglycemia 2013
Forebyggelse i ammeperspektiv og Baby Friendly
Normoglycaeligmisk tilstand boslashr opnaringes med mindst mulig intervention
Konventionel tilgang
bull 60 mlkgdoslashgn mm el mme oslashges med
20 mlkgdoslashgn x 8(-12)
bull Vallecasein 4060 mme = nedsat
ventrikeltoslashmning
bull Vi maringler stadig 1 t bs
bull Ved lav bs oslashges til 125 eller 150
af maeligngden
bull Glucose-infusion
bull Adskillelse af mor og barn
Individuel tilgangABM Protocol 2014
bull 1-3 mlkg (optil 5 mlkg) gerne hver 2 time
(3-5 mlkg i 2006-udgaven)
bull Hurtig passage af mm alle hjaeliglpestoffer er
med Vallecasein 9010
Bergmann
bull mavesaeligkkens stoslashrrelse lige foslashr foslashdslen
drikker barnet ca 10 ml gang Refererer til
studier der angiver ventiklen til hhv 10 12
15 20 ml
bull Anbefaler smaring hyppige amninger
suppleringer saring barnet ikke stresses og
bruger mere glucose end det tilfoslashres
bull Ward-Platt Laktat er rdquothe good guyrdquo og et
veloxideret velcirkuleret barn har alle
muligheder for at kompensere
bull Antenatal udmalkning af raringmaeliglk til DM-
boslashrn
Forskellen i et forloslashb
DPS
3000 gram
bull 180 ml 1 doslashgn
(60kgdoslashgn)
bull bsdarr oslashges til 225 ml 24
timer
Svaeligrt at faring udmalket dette
som ekstra
ABM
3000 gram
bull 36 ml foslashrste doslashgn
1 mlkg maringltid = 3 x 12
bull 108 ml v 3 ml kgmaringltid
(reduktion paring 40 )
Opnaringeligt at udmalke dette
som ekstra
Mon der er forskel paring
antal amninger
Haringndudmalkning korrektinkorrekt
bull httpswwwyoutubecomwatchv=k6V9xTZAWq0
24
Hvordan forholder vi os til dette
bull Vi kan ikke aeligndre instrukser for hypoglycaeligmi haringndtering det
er en laeliggefaglig opgave kan vi alligevel goslashre en forskel i
profylaktisk oslashjemed
bull Har vi et ansvar for at vaeligre kritiske overfor gamle strategier
ndash og dermed assistere paeligdiatere i forebyggelsesarbejdet
bull Hvordan kan vi balancere forebyggelse og ikke-skade
princippet naringr det ogsaring drejer sig om naturlig ernaeligring mor-
barn kontakt og medicinske interventioner
bull Kan vi med vores viden om colostrum og naturlige
processers effekt aeligndre praksis for disse boslashrn
bull Hvordan kan vi som sundhedsprofessionelle oslashge antallet af
risikoboslashrn der tidligt faringr mors maeliglk selv om det ikke sutter
bull Hvordan vil det aeligndre vores praksisarbejde
bull Hvordan klaeligdes novicen og vi paring til en rdquoWatch and Waitrdquo
tilgang til hypoglycaeligmiforebyggelse
bull POCT eller lab-svar
Mon ikke hypoglycaeligmi forebyggelse kvalitativt kan
komme videre end i 2014
Tak fordi I lyttede
referencerbull CHERTOK IR RAZ I SHOHAM I HADDAD H and WIZNITZER A 2009 Journal of human
nutrition and dietetics the official journal of the British Dietetic Association 22(2) pp 166-169
bull CHRISTESEN HT and ESBERG G 2014-last update Hypoglykaeligmi flowcharts DPS Available
httpvipregionhdkVIPRedaktoer151637nsfvLookupUploadATTACH-RHAP-
9K2D8Y$FILEHypoglykC3A6mi20-20neonatal20Flowcharts20Maj202014pdf [0916
2014]
bull CORDERO L TREUER SH LANDON MB and GABBE SG 1998 Management of infants of
diabetic mothers Archives of Pediatrics amp Adolescent Medicine 152(3) pp 249-254
bull CORNBLATH M HAWDON JM WILLIAMS AF AYNSLEY-GREEN A WARD-PLATT MP
SCHWARTZ R and KALHAN SC 2000 Controversies regarding definition of neonatal
hypoglycemia suggested operational thresholds Pediatrics 105(5) pp 1141-1145
bull CSONT GL GROTH S HOPKINS P and GUILLET R 2014 An evidence-based approach to
breastfeeding neonates at risk for hypoglycemia Journal of obstetric gynecologic and neonatal
nursing JOGNN NAACOG 43(1) pp 71-81
bull DE ROOY L and HAWDON J 2002 Nutritional factors that affect the postnatal metabolic
adaptation of full-term small- and large-for-gestational-age infants Pediatrics 109(3) pp E42
bull DOBSON LZ VIBEKE 2011 God blodsukkerregulering kun for barnets skyld 25(nr 4) pp 36--
47
bull FLORES-LE ROUX JA SAGARRA E BENAIGES D HERNANDEZ-RIVAS E CHILLARON
JJ PUIG DE DOU J MUR A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2012 A
prospective evaluation of neonatal hypoglycaemia in infants of women with gestational diabetes
mellitus Diabetes research and clinical practice 97(2) pp 217-222
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull HARRIS DL WESTON PJ SIGNAL M CHASE JG and HARDING JE 2013 Dextrose gel for neonatal
hypoglycaemia (the Sugar Babies Study) a randomised double-blind placebo-controlled trial Lancet (London
England) 382(9910) pp 2077-2083
bull HERNANDEZ-RIVAS E FLORES-LE ROUX JA BENAIGES D SAGARRA E CHILLARON JJ PAYA A
PUIG-DE DOU J GODAY A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2013 Gestational diabetes in a
multiethnic population of Spain clinical characteristics and perinatal outcomes Diabetes research and clinical
practice 100(2) pp 215-221
bull HOSETH E JOERGENSEN A EBBESEN F and MOELLER M 2000 Blood glucose levels in a population of
healthy breast fed term infants of appropriate size for gestational age Archives of disease in childhoodFetal and
neonatal edition 83(2) pp F117-9
bull JENSEN DM SORENSEN B FEILBERG-JORGENSEN N WESTERGAARD JG and BECK-NIELSEN H
2000 Maternal and perinatal outcomes in 143 Danish women with gestational diabetes mellitus and 143 controls with
a similar risk profile Diabetic medicine a journal of the British Diabetic Association 17(4) pp 281-286
bull MAAYAN-METZGER A LUBIN D and KUINT J 2009 Hypoglycemia rates in the first days of life among term
infants born to diabetic mothers Neonatology 96(2) pp 80-85
bull MAAYAN-METZGER A SCHUSHAN-EISEN I LUBIN D MORAN O KUINT J and MAZKERETH R 2014
Delivery room breastfeeding for prevention of hypoglycaemia in infants of diabetic mothers Fetal and pediatric
pathology 33(1) pp 23-28
bull MCKINLAY CEA 2015 neonatal hypoglycemia and neurodevelopment outcomes at 2 years N Engl J Med(373)
pp 1507-18
bull METZGER BE PERSSON B LOWE LP DYER AR CRUICKSHANK JK DEEROCHANAWONG C
HALLIDAY HL HENNIS AJ LILEY H NG PC COUSTAN DR HADDEN DR HOD M OATS JJ
TRIMBLE ER and HAPO STUDY COOPERATIVE RESEARCH GROUP 2010 Hyperglycemia and adverse
pregnancy outcome study neonatal glycemia Pediatrics 126(6) pp e1545-52
bull ROZANCE PJ and HAY WWJR 2012 Neonatal hypoglycemia--answers but more questions The Journal of
pediatrics 161(5) pp 775-776
bull SARKAR S WATMAN J SEIGEL WM and SCHAEFFER HA 2003 A prospective controlled study of neonatal
morbidities in infants born at 36 weeks or more gestation to Women with diet-controlled gestational diabetes (GDM-
class Al) Journal of perinatology official journal of the California Perinatal Association 23(3) pp 223-228
bull SOLTANI H DICKINSON FM KALK J and PAYNE K 2008 Breast feeding
practices and views among diabetic women a retrospective cohort study Midwifery
24(4) pp 471-479
bull TOZIER P 2013 Colostrum Versus Formula Supplentation for Glucose Stabilization in
Newborns of Diabetic Mothers 42(JOGNN The association of Womens Health
Obstetric and Neonatal Nurses) pp 619-628
bull VAN HOWE RS and STORMS MR 2008 Blood glucose determinations in large for
gestational age infants American Journal of Perinatology 25(5) pp 283-289
bull WIGHT N MARINELLI KA and ACADEMY OF BREASTFEEDING MEDICINE
PROTOCOL COMMITTEE 2006 ABM clinical protocol 1 guidelines for glucose
monitoring and treatment of hypoglycemia in breastfed neonates Breastfeeding
medicine the official journal of the Academy of Breastfeeding Medicine 1(3) pp 178-
184
bull VANHALTREN K and MALHOTRA A 2013 Characteristics of infants at risk of
hypoglycaemia secondary to being infant of a diabetic mother Journal of pediatric
endocrinology amp metabolism JPEM 26(9-10) pp 861-865
bull WIGHT NE 2014 Hypoglycemia in breastfed neonates Breastfeeding medicine the
official journal of the Academy of Breastfeeding Medicine 9(4) pp 173-179
bull DALSGAARD B and ECK K 2013-last update Klinisk retningslinje for
nonfarmakologisk forebyggelse af neonatal hypoglycaeligmi og energitab hos nyfoslashdte af
moslashdre med diaeligtbehandlet gestationel diabetes Available
httpwwwkliniskeretningslinjerdkimages88_gdm_godkendt_010713pdf [0917 2014]
hypoglycaeligmibull
bull BRAGG JJ GREEN R and HOLZMAN IR 2013 Does early enteral feeding prevent
hypoglycemia in small for gestational age neonates Journal of neonatal-perinatal medicine 6(2)
pp 131-135
bull HARRIS DL WESTON PJ and HARDING JE 2014 Lactate rather than ketones may provide
alternative cerebral fuel in hypoglycaemic newborns Archives of disease in childhoodFetal and
neonatal edition
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull LANG TF and HUSSAIN K 2014 Pediatric hypoglycemia Advances in Clinical Chemistry 63
pp 211-245
bull MITANCHEZ D BURGUET A and SIMEONI U 2014 Infants born to mothers with gestational
diabetes mellitus mild neonatal effects a long-term threat to global health The Journal of pediatrics
164(3) pp 445-450
bull SUNDERCOMBE SL RAYNES-GREENOW CH TURNER RM and JEFFERY HE 2014 Do
neonatal hypoglycaemia guidelines in Australia and New Zealand facilitate breast feeding
Midwifery 30(12) pp 1179-1186
bull TAM EW HAEUSSLEIN LA BONIFACIO SL GLASS HC ROGERS EE JEREMY RJ
BARKOVICH AJ and FERRIERO DM 2012 Hypoglycemia is associated with increased risk for
brain injury and adverse neurodevelopmental outcome in neonates at risk for encephalopathy The
Journal of pediatrics 161(1) pp 88-93
bull UNICEF 2013 hypoglycaemia guidance july 2013 UNICEF
Kilder tilfoslashjet 2016
bull AGHDAS K TALAT K and SEPIDEH B 2014 Effect of immediate and continuous mother-infant
skin-to-skin contact on breastfeeding self-efficacy of primiparous women a randomised control trial
Women and birth journal of the Australian College of Midwives 27(1) pp 37-40
bull BEIRANVAND S VALIZADEH F HOSSEINABADI R and POURNIA Y 2014 The Effects of
Skin-to-Skin Contact on Temperature and Breastfeeding Successfulness in Full-Term Newborns
after Cesarean Delivery International journal of pediatrics 2014 pp 846486
bull FENGER-GRON J FENGER-GRON M BLUNCK CH SCHONEMANN-RIGEL H and
WIELANDT HB 2015 Low breastfeeding rates and body mass index in Danish children of women
with gestational diabetes mellitus International breastfeeding journal 10 pp 26-015-0051-8
eCollection 2015
bull JAGIELLO KP and AZULAY CHERTOK IR 2015 Womens Experiences With Early
Breastfeeding After Gestational Diabetes Journal of obstetric gynecologic and neonatal nursing
JOGNN NAACOG 44(4) pp 500-509
bull SAMAYAM P RANGANATHAN PK KOTARI UD and BALASUNDARAM R 2015 Study of
Asymptomatic Hypoglycemia in Full Term Exclusively Breastfed Neonates in First 48 Hours of Life
Journal of clinical and diagnostic research JCDR 9(9) pp SC07-10
bull SOBREVIA L SALSOSO R SAEZ T SANHUEZA C PARDO F and LEIVA A 2015 Insulin
therapy and fetoplacental vascular function in gestational diabetes mellitus Experimental physiology
100(3) pp 231-238
bull STEWART CE SAGE EL and REYNOLDS P 2015 Supporting Baby Friendly a quality
improvement initiative for the management of transitional neonatal hypoglycaemia Archives of
disease in childhoodFetal and neonatal edition
bull
Burns Patterns of cerebral injury and
neurodevelopmental outcomes after symptomatic neonatal
hypoglycemia Pediatrics 2008
bull Alle var symptomatiske ge 37deg 61 havde kramper
bull Median bs paring 10 mmoll 86 havde
bs le15 mmoll 1 el flere gange flest 1 doslashgn
bull Alle havde neurologisk dysfunktion indenfor 1 uge
bull 40 IUGR (flest asymmetriske)
bull Overvaeliggt af moslashdre med DM eller hypertension
bull Akut sectio pga barnet
18 mdr boslashrn med forbigaringende tidlig hypoglycaeligmi eller ingen kramper udviklede
sig normalt trods WM-skade undtaget 1 barn
Win Tin 2014 566 praeligmature 47 laeligngerevarende svaeligr hypoglycaeligmi
bull Samme udvikling som parrede kontrolboslashrn hhv 2 og 15 aringr efter
Hypoglykaeligmi kohorte
bull 404 boslashrn i risiko for hypoglykaeligmi foslashlges i 2 aringr 53
havde bs lt 26 mmoll
bull Standard glucosemaringling og kontinuerlig skjult glucose
maringling i de foslashrste 48 timer eller til stabilt blodsukker
bull Overraskende var der 23 der havde lavt blodsukker
uden at det blev opdaget
Udvikling ved 24 maringneder
bull Ingen signifikant forskel i neurologisk udvikling eller
problemloslashsningsevne
bull Det ses dog at boslashrn der laring hoslashjt i bs (gt4) de foslashrste 12 timer
efter et bs-fald fik laveste score i neurologisk udvikling
bull Det tyder paring at et stabilt middel blodsukker er maringletMcKinlay 2015
Normale boslashrn
bull Glucose er eacuten af mange energikilder
for det nyfoslashdte barn
bull Hoseth 2000 laveste blodsukker 14
mmoll 1 time efter foslashdslen median 31
mmol l (14 til 53)
bull Hapo studiet 2010 Mean 32 mmol plusmn
09
Normale hjaeliglpesystemer
bull Ketogenese Normale nyfoslashdte har en
optil 40 x kapacitet af en voksen til at
starte ketogenese som skaffer energi
til barnet
bull Laktat betragtes som rdquoskurkrdquo men er
ogsaring en stor energi kilde da 2 x lactat
= glucose
Processer og tilfoslashrsel via colostrum
bull Glycogenolyse = omdannelse af glycogen
bull Gluconeogenese = nydannelse af glucose
bull Lipolyse = omdannelse af fedt til frie fedtsyrer
bull Ketogenese = udnyttelse af frie fedtsyrer til energi
Colostrum indeholder
bull Oligosaccharider Laktat laktose
bull Fedtsyrer monoumaeligttet fedt fedtmolekyler er store
energitaeligtte og medbringer selv lipase
bull Aminosyrer og proteiner
bull Vaeligkstfaktorer til hurtig transport af naeligringsstoffer
HYPOGLYCAEligMI
Alternative tilgange
bull Neonatal Hypoglycaeligmi er ikke en egentlig diagnose men en
beskrivelse af en tilstand
bull En tilstand hvor barnets metaboliske tilpasningsevne er reduceret og
DERFOR faringr hypoglycaeligmi
bull Alle nyfoslashdte har en back-up plan i form af alternative energikilder nogle boslashrn dog i
reduceret grad og DE er i risiko for hypoglycaeligmiCornblathM HawdonJM
Controversies regarding definition of neonatal hypoglycemia
suggested operational thresholds Pediatrics 2000 105 5 1141-1145
Der sker rigtig meget lige nu paring det laeliggefaglige omraringde (Win Tin 2014) Nye
forslag er at
bull asymptomatiske boslashrn er hypoglycaeligmiske med et bs lt 20 ogsaring ved naeligste
maringling altsaring over laeligngere tid og ikke kun eacuten vaeligrdi
bull Der maring kun vaeligre eacuten maringling lt 10 behandles straks
bull Ved symptomer skal der ogsaring reageres med det samme v bslt 25
Deacutet er laeliggefaglige beslutninger som vi maringske faringr at se
Hvem er Risikoboslashrn
Halvdelen af boslashrnene i Sugar Baby study
udaf 514 risikoboslashrn havde
51 bs lt 26 20 lt 20
Fordelingen i grupperne er helt ens
bull 79 var asymptomatiske
bull 15 var for traeligtte til at sutte
bull 7 sitrede
Incidence of Neonatal Hypoglycemia in Babies Identified as at Risk
Deborah L Harris
2012 J of Pediatrics
Burde vi taelignke Hvad
er dette barns
specifikke evne til
metabolisk tilpasning
efter foslashdslen og
hvordan stoslashtter vi
barnet bedst paring
naturlig vis i denne
proces og stadig
forebygger skade
Saeligrlige risikoboslashrn
bull IUGR boslashrn kan vaeligre meget uforudsigelige Deres
pancreas kan vaeligre overaktiv og dermed udsende for
meget insulin og pancreas kan vaeligre haeligmmet
bull Saeligrlig de boslashrn der er asymmetriske i deres vaeligkst
Soslashgning af litteratur
En hurtig PubMed soslashgning giver foslashlgende
1Neonatal hypoglycemia 2404
2Breastfeeding 36873
3Colostrum 7435
1+2 70
1+3 3
Early feeding
bull Der er ingen enighed om definition paring Early Feeding
bull Hawdon rdquofoslashrhen sendte boslashrnene hurtigt maeliglken tilbage til den velmenende
afsenderrdquo
bull Early Feeding kan vaeligre tidlig hyppig amning sukkervand modermaeliglk
erstatning dextrosegel Maeligngde
bull Udover amning er der mange modeller og ingen af dem er evidensbaserede
bull I 2015-16 kommer der stadig artikler om neonatal hypoglycaeligmi der ikke
skriver om ernaeligring overhovedet
Modermaeliglkserstatning og hjaeliglpestoffer
De Rooyrsquos studie fra 2002 viser
bull I et prospektivt studie med i alt 165 boslashrn blev boslashrnenes ketogenese
undersoslashgt
bull Deacuten gruppe der er taeligttest paring en af vores maringlgrupper GDM er Large
for Gestational Age boslashrnene Her paringvises det med signifikant forskel
at amning oslashger ketogenesen og at amning + modermaeliglkserstatning
ikke har saring god respons
bull Flaskeboslashrn danner stort set ikke ketonstoffer i starten foslashrst efter 12
timer
Det kan antyde at mme reducerer barnets evne til
modregulering og selvhjaeliglp
At mme har bivirkningersideeffekter der bestemt ikke
er hensigtsmaeligssige naringr vi taler om forebyggelse
Guidelines hvor er vi
Unicef 2013
bull Alle hud mod hud lige efter foslashdslen
bull Amning indenfor den foslashrste time
bull Foslashrste bs tidligst efter 2 timer og foslashr andet maringltid
bull Ved lavt bs (graelignse 26 el 20) ammes igen eller udmalket maeliglk Ved
fortsat lavt bs efter 1 time gives mme i de maeligngder vi kender
Survey af neonatale hypoglykaeligmi guidelines i Australien og New
Zealand vha Unicef(Sundercombe 2014)
bull Kun 9 ud af 22 naeligvner hud mod hud lige efter foslashdslen
bull Kun enkelte naeligvner hjaeliglp til effektiv amning og information om tegn
paring spiselyst
bull Mere end halvdelen anbefaler supplering med mors udmalkede maeliglk
bull Kun 8 ud af 22 sikrer sig samtykke foslashr mme og info til foraeligldre om
aringrsag til suppleringen
Unicef hypoglycemia 2013
Forebyggelse i ammeperspektiv og Baby Friendly
Normoglycaeligmisk tilstand boslashr opnaringes med mindst mulig intervention
Konventionel tilgang
bull 60 mlkgdoslashgn mm el mme oslashges med
20 mlkgdoslashgn x 8(-12)
bull Vallecasein 4060 mme = nedsat
ventrikeltoslashmning
bull Vi maringler stadig 1 t bs
bull Ved lav bs oslashges til 125 eller 150
af maeligngden
bull Glucose-infusion
bull Adskillelse af mor og barn
Individuel tilgangABM Protocol 2014
bull 1-3 mlkg (optil 5 mlkg) gerne hver 2 time
(3-5 mlkg i 2006-udgaven)
bull Hurtig passage af mm alle hjaeliglpestoffer er
med Vallecasein 9010
Bergmann
bull mavesaeligkkens stoslashrrelse lige foslashr foslashdslen
drikker barnet ca 10 ml gang Refererer til
studier der angiver ventiklen til hhv 10 12
15 20 ml
bull Anbefaler smaring hyppige amninger
suppleringer saring barnet ikke stresses og
bruger mere glucose end det tilfoslashres
bull Ward-Platt Laktat er rdquothe good guyrdquo og et
veloxideret velcirkuleret barn har alle
muligheder for at kompensere
bull Antenatal udmalkning af raringmaeliglk til DM-
boslashrn
Forskellen i et forloslashb
DPS
3000 gram
bull 180 ml 1 doslashgn
(60kgdoslashgn)
bull bsdarr oslashges til 225 ml 24
timer
Svaeligrt at faring udmalket dette
som ekstra
ABM
3000 gram
bull 36 ml foslashrste doslashgn
1 mlkg maringltid = 3 x 12
bull 108 ml v 3 ml kgmaringltid
(reduktion paring 40 )
Opnaringeligt at udmalke dette
som ekstra
Mon der er forskel paring
antal amninger
Haringndudmalkning korrektinkorrekt
bull httpswwwyoutubecomwatchv=k6V9xTZAWq0
24
Hvordan forholder vi os til dette
bull Vi kan ikke aeligndre instrukser for hypoglycaeligmi haringndtering det
er en laeliggefaglig opgave kan vi alligevel goslashre en forskel i
profylaktisk oslashjemed
bull Har vi et ansvar for at vaeligre kritiske overfor gamle strategier
ndash og dermed assistere paeligdiatere i forebyggelsesarbejdet
bull Hvordan kan vi balancere forebyggelse og ikke-skade
princippet naringr det ogsaring drejer sig om naturlig ernaeligring mor-
barn kontakt og medicinske interventioner
bull Kan vi med vores viden om colostrum og naturlige
processers effekt aeligndre praksis for disse boslashrn
bull Hvordan kan vi som sundhedsprofessionelle oslashge antallet af
risikoboslashrn der tidligt faringr mors maeliglk selv om det ikke sutter
bull Hvordan vil det aeligndre vores praksisarbejde
bull Hvordan klaeligdes novicen og vi paring til en rdquoWatch and Waitrdquo
tilgang til hypoglycaeligmiforebyggelse
bull POCT eller lab-svar
Mon ikke hypoglycaeligmi forebyggelse kvalitativt kan
komme videre end i 2014
Tak fordi I lyttede
referencerbull CHERTOK IR RAZ I SHOHAM I HADDAD H and WIZNITZER A 2009 Journal of human
nutrition and dietetics the official journal of the British Dietetic Association 22(2) pp 166-169
bull CHRISTESEN HT and ESBERG G 2014-last update Hypoglykaeligmi flowcharts DPS Available
httpvipregionhdkVIPRedaktoer151637nsfvLookupUploadATTACH-RHAP-
9K2D8Y$FILEHypoglykC3A6mi20-20neonatal20Flowcharts20Maj202014pdf [0916
2014]
bull CORDERO L TREUER SH LANDON MB and GABBE SG 1998 Management of infants of
diabetic mothers Archives of Pediatrics amp Adolescent Medicine 152(3) pp 249-254
bull CORNBLATH M HAWDON JM WILLIAMS AF AYNSLEY-GREEN A WARD-PLATT MP
SCHWARTZ R and KALHAN SC 2000 Controversies regarding definition of neonatal
hypoglycemia suggested operational thresholds Pediatrics 105(5) pp 1141-1145
bull CSONT GL GROTH S HOPKINS P and GUILLET R 2014 An evidence-based approach to
breastfeeding neonates at risk for hypoglycemia Journal of obstetric gynecologic and neonatal
nursing JOGNN NAACOG 43(1) pp 71-81
bull DE ROOY L and HAWDON J 2002 Nutritional factors that affect the postnatal metabolic
adaptation of full-term small- and large-for-gestational-age infants Pediatrics 109(3) pp E42
bull DOBSON LZ VIBEKE 2011 God blodsukkerregulering kun for barnets skyld 25(nr 4) pp 36--
47
bull FLORES-LE ROUX JA SAGARRA E BENAIGES D HERNANDEZ-RIVAS E CHILLARON
JJ PUIG DE DOU J MUR A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2012 A
prospective evaluation of neonatal hypoglycaemia in infants of women with gestational diabetes
mellitus Diabetes research and clinical practice 97(2) pp 217-222
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull HARRIS DL WESTON PJ SIGNAL M CHASE JG and HARDING JE 2013 Dextrose gel for neonatal
hypoglycaemia (the Sugar Babies Study) a randomised double-blind placebo-controlled trial Lancet (London
England) 382(9910) pp 2077-2083
bull HERNANDEZ-RIVAS E FLORES-LE ROUX JA BENAIGES D SAGARRA E CHILLARON JJ PAYA A
PUIG-DE DOU J GODAY A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2013 Gestational diabetes in a
multiethnic population of Spain clinical characteristics and perinatal outcomes Diabetes research and clinical
practice 100(2) pp 215-221
bull HOSETH E JOERGENSEN A EBBESEN F and MOELLER M 2000 Blood glucose levels in a population of
healthy breast fed term infants of appropriate size for gestational age Archives of disease in childhoodFetal and
neonatal edition 83(2) pp F117-9
bull JENSEN DM SORENSEN B FEILBERG-JORGENSEN N WESTERGAARD JG and BECK-NIELSEN H
2000 Maternal and perinatal outcomes in 143 Danish women with gestational diabetes mellitus and 143 controls with
a similar risk profile Diabetic medicine a journal of the British Diabetic Association 17(4) pp 281-286
bull MAAYAN-METZGER A LUBIN D and KUINT J 2009 Hypoglycemia rates in the first days of life among term
infants born to diabetic mothers Neonatology 96(2) pp 80-85
bull MAAYAN-METZGER A SCHUSHAN-EISEN I LUBIN D MORAN O KUINT J and MAZKERETH R 2014
Delivery room breastfeeding for prevention of hypoglycaemia in infants of diabetic mothers Fetal and pediatric
pathology 33(1) pp 23-28
bull MCKINLAY CEA 2015 neonatal hypoglycemia and neurodevelopment outcomes at 2 years N Engl J Med(373)
pp 1507-18
bull METZGER BE PERSSON B LOWE LP DYER AR CRUICKSHANK JK DEEROCHANAWONG C
HALLIDAY HL HENNIS AJ LILEY H NG PC COUSTAN DR HADDEN DR HOD M OATS JJ
TRIMBLE ER and HAPO STUDY COOPERATIVE RESEARCH GROUP 2010 Hyperglycemia and adverse
pregnancy outcome study neonatal glycemia Pediatrics 126(6) pp e1545-52
bull ROZANCE PJ and HAY WWJR 2012 Neonatal hypoglycemia--answers but more questions The Journal of
pediatrics 161(5) pp 775-776
bull SARKAR S WATMAN J SEIGEL WM and SCHAEFFER HA 2003 A prospective controlled study of neonatal
morbidities in infants born at 36 weeks or more gestation to Women with diet-controlled gestational diabetes (GDM-
class Al) Journal of perinatology official journal of the California Perinatal Association 23(3) pp 223-228
bull SOLTANI H DICKINSON FM KALK J and PAYNE K 2008 Breast feeding
practices and views among diabetic women a retrospective cohort study Midwifery
24(4) pp 471-479
bull TOZIER P 2013 Colostrum Versus Formula Supplentation for Glucose Stabilization in
Newborns of Diabetic Mothers 42(JOGNN The association of Womens Health
Obstetric and Neonatal Nurses) pp 619-628
bull VAN HOWE RS and STORMS MR 2008 Blood glucose determinations in large for
gestational age infants American Journal of Perinatology 25(5) pp 283-289
bull WIGHT N MARINELLI KA and ACADEMY OF BREASTFEEDING MEDICINE
PROTOCOL COMMITTEE 2006 ABM clinical protocol 1 guidelines for glucose
monitoring and treatment of hypoglycemia in breastfed neonates Breastfeeding
medicine the official journal of the Academy of Breastfeeding Medicine 1(3) pp 178-
184
bull VANHALTREN K and MALHOTRA A 2013 Characteristics of infants at risk of
hypoglycaemia secondary to being infant of a diabetic mother Journal of pediatric
endocrinology amp metabolism JPEM 26(9-10) pp 861-865
bull WIGHT NE 2014 Hypoglycemia in breastfed neonates Breastfeeding medicine the
official journal of the Academy of Breastfeeding Medicine 9(4) pp 173-179
bull DALSGAARD B and ECK K 2013-last update Klinisk retningslinje for
nonfarmakologisk forebyggelse af neonatal hypoglycaeligmi og energitab hos nyfoslashdte af
moslashdre med diaeligtbehandlet gestationel diabetes Available
httpwwwkliniskeretningslinjerdkimages88_gdm_godkendt_010713pdf [0917 2014]
hypoglycaeligmibull
bull BRAGG JJ GREEN R and HOLZMAN IR 2013 Does early enteral feeding prevent
hypoglycemia in small for gestational age neonates Journal of neonatal-perinatal medicine 6(2)
pp 131-135
bull HARRIS DL WESTON PJ and HARDING JE 2014 Lactate rather than ketones may provide
alternative cerebral fuel in hypoglycaemic newborns Archives of disease in childhoodFetal and
neonatal edition
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull LANG TF and HUSSAIN K 2014 Pediatric hypoglycemia Advances in Clinical Chemistry 63
pp 211-245
bull MITANCHEZ D BURGUET A and SIMEONI U 2014 Infants born to mothers with gestational
diabetes mellitus mild neonatal effects a long-term threat to global health The Journal of pediatrics
164(3) pp 445-450
bull SUNDERCOMBE SL RAYNES-GREENOW CH TURNER RM and JEFFERY HE 2014 Do
neonatal hypoglycaemia guidelines in Australia and New Zealand facilitate breast feeding
Midwifery 30(12) pp 1179-1186
bull TAM EW HAEUSSLEIN LA BONIFACIO SL GLASS HC ROGERS EE JEREMY RJ
BARKOVICH AJ and FERRIERO DM 2012 Hypoglycemia is associated with increased risk for
brain injury and adverse neurodevelopmental outcome in neonates at risk for encephalopathy The
Journal of pediatrics 161(1) pp 88-93
bull UNICEF 2013 hypoglycaemia guidance july 2013 UNICEF
Kilder tilfoslashjet 2016
bull AGHDAS K TALAT K and SEPIDEH B 2014 Effect of immediate and continuous mother-infant
skin-to-skin contact on breastfeeding self-efficacy of primiparous women a randomised control trial
Women and birth journal of the Australian College of Midwives 27(1) pp 37-40
bull BEIRANVAND S VALIZADEH F HOSSEINABADI R and POURNIA Y 2014 The Effects of
Skin-to-Skin Contact on Temperature and Breastfeeding Successfulness in Full-Term Newborns
after Cesarean Delivery International journal of pediatrics 2014 pp 846486
bull FENGER-GRON J FENGER-GRON M BLUNCK CH SCHONEMANN-RIGEL H and
WIELANDT HB 2015 Low breastfeeding rates and body mass index in Danish children of women
with gestational diabetes mellitus International breastfeeding journal 10 pp 26-015-0051-8
eCollection 2015
bull JAGIELLO KP and AZULAY CHERTOK IR 2015 Womens Experiences With Early
Breastfeeding After Gestational Diabetes Journal of obstetric gynecologic and neonatal nursing
JOGNN NAACOG 44(4) pp 500-509
bull SAMAYAM P RANGANATHAN PK KOTARI UD and BALASUNDARAM R 2015 Study of
Asymptomatic Hypoglycemia in Full Term Exclusively Breastfed Neonates in First 48 Hours of Life
Journal of clinical and diagnostic research JCDR 9(9) pp SC07-10
bull SOBREVIA L SALSOSO R SAEZ T SANHUEZA C PARDO F and LEIVA A 2015 Insulin
therapy and fetoplacental vascular function in gestational diabetes mellitus Experimental physiology
100(3) pp 231-238
bull STEWART CE SAGE EL and REYNOLDS P 2015 Supporting Baby Friendly a quality
improvement initiative for the management of transitional neonatal hypoglycaemia Archives of
disease in childhoodFetal and neonatal edition
bull
Hypoglykaeligmi kohorte
bull 404 boslashrn i risiko for hypoglykaeligmi foslashlges i 2 aringr 53
havde bs lt 26 mmoll
bull Standard glucosemaringling og kontinuerlig skjult glucose
maringling i de foslashrste 48 timer eller til stabilt blodsukker
bull Overraskende var der 23 der havde lavt blodsukker
uden at det blev opdaget
Udvikling ved 24 maringneder
bull Ingen signifikant forskel i neurologisk udvikling eller
problemloslashsningsevne
bull Det ses dog at boslashrn der laring hoslashjt i bs (gt4) de foslashrste 12 timer
efter et bs-fald fik laveste score i neurologisk udvikling
bull Det tyder paring at et stabilt middel blodsukker er maringletMcKinlay 2015
Normale boslashrn
bull Glucose er eacuten af mange energikilder
for det nyfoslashdte barn
bull Hoseth 2000 laveste blodsukker 14
mmoll 1 time efter foslashdslen median 31
mmol l (14 til 53)
bull Hapo studiet 2010 Mean 32 mmol plusmn
09
Normale hjaeliglpesystemer
bull Ketogenese Normale nyfoslashdte har en
optil 40 x kapacitet af en voksen til at
starte ketogenese som skaffer energi
til barnet
bull Laktat betragtes som rdquoskurkrdquo men er
ogsaring en stor energi kilde da 2 x lactat
= glucose
Processer og tilfoslashrsel via colostrum
bull Glycogenolyse = omdannelse af glycogen
bull Gluconeogenese = nydannelse af glucose
bull Lipolyse = omdannelse af fedt til frie fedtsyrer
bull Ketogenese = udnyttelse af frie fedtsyrer til energi
Colostrum indeholder
bull Oligosaccharider Laktat laktose
bull Fedtsyrer monoumaeligttet fedt fedtmolekyler er store
energitaeligtte og medbringer selv lipase
bull Aminosyrer og proteiner
bull Vaeligkstfaktorer til hurtig transport af naeligringsstoffer
HYPOGLYCAEligMI
Alternative tilgange
bull Neonatal Hypoglycaeligmi er ikke en egentlig diagnose men en
beskrivelse af en tilstand
bull En tilstand hvor barnets metaboliske tilpasningsevne er reduceret og
DERFOR faringr hypoglycaeligmi
bull Alle nyfoslashdte har en back-up plan i form af alternative energikilder nogle boslashrn dog i
reduceret grad og DE er i risiko for hypoglycaeligmiCornblathM HawdonJM
Controversies regarding definition of neonatal hypoglycemia
suggested operational thresholds Pediatrics 2000 105 5 1141-1145
Der sker rigtig meget lige nu paring det laeliggefaglige omraringde (Win Tin 2014) Nye
forslag er at
bull asymptomatiske boslashrn er hypoglycaeligmiske med et bs lt 20 ogsaring ved naeligste
maringling altsaring over laeligngere tid og ikke kun eacuten vaeligrdi
bull Der maring kun vaeligre eacuten maringling lt 10 behandles straks
bull Ved symptomer skal der ogsaring reageres med det samme v bslt 25
Deacutet er laeliggefaglige beslutninger som vi maringske faringr at se
Hvem er Risikoboslashrn
Halvdelen af boslashrnene i Sugar Baby study
udaf 514 risikoboslashrn havde
51 bs lt 26 20 lt 20
Fordelingen i grupperne er helt ens
bull 79 var asymptomatiske
bull 15 var for traeligtte til at sutte
bull 7 sitrede
Incidence of Neonatal Hypoglycemia in Babies Identified as at Risk
Deborah L Harris
2012 J of Pediatrics
Burde vi taelignke Hvad
er dette barns
specifikke evne til
metabolisk tilpasning
efter foslashdslen og
hvordan stoslashtter vi
barnet bedst paring
naturlig vis i denne
proces og stadig
forebygger skade
Saeligrlige risikoboslashrn
bull IUGR boslashrn kan vaeligre meget uforudsigelige Deres
pancreas kan vaeligre overaktiv og dermed udsende for
meget insulin og pancreas kan vaeligre haeligmmet
bull Saeligrlig de boslashrn der er asymmetriske i deres vaeligkst
Soslashgning af litteratur
En hurtig PubMed soslashgning giver foslashlgende
1Neonatal hypoglycemia 2404
2Breastfeeding 36873
3Colostrum 7435
1+2 70
1+3 3
Early feeding
bull Der er ingen enighed om definition paring Early Feeding
bull Hawdon rdquofoslashrhen sendte boslashrnene hurtigt maeliglken tilbage til den velmenende
afsenderrdquo
bull Early Feeding kan vaeligre tidlig hyppig amning sukkervand modermaeliglk
erstatning dextrosegel Maeligngde
bull Udover amning er der mange modeller og ingen af dem er evidensbaserede
bull I 2015-16 kommer der stadig artikler om neonatal hypoglycaeligmi der ikke
skriver om ernaeligring overhovedet
Modermaeliglkserstatning og hjaeliglpestoffer
De Rooyrsquos studie fra 2002 viser
bull I et prospektivt studie med i alt 165 boslashrn blev boslashrnenes ketogenese
undersoslashgt
bull Deacuten gruppe der er taeligttest paring en af vores maringlgrupper GDM er Large
for Gestational Age boslashrnene Her paringvises det med signifikant forskel
at amning oslashger ketogenesen og at amning + modermaeliglkserstatning
ikke har saring god respons
bull Flaskeboslashrn danner stort set ikke ketonstoffer i starten foslashrst efter 12
timer
Det kan antyde at mme reducerer barnets evne til
modregulering og selvhjaeliglp
At mme har bivirkningersideeffekter der bestemt ikke
er hensigtsmaeligssige naringr vi taler om forebyggelse
Guidelines hvor er vi
Unicef 2013
bull Alle hud mod hud lige efter foslashdslen
bull Amning indenfor den foslashrste time
bull Foslashrste bs tidligst efter 2 timer og foslashr andet maringltid
bull Ved lavt bs (graelignse 26 el 20) ammes igen eller udmalket maeliglk Ved
fortsat lavt bs efter 1 time gives mme i de maeligngder vi kender
Survey af neonatale hypoglykaeligmi guidelines i Australien og New
Zealand vha Unicef(Sundercombe 2014)
bull Kun 9 ud af 22 naeligvner hud mod hud lige efter foslashdslen
bull Kun enkelte naeligvner hjaeliglp til effektiv amning og information om tegn
paring spiselyst
bull Mere end halvdelen anbefaler supplering med mors udmalkede maeliglk
bull Kun 8 ud af 22 sikrer sig samtykke foslashr mme og info til foraeligldre om
aringrsag til suppleringen
Unicef hypoglycemia 2013
Forebyggelse i ammeperspektiv og Baby Friendly
Normoglycaeligmisk tilstand boslashr opnaringes med mindst mulig intervention
Konventionel tilgang
bull 60 mlkgdoslashgn mm el mme oslashges med
20 mlkgdoslashgn x 8(-12)
bull Vallecasein 4060 mme = nedsat
ventrikeltoslashmning
bull Vi maringler stadig 1 t bs
bull Ved lav bs oslashges til 125 eller 150
af maeligngden
bull Glucose-infusion
bull Adskillelse af mor og barn
Individuel tilgangABM Protocol 2014
bull 1-3 mlkg (optil 5 mlkg) gerne hver 2 time
(3-5 mlkg i 2006-udgaven)
bull Hurtig passage af mm alle hjaeliglpestoffer er
med Vallecasein 9010
Bergmann
bull mavesaeligkkens stoslashrrelse lige foslashr foslashdslen
drikker barnet ca 10 ml gang Refererer til
studier der angiver ventiklen til hhv 10 12
15 20 ml
bull Anbefaler smaring hyppige amninger
suppleringer saring barnet ikke stresses og
bruger mere glucose end det tilfoslashres
bull Ward-Platt Laktat er rdquothe good guyrdquo og et
veloxideret velcirkuleret barn har alle
muligheder for at kompensere
bull Antenatal udmalkning af raringmaeliglk til DM-
boslashrn
Forskellen i et forloslashb
DPS
3000 gram
bull 180 ml 1 doslashgn
(60kgdoslashgn)
bull bsdarr oslashges til 225 ml 24
timer
Svaeligrt at faring udmalket dette
som ekstra
ABM
3000 gram
bull 36 ml foslashrste doslashgn
1 mlkg maringltid = 3 x 12
bull 108 ml v 3 ml kgmaringltid
(reduktion paring 40 )
Opnaringeligt at udmalke dette
som ekstra
Mon der er forskel paring
antal amninger
Haringndudmalkning korrektinkorrekt
bull httpswwwyoutubecomwatchv=k6V9xTZAWq0
24
Hvordan forholder vi os til dette
bull Vi kan ikke aeligndre instrukser for hypoglycaeligmi haringndtering det
er en laeliggefaglig opgave kan vi alligevel goslashre en forskel i
profylaktisk oslashjemed
bull Har vi et ansvar for at vaeligre kritiske overfor gamle strategier
ndash og dermed assistere paeligdiatere i forebyggelsesarbejdet
bull Hvordan kan vi balancere forebyggelse og ikke-skade
princippet naringr det ogsaring drejer sig om naturlig ernaeligring mor-
barn kontakt og medicinske interventioner
bull Kan vi med vores viden om colostrum og naturlige
processers effekt aeligndre praksis for disse boslashrn
bull Hvordan kan vi som sundhedsprofessionelle oslashge antallet af
risikoboslashrn der tidligt faringr mors maeliglk selv om det ikke sutter
bull Hvordan vil det aeligndre vores praksisarbejde
bull Hvordan klaeligdes novicen og vi paring til en rdquoWatch and Waitrdquo
tilgang til hypoglycaeligmiforebyggelse
bull POCT eller lab-svar
Mon ikke hypoglycaeligmi forebyggelse kvalitativt kan
komme videre end i 2014
Tak fordi I lyttede
referencerbull CHERTOK IR RAZ I SHOHAM I HADDAD H and WIZNITZER A 2009 Journal of human
nutrition and dietetics the official journal of the British Dietetic Association 22(2) pp 166-169
bull CHRISTESEN HT and ESBERG G 2014-last update Hypoglykaeligmi flowcharts DPS Available
httpvipregionhdkVIPRedaktoer151637nsfvLookupUploadATTACH-RHAP-
9K2D8Y$FILEHypoglykC3A6mi20-20neonatal20Flowcharts20Maj202014pdf [0916
2014]
bull CORDERO L TREUER SH LANDON MB and GABBE SG 1998 Management of infants of
diabetic mothers Archives of Pediatrics amp Adolescent Medicine 152(3) pp 249-254
bull CORNBLATH M HAWDON JM WILLIAMS AF AYNSLEY-GREEN A WARD-PLATT MP
SCHWARTZ R and KALHAN SC 2000 Controversies regarding definition of neonatal
hypoglycemia suggested operational thresholds Pediatrics 105(5) pp 1141-1145
bull CSONT GL GROTH S HOPKINS P and GUILLET R 2014 An evidence-based approach to
breastfeeding neonates at risk for hypoglycemia Journal of obstetric gynecologic and neonatal
nursing JOGNN NAACOG 43(1) pp 71-81
bull DE ROOY L and HAWDON J 2002 Nutritional factors that affect the postnatal metabolic
adaptation of full-term small- and large-for-gestational-age infants Pediatrics 109(3) pp E42
bull DOBSON LZ VIBEKE 2011 God blodsukkerregulering kun for barnets skyld 25(nr 4) pp 36--
47
bull FLORES-LE ROUX JA SAGARRA E BENAIGES D HERNANDEZ-RIVAS E CHILLARON
JJ PUIG DE DOU J MUR A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2012 A
prospective evaluation of neonatal hypoglycaemia in infants of women with gestational diabetes
mellitus Diabetes research and clinical practice 97(2) pp 217-222
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull HARRIS DL WESTON PJ SIGNAL M CHASE JG and HARDING JE 2013 Dextrose gel for neonatal
hypoglycaemia (the Sugar Babies Study) a randomised double-blind placebo-controlled trial Lancet (London
England) 382(9910) pp 2077-2083
bull HERNANDEZ-RIVAS E FLORES-LE ROUX JA BENAIGES D SAGARRA E CHILLARON JJ PAYA A
PUIG-DE DOU J GODAY A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2013 Gestational diabetes in a
multiethnic population of Spain clinical characteristics and perinatal outcomes Diabetes research and clinical
practice 100(2) pp 215-221
bull HOSETH E JOERGENSEN A EBBESEN F and MOELLER M 2000 Blood glucose levels in a population of
healthy breast fed term infants of appropriate size for gestational age Archives of disease in childhoodFetal and
neonatal edition 83(2) pp F117-9
bull JENSEN DM SORENSEN B FEILBERG-JORGENSEN N WESTERGAARD JG and BECK-NIELSEN H
2000 Maternal and perinatal outcomes in 143 Danish women with gestational diabetes mellitus and 143 controls with
a similar risk profile Diabetic medicine a journal of the British Diabetic Association 17(4) pp 281-286
bull MAAYAN-METZGER A LUBIN D and KUINT J 2009 Hypoglycemia rates in the first days of life among term
infants born to diabetic mothers Neonatology 96(2) pp 80-85
bull MAAYAN-METZGER A SCHUSHAN-EISEN I LUBIN D MORAN O KUINT J and MAZKERETH R 2014
Delivery room breastfeeding for prevention of hypoglycaemia in infants of diabetic mothers Fetal and pediatric
pathology 33(1) pp 23-28
bull MCKINLAY CEA 2015 neonatal hypoglycemia and neurodevelopment outcomes at 2 years N Engl J Med(373)
pp 1507-18
bull METZGER BE PERSSON B LOWE LP DYER AR CRUICKSHANK JK DEEROCHANAWONG C
HALLIDAY HL HENNIS AJ LILEY H NG PC COUSTAN DR HADDEN DR HOD M OATS JJ
TRIMBLE ER and HAPO STUDY COOPERATIVE RESEARCH GROUP 2010 Hyperglycemia and adverse
pregnancy outcome study neonatal glycemia Pediatrics 126(6) pp e1545-52
bull ROZANCE PJ and HAY WWJR 2012 Neonatal hypoglycemia--answers but more questions The Journal of
pediatrics 161(5) pp 775-776
bull SARKAR S WATMAN J SEIGEL WM and SCHAEFFER HA 2003 A prospective controlled study of neonatal
morbidities in infants born at 36 weeks or more gestation to Women with diet-controlled gestational diabetes (GDM-
class Al) Journal of perinatology official journal of the California Perinatal Association 23(3) pp 223-228
bull SOLTANI H DICKINSON FM KALK J and PAYNE K 2008 Breast feeding
practices and views among diabetic women a retrospective cohort study Midwifery
24(4) pp 471-479
bull TOZIER P 2013 Colostrum Versus Formula Supplentation for Glucose Stabilization in
Newborns of Diabetic Mothers 42(JOGNN The association of Womens Health
Obstetric and Neonatal Nurses) pp 619-628
bull VAN HOWE RS and STORMS MR 2008 Blood glucose determinations in large for
gestational age infants American Journal of Perinatology 25(5) pp 283-289
bull WIGHT N MARINELLI KA and ACADEMY OF BREASTFEEDING MEDICINE
PROTOCOL COMMITTEE 2006 ABM clinical protocol 1 guidelines for glucose
monitoring and treatment of hypoglycemia in breastfed neonates Breastfeeding
medicine the official journal of the Academy of Breastfeeding Medicine 1(3) pp 178-
184
bull VANHALTREN K and MALHOTRA A 2013 Characteristics of infants at risk of
hypoglycaemia secondary to being infant of a diabetic mother Journal of pediatric
endocrinology amp metabolism JPEM 26(9-10) pp 861-865
bull WIGHT NE 2014 Hypoglycemia in breastfed neonates Breastfeeding medicine the
official journal of the Academy of Breastfeeding Medicine 9(4) pp 173-179
bull DALSGAARD B and ECK K 2013-last update Klinisk retningslinje for
nonfarmakologisk forebyggelse af neonatal hypoglycaeligmi og energitab hos nyfoslashdte af
moslashdre med diaeligtbehandlet gestationel diabetes Available
httpwwwkliniskeretningslinjerdkimages88_gdm_godkendt_010713pdf [0917 2014]
hypoglycaeligmibull
bull BRAGG JJ GREEN R and HOLZMAN IR 2013 Does early enteral feeding prevent
hypoglycemia in small for gestational age neonates Journal of neonatal-perinatal medicine 6(2)
pp 131-135
bull HARRIS DL WESTON PJ and HARDING JE 2014 Lactate rather than ketones may provide
alternative cerebral fuel in hypoglycaemic newborns Archives of disease in childhoodFetal and
neonatal edition
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull LANG TF and HUSSAIN K 2014 Pediatric hypoglycemia Advances in Clinical Chemistry 63
pp 211-245
bull MITANCHEZ D BURGUET A and SIMEONI U 2014 Infants born to mothers with gestational
diabetes mellitus mild neonatal effects a long-term threat to global health The Journal of pediatrics
164(3) pp 445-450
bull SUNDERCOMBE SL RAYNES-GREENOW CH TURNER RM and JEFFERY HE 2014 Do
neonatal hypoglycaemia guidelines in Australia and New Zealand facilitate breast feeding
Midwifery 30(12) pp 1179-1186
bull TAM EW HAEUSSLEIN LA BONIFACIO SL GLASS HC ROGERS EE JEREMY RJ
BARKOVICH AJ and FERRIERO DM 2012 Hypoglycemia is associated with increased risk for
brain injury and adverse neurodevelopmental outcome in neonates at risk for encephalopathy The
Journal of pediatrics 161(1) pp 88-93
bull UNICEF 2013 hypoglycaemia guidance july 2013 UNICEF
Kilder tilfoslashjet 2016
bull AGHDAS K TALAT K and SEPIDEH B 2014 Effect of immediate and continuous mother-infant
skin-to-skin contact on breastfeeding self-efficacy of primiparous women a randomised control trial
Women and birth journal of the Australian College of Midwives 27(1) pp 37-40
bull BEIRANVAND S VALIZADEH F HOSSEINABADI R and POURNIA Y 2014 The Effects of
Skin-to-Skin Contact on Temperature and Breastfeeding Successfulness in Full-Term Newborns
after Cesarean Delivery International journal of pediatrics 2014 pp 846486
bull FENGER-GRON J FENGER-GRON M BLUNCK CH SCHONEMANN-RIGEL H and
WIELANDT HB 2015 Low breastfeeding rates and body mass index in Danish children of women
with gestational diabetes mellitus International breastfeeding journal 10 pp 26-015-0051-8
eCollection 2015
bull JAGIELLO KP and AZULAY CHERTOK IR 2015 Womens Experiences With Early
Breastfeeding After Gestational Diabetes Journal of obstetric gynecologic and neonatal nursing
JOGNN NAACOG 44(4) pp 500-509
bull SAMAYAM P RANGANATHAN PK KOTARI UD and BALASUNDARAM R 2015 Study of
Asymptomatic Hypoglycemia in Full Term Exclusively Breastfed Neonates in First 48 Hours of Life
Journal of clinical and diagnostic research JCDR 9(9) pp SC07-10
bull SOBREVIA L SALSOSO R SAEZ T SANHUEZA C PARDO F and LEIVA A 2015 Insulin
therapy and fetoplacental vascular function in gestational diabetes mellitus Experimental physiology
100(3) pp 231-238
bull STEWART CE SAGE EL and REYNOLDS P 2015 Supporting Baby Friendly a quality
improvement initiative for the management of transitional neonatal hypoglycaemia Archives of
disease in childhoodFetal and neonatal edition
bull
Normale boslashrn
bull Glucose er eacuten af mange energikilder
for det nyfoslashdte barn
bull Hoseth 2000 laveste blodsukker 14
mmoll 1 time efter foslashdslen median 31
mmol l (14 til 53)
bull Hapo studiet 2010 Mean 32 mmol plusmn
09
Normale hjaeliglpesystemer
bull Ketogenese Normale nyfoslashdte har en
optil 40 x kapacitet af en voksen til at
starte ketogenese som skaffer energi
til barnet
bull Laktat betragtes som rdquoskurkrdquo men er
ogsaring en stor energi kilde da 2 x lactat
= glucose
Processer og tilfoslashrsel via colostrum
bull Glycogenolyse = omdannelse af glycogen
bull Gluconeogenese = nydannelse af glucose
bull Lipolyse = omdannelse af fedt til frie fedtsyrer
bull Ketogenese = udnyttelse af frie fedtsyrer til energi
Colostrum indeholder
bull Oligosaccharider Laktat laktose
bull Fedtsyrer monoumaeligttet fedt fedtmolekyler er store
energitaeligtte og medbringer selv lipase
bull Aminosyrer og proteiner
bull Vaeligkstfaktorer til hurtig transport af naeligringsstoffer
HYPOGLYCAEligMI
Alternative tilgange
bull Neonatal Hypoglycaeligmi er ikke en egentlig diagnose men en
beskrivelse af en tilstand
bull En tilstand hvor barnets metaboliske tilpasningsevne er reduceret og
DERFOR faringr hypoglycaeligmi
bull Alle nyfoslashdte har en back-up plan i form af alternative energikilder nogle boslashrn dog i
reduceret grad og DE er i risiko for hypoglycaeligmiCornblathM HawdonJM
Controversies regarding definition of neonatal hypoglycemia
suggested operational thresholds Pediatrics 2000 105 5 1141-1145
Der sker rigtig meget lige nu paring det laeliggefaglige omraringde (Win Tin 2014) Nye
forslag er at
bull asymptomatiske boslashrn er hypoglycaeligmiske med et bs lt 20 ogsaring ved naeligste
maringling altsaring over laeligngere tid og ikke kun eacuten vaeligrdi
bull Der maring kun vaeligre eacuten maringling lt 10 behandles straks
bull Ved symptomer skal der ogsaring reageres med det samme v bslt 25
Deacutet er laeliggefaglige beslutninger som vi maringske faringr at se
Hvem er Risikoboslashrn
Halvdelen af boslashrnene i Sugar Baby study
udaf 514 risikoboslashrn havde
51 bs lt 26 20 lt 20
Fordelingen i grupperne er helt ens
bull 79 var asymptomatiske
bull 15 var for traeligtte til at sutte
bull 7 sitrede
Incidence of Neonatal Hypoglycemia in Babies Identified as at Risk
Deborah L Harris
2012 J of Pediatrics
Burde vi taelignke Hvad
er dette barns
specifikke evne til
metabolisk tilpasning
efter foslashdslen og
hvordan stoslashtter vi
barnet bedst paring
naturlig vis i denne
proces og stadig
forebygger skade
Saeligrlige risikoboslashrn
bull IUGR boslashrn kan vaeligre meget uforudsigelige Deres
pancreas kan vaeligre overaktiv og dermed udsende for
meget insulin og pancreas kan vaeligre haeligmmet
bull Saeligrlig de boslashrn der er asymmetriske i deres vaeligkst
Soslashgning af litteratur
En hurtig PubMed soslashgning giver foslashlgende
1Neonatal hypoglycemia 2404
2Breastfeeding 36873
3Colostrum 7435
1+2 70
1+3 3
Early feeding
bull Der er ingen enighed om definition paring Early Feeding
bull Hawdon rdquofoslashrhen sendte boslashrnene hurtigt maeliglken tilbage til den velmenende
afsenderrdquo
bull Early Feeding kan vaeligre tidlig hyppig amning sukkervand modermaeliglk
erstatning dextrosegel Maeligngde
bull Udover amning er der mange modeller og ingen af dem er evidensbaserede
bull I 2015-16 kommer der stadig artikler om neonatal hypoglycaeligmi der ikke
skriver om ernaeligring overhovedet
Modermaeliglkserstatning og hjaeliglpestoffer
De Rooyrsquos studie fra 2002 viser
bull I et prospektivt studie med i alt 165 boslashrn blev boslashrnenes ketogenese
undersoslashgt
bull Deacuten gruppe der er taeligttest paring en af vores maringlgrupper GDM er Large
for Gestational Age boslashrnene Her paringvises det med signifikant forskel
at amning oslashger ketogenesen og at amning + modermaeliglkserstatning
ikke har saring god respons
bull Flaskeboslashrn danner stort set ikke ketonstoffer i starten foslashrst efter 12
timer
Det kan antyde at mme reducerer barnets evne til
modregulering og selvhjaeliglp
At mme har bivirkningersideeffekter der bestemt ikke
er hensigtsmaeligssige naringr vi taler om forebyggelse
Guidelines hvor er vi
Unicef 2013
bull Alle hud mod hud lige efter foslashdslen
bull Amning indenfor den foslashrste time
bull Foslashrste bs tidligst efter 2 timer og foslashr andet maringltid
bull Ved lavt bs (graelignse 26 el 20) ammes igen eller udmalket maeliglk Ved
fortsat lavt bs efter 1 time gives mme i de maeligngder vi kender
Survey af neonatale hypoglykaeligmi guidelines i Australien og New
Zealand vha Unicef(Sundercombe 2014)
bull Kun 9 ud af 22 naeligvner hud mod hud lige efter foslashdslen
bull Kun enkelte naeligvner hjaeliglp til effektiv amning og information om tegn
paring spiselyst
bull Mere end halvdelen anbefaler supplering med mors udmalkede maeliglk
bull Kun 8 ud af 22 sikrer sig samtykke foslashr mme og info til foraeligldre om
aringrsag til suppleringen
Unicef hypoglycemia 2013
Forebyggelse i ammeperspektiv og Baby Friendly
Normoglycaeligmisk tilstand boslashr opnaringes med mindst mulig intervention
Konventionel tilgang
bull 60 mlkgdoslashgn mm el mme oslashges med
20 mlkgdoslashgn x 8(-12)
bull Vallecasein 4060 mme = nedsat
ventrikeltoslashmning
bull Vi maringler stadig 1 t bs
bull Ved lav bs oslashges til 125 eller 150
af maeligngden
bull Glucose-infusion
bull Adskillelse af mor og barn
Individuel tilgangABM Protocol 2014
bull 1-3 mlkg (optil 5 mlkg) gerne hver 2 time
(3-5 mlkg i 2006-udgaven)
bull Hurtig passage af mm alle hjaeliglpestoffer er
med Vallecasein 9010
Bergmann
bull mavesaeligkkens stoslashrrelse lige foslashr foslashdslen
drikker barnet ca 10 ml gang Refererer til
studier der angiver ventiklen til hhv 10 12
15 20 ml
bull Anbefaler smaring hyppige amninger
suppleringer saring barnet ikke stresses og
bruger mere glucose end det tilfoslashres
bull Ward-Platt Laktat er rdquothe good guyrdquo og et
veloxideret velcirkuleret barn har alle
muligheder for at kompensere
bull Antenatal udmalkning af raringmaeliglk til DM-
boslashrn
Forskellen i et forloslashb
DPS
3000 gram
bull 180 ml 1 doslashgn
(60kgdoslashgn)
bull bsdarr oslashges til 225 ml 24
timer
Svaeligrt at faring udmalket dette
som ekstra
ABM
3000 gram
bull 36 ml foslashrste doslashgn
1 mlkg maringltid = 3 x 12
bull 108 ml v 3 ml kgmaringltid
(reduktion paring 40 )
Opnaringeligt at udmalke dette
som ekstra
Mon der er forskel paring
antal amninger
Haringndudmalkning korrektinkorrekt
bull httpswwwyoutubecomwatchv=k6V9xTZAWq0
24
Hvordan forholder vi os til dette
bull Vi kan ikke aeligndre instrukser for hypoglycaeligmi haringndtering det
er en laeliggefaglig opgave kan vi alligevel goslashre en forskel i
profylaktisk oslashjemed
bull Har vi et ansvar for at vaeligre kritiske overfor gamle strategier
ndash og dermed assistere paeligdiatere i forebyggelsesarbejdet
bull Hvordan kan vi balancere forebyggelse og ikke-skade
princippet naringr det ogsaring drejer sig om naturlig ernaeligring mor-
barn kontakt og medicinske interventioner
bull Kan vi med vores viden om colostrum og naturlige
processers effekt aeligndre praksis for disse boslashrn
bull Hvordan kan vi som sundhedsprofessionelle oslashge antallet af
risikoboslashrn der tidligt faringr mors maeliglk selv om det ikke sutter
bull Hvordan vil det aeligndre vores praksisarbejde
bull Hvordan klaeligdes novicen og vi paring til en rdquoWatch and Waitrdquo
tilgang til hypoglycaeligmiforebyggelse
bull POCT eller lab-svar
Mon ikke hypoglycaeligmi forebyggelse kvalitativt kan
komme videre end i 2014
Tak fordi I lyttede
referencerbull CHERTOK IR RAZ I SHOHAM I HADDAD H and WIZNITZER A 2009 Journal of human
nutrition and dietetics the official journal of the British Dietetic Association 22(2) pp 166-169
bull CHRISTESEN HT and ESBERG G 2014-last update Hypoglykaeligmi flowcharts DPS Available
httpvipregionhdkVIPRedaktoer151637nsfvLookupUploadATTACH-RHAP-
9K2D8Y$FILEHypoglykC3A6mi20-20neonatal20Flowcharts20Maj202014pdf [0916
2014]
bull CORDERO L TREUER SH LANDON MB and GABBE SG 1998 Management of infants of
diabetic mothers Archives of Pediatrics amp Adolescent Medicine 152(3) pp 249-254
bull CORNBLATH M HAWDON JM WILLIAMS AF AYNSLEY-GREEN A WARD-PLATT MP
SCHWARTZ R and KALHAN SC 2000 Controversies regarding definition of neonatal
hypoglycemia suggested operational thresholds Pediatrics 105(5) pp 1141-1145
bull CSONT GL GROTH S HOPKINS P and GUILLET R 2014 An evidence-based approach to
breastfeeding neonates at risk for hypoglycemia Journal of obstetric gynecologic and neonatal
nursing JOGNN NAACOG 43(1) pp 71-81
bull DE ROOY L and HAWDON J 2002 Nutritional factors that affect the postnatal metabolic
adaptation of full-term small- and large-for-gestational-age infants Pediatrics 109(3) pp E42
bull DOBSON LZ VIBEKE 2011 God blodsukkerregulering kun for barnets skyld 25(nr 4) pp 36--
47
bull FLORES-LE ROUX JA SAGARRA E BENAIGES D HERNANDEZ-RIVAS E CHILLARON
JJ PUIG DE DOU J MUR A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2012 A
prospective evaluation of neonatal hypoglycaemia in infants of women with gestational diabetes
mellitus Diabetes research and clinical practice 97(2) pp 217-222
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull HARRIS DL WESTON PJ SIGNAL M CHASE JG and HARDING JE 2013 Dextrose gel for neonatal
hypoglycaemia (the Sugar Babies Study) a randomised double-blind placebo-controlled trial Lancet (London
England) 382(9910) pp 2077-2083
bull HERNANDEZ-RIVAS E FLORES-LE ROUX JA BENAIGES D SAGARRA E CHILLARON JJ PAYA A
PUIG-DE DOU J GODAY A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2013 Gestational diabetes in a
multiethnic population of Spain clinical characteristics and perinatal outcomes Diabetes research and clinical
practice 100(2) pp 215-221
bull HOSETH E JOERGENSEN A EBBESEN F and MOELLER M 2000 Blood glucose levels in a population of
healthy breast fed term infants of appropriate size for gestational age Archives of disease in childhoodFetal and
neonatal edition 83(2) pp F117-9
bull JENSEN DM SORENSEN B FEILBERG-JORGENSEN N WESTERGAARD JG and BECK-NIELSEN H
2000 Maternal and perinatal outcomes in 143 Danish women with gestational diabetes mellitus and 143 controls with
a similar risk profile Diabetic medicine a journal of the British Diabetic Association 17(4) pp 281-286
bull MAAYAN-METZGER A LUBIN D and KUINT J 2009 Hypoglycemia rates in the first days of life among term
infants born to diabetic mothers Neonatology 96(2) pp 80-85
bull MAAYAN-METZGER A SCHUSHAN-EISEN I LUBIN D MORAN O KUINT J and MAZKERETH R 2014
Delivery room breastfeeding for prevention of hypoglycaemia in infants of diabetic mothers Fetal and pediatric
pathology 33(1) pp 23-28
bull MCKINLAY CEA 2015 neonatal hypoglycemia and neurodevelopment outcomes at 2 years N Engl J Med(373)
pp 1507-18
bull METZGER BE PERSSON B LOWE LP DYER AR CRUICKSHANK JK DEEROCHANAWONG C
HALLIDAY HL HENNIS AJ LILEY H NG PC COUSTAN DR HADDEN DR HOD M OATS JJ
TRIMBLE ER and HAPO STUDY COOPERATIVE RESEARCH GROUP 2010 Hyperglycemia and adverse
pregnancy outcome study neonatal glycemia Pediatrics 126(6) pp e1545-52
bull ROZANCE PJ and HAY WWJR 2012 Neonatal hypoglycemia--answers but more questions The Journal of
pediatrics 161(5) pp 775-776
bull SARKAR S WATMAN J SEIGEL WM and SCHAEFFER HA 2003 A prospective controlled study of neonatal
morbidities in infants born at 36 weeks or more gestation to Women with diet-controlled gestational diabetes (GDM-
class Al) Journal of perinatology official journal of the California Perinatal Association 23(3) pp 223-228
bull SOLTANI H DICKINSON FM KALK J and PAYNE K 2008 Breast feeding
practices and views among diabetic women a retrospective cohort study Midwifery
24(4) pp 471-479
bull TOZIER P 2013 Colostrum Versus Formula Supplentation for Glucose Stabilization in
Newborns of Diabetic Mothers 42(JOGNN The association of Womens Health
Obstetric and Neonatal Nurses) pp 619-628
bull VAN HOWE RS and STORMS MR 2008 Blood glucose determinations in large for
gestational age infants American Journal of Perinatology 25(5) pp 283-289
bull WIGHT N MARINELLI KA and ACADEMY OF BREASTFEEDING MEDICINE
PROTOCOL COMMITTEE 2006 ABM clinical protocol 1 guidelines for glucose
monitoring and treatment of hypoglycemia in breastfed neonates Breastfeeding
medicine the official journal of the Academy of Breastfeeding Medicine 1(3) pp 178-
184
bull VANHALTREN K and MALHOTRA A 2013 Characteristics of infants at risk of
hypoglycaemia secondary to being infant of a diabetic mother Journal of pediatric
endocrinology amp metabolism JPEM 26(9-10) pp 861-865
bull WIGHT NE 2014 Hypoglycemia in breastfed neonates Breastfeeding medicine the
official journal of the Academy of Breastfeeding Medicine 9(4) pp 173-179
bull DALSGAARD B and ECK K 2013-last update Klinisk retningslinje for
nonfarmakologisk forebyggelse af neonatal hypoglycaeligmi og energitab hos nyfoslashdte af
moslashdre med diaeligtbehandlet gestationel diabetes Available
httpwwwkliniskeretningslinjerdkimages88_gdm_godkendt_010713pdf [0917 2014]
hypoglycaeligmibull
bull BRAGG JJ GREEN R and HOLZMAN IR 2013 Does early enteral feeding prevent
hypoglycemia in small for gestational age neonates Journal of neonatal-perinatal medicine 6(2)
pp 131-135
bull HARRIS DL WESTON PJ and HARDING JE 2014 Lactate rather than ketones may provide
alternative cerebral fuel in hypoglycaemic newborns Archives of disease in childhoodFetal and
neonatal edition
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull LANG TF and HUSSAIN K 2014 Pediatric hypoglycemia Advances in Clinical Chemistry 63
pp 211-245
bull MITANCHEZ D BURGUET A and SIMEONI U 2014 Infants born to mothers with gestational
diabetes mellitus mild neonatal effects a long-term threat to global health The Journal of pediatrics
164(3) pp 445-450
bull SUNDERCOMBE SL RAYNES-GREENOW CH TURNER RM and JEFFERY HE 2014 Do
neonatal hypoglycaemia guidelines in Australia and New Zealand facilitate breast feeding
Midwifery 30(12) pp 1179-1186
bull TAM EW HAEUSSLEIN LA BONIFACIO SL GLASS HC ROGERS EE JEREMY RJ
BARKOVICH AJ and FERRIERO DM 2012 Hypoglycemia is associated with increased risk for
brain injury and adverse neurodevelopmental outcome in neonates at risk for encephalopathy The
Journal of pediatrics 161(1) pp 88-93
bull UNICEF 2013 hypoglycaemia guidance july 2013 UNICEF
Kilder tilfoslashjet 2016
bull AGHDAS K TALAT K and SEPIDEH B 2014 Effect of immediate and continuous mother-infant
skin-to-skin contact on breastfeeding self-efficacy of primiparous women a randomised control trial
Women and birth journal of the Australian College of Midwives 27(1) pp 37-40
bull BEIRANVAND S VALIZADEH F HOSSEINABADI R and POURNIA Y 2014 The Effects of
Skin-to-Skin Contact on Temperature and Breastfeeding Successfulness in Full-Term Newborns
after Cesarean Delivery International journal of pediatrics 2014 pp 846486
bull FENGER-GRON J FENGER-GRON M BLUNCK CH SCHONEMANN-RIGEL H and
WIELANDT HB 2015 Low breastfeeding rates and body mass index in Danish children of women
with gestational diabetes mellitus International breastfeeding journal 10 pp 26-015-0051-8
eCollection 2015
bull JAGIELLO KP and AZULAY CHERTOK IR 2015 Womens Experiences With Early
Breastfeeding After Gestational Diabetes Journal of obstetric gynecologic and neonatal nursing
JOGNN NAACOG 44(4) pp 500-509
bull SAMAYAM P RANGANATHAN PK KOTARI UD and BALASUNDARAM R 2015 Study of
Asymptomatic Hypoglycemia in Full Term Exclusively Breastfed Neonates in First 48 Hours of Life
Journal of clinical and diagnostic research JCDR 9(9) pp SC07-10
bull SOBREVIA L SALSOSO R SAEZ T SANHUEZA C PARDO F and LEIVA A 2015 Insulin
therapy and fetoplacental vascular function in gestational diabetes mellitus Experimental physiology
100(3) pp 231-238
bull STEWART CE SAGE EL and REYNOLDS P 2015 Supporting Baby Friendly a quality
improvement initiative for the management of transitional neonatal hypoglycaemia Archives of
disease in childhoodFetal and neonatal edition
bull
Processer og tilfoslashrsel via colostrum
bull Glycogenolyse = omdannelse af glycogen
bull Gluconeogenese = nydannelse af glucose
bull Lipolyse = omdannelse af fedt til frie fedtsyrer
bull Ketogenese = udnyttelse af frie fedtsyrer til energi
Colostrum indeholder
bull Oligosaccharider Laktat laktose
bull Fedtsyrer monoumaeligttet fedt fedtmolekyler er store
energitaeligtte og medbringer selv lipase
bull Aminosyrer og proteiner
bull Vaeligkstfaktorer til hurtig transport af naeligringsstoffer
HYPOGLYCAEligMI
Alternative tilgange
bull Neonatal Hypoglycaeligmi er ikke en egentlig diagnose men en
beskrivelse af en tilstand
bull En tilstand hvor barnets metaboliske tilpasningsevne er reduceret og
DERFOR faringr hypoglycaeligmi
bull Alle nyfoslashdte har en back-up plan i form af alternative energikilder nogle boslashrn dog i
reduceret grad og DE er i risiko for hypoglycaeligmiCornblathM HawdonJM
Controversies regarding definition of neonatal hypoglycemia
suggested operational thresholds Pediatrics 2000 105 5 1141-1145
Der sker rigtig meget lige nu paring det laeliggefaglige omraringde (Win Tin 2014) Nye
forslag er at
bull asymptomatiske boslashrn er hypoglycaeligmiske med et bs lt 20 ogsaring ved naeligste
maringling altsaring over laeligngere tid og ikke kun eacuten vaeligrdi
bull Der maring kun vaeligre eacuten maringling lt 10 behandles straks
bull Ved symptomer skal der ogsaring reageres med det samme v bslt 25
Deacutet er laeliggefaglige beslutninger som vi maringske faringr at se
Hvem er Risikoboslashrn
Halvdelen af boslashrnene i Sugar Baby study
udaf 514 risikoboslashrn havde
51 bs lt 26 20 lt 20
Fordelingen i grupperne er helt ens
bull 79 var asymptomatiske
bull 15 var for traeligtte til at sutte
bull 7 sitrede
Incidence of Neonatal Hypoglycemia in Babies Identified as at Risk
Deborah L Harris
2012 J of Pediatrics
Burde vi taelignke Hvad
er dette barns
specifikke evne til
metabolisk tilpasning
efter foslashdslen og
hvordan stoslashtter vi
barnet bedst paring
naturlig vis i denne
proces og stadig
forebygger skade
Saeligrlige risikoboslashrn
bull IUGR boslashrn kan vaeligre meget uforudsigelige Deres
pancreas kan vaeligre overaktiv og dermed udsende for
meget insulin og pancreas kan vaeligre haeligmmet
bull Saeligrlig de boslashrn der er asymmetriske i deres vaeligkst
Soslashgning af litteratur
En hurtig PubMed soslashgning giver foslashlgende
1Neonatal hypoglycemia 2404
2Breastfeeding 36873
3Colostrum 7435
1+2 70
1+3 3
Early feeding
bull Der er ingen enighed om definition paring Early Feeding
bull Hawdon rdquofoslashrhen sendte boslashrnene hurtigt maeliglken tilbage til den velmenende
afsenderrdquo
bull Early Feeding kan vaeligre tidlig hyppig amning sukkervand modermaeliglk
erstatning dextrosegel Maeligngde
bull Udover amning er der mange modeller og ingen af dem er evidensbaserede
bull I 2015-16 kommer der stadig artikler om neonatal hypoglycaeligmi der ikke
skriver om ernaeligring overhovedet
Modermaeliglkserstatning og hjaeliglpestoffer
De Rooyrsquos studie fra 2002 viser
bull I et prospektivt studie med i alt 165 boslashrn blev boslashrnenes ketogenese
undersoslashgt
bull Deacuten gruppe der er taeligttest paring en af vores maringlgrupper GDM er Large
for Gestational Age boslashrnene Her paringvises det med signifikant forskel
at amning oslashger ketogenesen og at amning + modermaeliglkserstatning
ikke har saring god respons
bull Flaskeboslashrn danner stort set ikke ketonstoffer i starten foslashrst efter 12
timer
Det kan antyde at mme reducerer barnets evne til
modregulering og selvhjaeliglp
At mme har bivirkningersideeffekter der bestemt ikke
er hensigtsmaeligssige naringr vi taler om forebyggelse
Guidelines hvor er vi
Unicef 2013
bull Alle hud mod hud lige efter foslashdslen
bull Amning indenfor den foslashrste time
bull Foslashrste bs tidligst efter 2 timer og foslashr andet maringltid
bull Ved lavt bs (graelignse 26 el 20) ammes igen eller udmalket maeliglk Ved
fortsat lavt bs efter 1 time gives mme i de maeligngder vi kender
Survey af neonatale hypoglykaeligmi guidelines i Australien og New
Zealand vha Unicef(Sundercombe 2014)
bull Kun 9 ud af 22 naeligvner hud mod hud lige efter foslashdslen
bull Kun enkelte naeligvner hjaeliglp til effektiv amning og information om tegn
paring spiselyst
bull Mere end halvdelen anbefaler supplering med mors udmalkede maeliglk
bull Kun 8 ud af 22 sikrer sig samtykke foslashr mme og info til foraeligldre om
aringrsag til suppleringen
Unicef hypoglycemia 2013
Forebyggelse i ammeperspektiv og Baby Friendly
Normoglycaeligmisk tilstand boslashr opnaringes med mindst mulig intervention
Konventionel tilgang
bull 60 mlkgdoslashgn mm el mme oslashges med
20 mlkgdoslashgn x 8(-12)
bull Vallecasein 4060 mme = nedsat
ventrikeltoslashmning
bull Vi maringler stadig 1 t bs
bull Ved lav bs oslashges til 125 eller 150
af maeligngden
bull Glucose-infusion
bull Adskillelse af mor og barn
Individuel tilgangABM Protocol 2014
bull 1-3 mlkg (optil 5 mlkg) gerne hver 2 time
(3-5 mlkg i 2006-udgaven)
bull Hurtig passage af mm alle hjaeliglpestoffer er
med Vallecasein 9010
Bergmann
bull mavesaeligkkens stoslashrrelse lige foslashr foslashdslen
drikker barnet ca 10 ml gang Refererer til
studier der angiver ventiklen til hhv 10 12
15 20 ml
bull Anbefaler smaring hyppige amninger
suppleringer saring barnet ikke stresses og
bruger mere glucose end det tilfoslashres
bull Ward-Platt Laktat er rdquothe good guyrdquo og et
veloxideret velcirkuleret barn har alle
muligheder for at kompensere
bull Antenatal udmalkning af raringmaeliglk til DM-
boslashrn
Forskellen i et forloslashb
DPS
3000 gram
bull 180 ml 1 doslashgn
(60kgdoslashgn)
bull bsdarr oslashges til 225 ml 24
timer
Svaeligrt at faring udmalket dette
som ekstra
ABM
3000 gram
bull 36 ml foslashrste doslashgn
1 mlkg maringltid = 3 x 12
bull 108 ml v 3 ml kgmaringltid
(reduktion paring 40 )
Opnaringeligt at udmalke dette
som ekstra
Mon der er forskel paring
antal amninger
Haringndudmalkning korrektinkorrekt
bull httpswwwyoutubecomwatchv=k6V9xTZAWq0
24
Hvordan forholder vi os til dette
bull Vi kan ikke aeligndre instrukser for hypoglycaeligmi haringndtering det
er en laeliggefaglig opgave kan vi alligevel goslashre en forskel i
profylaktisk oslashjemed
bull Har vi et ansvar for at vaeligre kritiske overfor gamle strategier
ndash og dermed assistere paeligdiatere i forebyggelsesarbejdet
bull Hvordan kan vi balancere forebyggelse og ikke-skade
princippet naringr det ogsaring drejer sig om naturlig ernaeligring mor-
barn kontakt og medicinske interventioner
bull Kan vi med vores viden om colostrum og naturlige
processers effekt aeligndre praksis for disse boslashrn
bull Hvordan kan vi som sundhedsprofessionelle oslashge antallet af
risikoboslashrn der tidligt faringr mors maeliglk selv om det ikke sutter
bull Hvordan vil det aeligndre vores praksisarbejde
bull Hvordan klaeligdes novicen og vi paring til en rdquoWatch and Waitrdquo
tilgang til hypoglycaeligmiforebyggelse
bull POCT eller lab-svar
Mon ikke hypoglycaeligmi forebyggelse kvalitativt kan
komme videre end i 2014
Tak fordi I lyttede
referencerbull CHERTOK IR RAZ I SHOHAM I HADDAD H and WIZNITZER A 2009 Journal of human
nutrition and dietetics the official journal of the British Dietetic Association 22(2) pp 166-169
bull CHRISTESEN HT and ESBERG G 2014-last update Hypoglykaeligmi flowcharts DPS Available
httpvipregionhdkVIPRedaktoer151637nsfvLookupUploadATTACH-RHAP-
9K2D8Y$FILEHypoglykC3A6mi20-20neonatal20Flowcharts20Maj202014pdf [0916
2014]
bull CORDERO L TREUER SH LANDON MB and GABBE SG 1998 Management of infants of
diabetic mothers Archives of Pediatrics amp Adolescent Medicine 152(3) pp 249-254
bull CORNBLATH M HAWDON JM WILLIAMS AF AYNSLEY-GREEN A WARD-PLATT MP
SCHWARTZ R and KALHAN SC 2000 Controversies regarding definition of neonatal
hypoglycemia suggested operational thresholds Pediatrics 105(5) pp 1141-1145
bull CSONT GL GROTH S HOPKINS P and GUILLET R 2014 An evidence-based approach to
breastfeeding neonates at risk for hypoglycemia Journal of obstetric gynecologic and neonatal
nursing JOGNN NAACOG 43(1) pp 71-81
bull DE ROOY L and HAWDON J 2002 Nutritional factors that affect the postnatal metabolic
adaptation of full-term small- and large-for-gestational-age infants Pediatrics 109(3) pp E42
bull DOBSON LZ VIBEKE 2011 God blodsukkerregulering kun for barnets skyld 25(nr 4) pp 36--
47
bull FLORES-LE ROUX JA SAGARRA E BENAIGES D HERNANDEZ-RIVAS E CHILLARON
JJ PUIG DE DOU J MUR A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2012 A
prospective evaluation of neonatal hypoglycaemia in infants of women with gestational diabetes
mellitus Diabetes research and clinical practice 97(2) pp 217-222
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull HARRIS DL WESTON PJ SIGNAL M CHASE JG and HARDING JE 2013 Dextrose gel for neonatal
hypoglycaemia (the Sugar Babies Study) a randomised double-blind placebo-controlled trial Lancet (London
England) 382(9910) pp 2077-2083
bull HERNANDEZ-RIVAS E FLORES-LE ROUX JA BENAIGES D SAGARRA E CHILLARON JJ PAYA A
PUIG-DE DOU J GODAY A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2013 Gestational diabetes in a
multiethnic population of Spain clinical characteristics and perinatal outcomes Diabetes research and clinical
practice 100(2) pp 215-221
bull HOSETH E JOERGENSEN A EBBESEN F and MOELLER M 2000 Blood glucose levels in a population of
healthy breast fed term infants of appropriate size for gestational age Archives of disease in childhoodFetal and
neonatal edition 83(2) pp F117-9
bull JENSEN DM SORENSEN B FEILBERG-JORGENSEN N WESTERGAARD JG and BECK-NIELSEN H
2000 Maternal and perinatal outcomes in 143 Danish women with gestational diabetes mellitus and 143 controls with
a similar risk profile Diabetic medicine a journal of the British Diabetic Association 17(4) pp 281-286
bull MAAYAN-METZGER A LUBIN D and KUINT J 2009 Hypoglycemia rates in the first days of life among term
infants born to diabetic mothers Neonatology 96(2) pp 80-85
bull MAAYAN-METZGER A SCHUSHAN-EISEN I LUBIN D MORAN O KUINT J and MAZKERETH R 2014
Delivery room breastfeeding for prevention of hypoglycaemia in infants of diabetic mothers Fetal and pediatric
pathology 33(1) pp 23-28
bull MCKINLAY CEA 2015 neonatal hypoglycemia and neurodevelopment outcomes at 2 years N Engl J Med(373)
pp 1507-18
bull METZGER BE PERSSON B LOWE LP DYER AR CRUICKSHANK JK DEEROCHANAWONG C
HALLIDAY HL HENNIS AJ LILEY H NG PC COUSTAN DR HADDEN DR HOD M OATS JJ
TRIMBLE ER and HAPO STUDY COOPERATIVE RESEARCH GROUP 2010 Hyperglycemia and adverse
pregnancy outcome study neonatal glycemia Pediatrics 126(6) pp e1545-52
bull ROZANCE PJ and HAY WWJR 2012 Neonatal hypoglycemia--answers but more questions The Journal of
pediatrics 161(5) pp 775-776
bull SARKAR S WATMAN J SEIGEL WM and SCHAEFFER HA 2003 A prospective controlled study of neonatal
morbidities in infants born at 36 weeks or more gestation to Women with diet-controlled gestational diabetes (GDM-
class Al) Journal of perinatology official journal of the California Perinatal Association 23(3) pp 223-228
bull SOLTANI H DICKINSON FM KALK J and PAYNE K 2008 Breast feeding
practices and views among diabetic women a retrospective cohort study Midwifery
24(4) pp 471-479
bull TOZIER P 2013 Colostrum Versus Formula Supplentation for Glucose Stabilization in
Newborns of Diabetic Mothers 42(JOGNN The association of Womens Health
Obstetric and Neonatal Nurses) pp 619-628
bull VAN HOWE RS and STORMS MR 2008 Blood glucose determinations in large for
gestational age infants American Journal of Perinatology 25(5) pp 283-289
bull WIGHT N MARINELLI KA and ACADEMY OF BREASTFEEDING MEDICINE
PROTOCOL COMMITTEE 2006 ABM clinical protocol 1 guidelines for glucose
monitoring and treatment of hypoglycemia in breastfed neonates Breastfeeding
medicine the official journal of the Academy of Breastfeeding Medicine 1(3) pp 178-
184
bull VANHALTREN K and MALHOTRA A 2013 Characteristics of infants at risk of
hypoglycaemia secondary to being infant of a diabetic mother Journal of pediatric
endocrinology amp metabolism JPEM 26(9-10) pp 861-865
bull WIGHT NE 2014 Hypoglycemia in breastfed neonates Breastfeeding medicine the
official journal of the Academy of Breastfeeding Medicine 9(4) pp 173-179
bull DALSGAARD B and ECK K 2013-last update Klinisk retningslinje for
nonfarmakologisk forebyggelse af neonatal hypoglycaeligmi og energitab hos nyfoslashdte af
moslashdre med diaeligtbehandlet gestationel diabetes Available
httpwwwkliniskeretningslinjerdkimages88_gdm_godkendt_010713pdf [0917 2014]
hypoglycaeligmibull
bull BRAGG JJ GREEN R and HOLZMAN IR 2013 Does early enteral feeding prevent
hypoglycemia in small for gestational age neonates Journal of neonatal-perinatal medicine 6(2)
pp 131-135
bull HARRIS DL WESTON PJ and HARDING JE 2014 Lactate rather than ketones may provide
alternative cerebral fuel in hypoglycaemic newborns Archives of disease in childhoodFetal and
neonatal edition
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull LANG TF and HUSSAIN K 2014 Pediatric hypoglycemia Advances in Clinical Chemistry 63
pp 211-245
bull MITANCHEZ D BURGUET A and SIMEONI U 2014 Infants born to mothers with gestational
diabetes mellitus mild neonatal effects a long-term threat to global health The Journal of pediatrics
164(3) pp 445-450
bull SUNDERCOMBE SL RAYNES-GREENOW CH TURNER RM and JEFFERY HE 2014 Do
neonatal hypoglycaemia guidelines in Australia and New Zealand facilitate breast feeding
Midwifery 30(12) pp 1179-1186
bull TAM EW HAEUSSLEIN LA BONIFACIO SL GLASS HC ROGERS EE JEREMY RJ
BARKOVICH AJ and FERRIERO DM 2012 Hypoglycemia is associated with increased risk for
brain injury and adverse neurodevelopmental outcome in neonates at risk for encephalopathy The
Journal of pediatrics 161(1) pp 88-93
bull UNICEF 2013 hypoglycaemia guidance july 2013 UNICEF
Kilder tilfoslashjet 2016
bull AGHDAS K TALAT K and SEPIDEH B 2014 Effect of immediate and continuous mother-infant
skin-to-skin contact on breastfeeding self-efficacy of primiparous women a randomised control trial
Women and birth journal of the Australian College of Midwives 27(1) pp 37-40
bull BEIRANVAND S VALIZADEH F HOSSEINABADI R and POURNIA Y 2014 The Effects of
Skin-to-Skin Contact on Temperature and Breastfeeding Successfulness in Full-Term Newborns
after Cesarean Delivery International journal of pediatrics 2014 pp 846486
bull FENGER-GRON J FENGER-GRON M BLUNCK CH SCHONEMANN-RIGEL H and
WIELANDT HB 2015 Low breastfeeding rates and body mass index in Danish children of women
with gestational diabetes mellitus International breastfeeding journal 10 pp 26-015-0051-8
eCollection 2015
bull JAGIELLO KP and AZULAY CHERTOK IR 2015 Womens Experiences With Early
Breastfeeding After Gestational Diabetes Journal of obstetric gynecologic and neonatal nursing
JOGNN NAACOG 44(4) pp 500-509
bull SAMAYAM P RANGANATHAN PK KOTARI UD and BALASUNDARAM R 2015 Study of
Asymptomatic Hypoglycemia in Full Term Exclusively Breastfed Neonates in First 48 Hours of Life
Journal of clinical and diagnostic research JCDR 9(9) pp SC07-10
bull SOBREVIA L SALSOSO R SAEZ T SANHUEZA C PARDO F and LEIVA A 2015 Insulin
therapy and fetoplacental vascular function in gestational diabetes mellitus Experimental physiology
100(3) pp 231-238
bull STEWART CE SAGE EL and REYNOLDS P 2015 Supporting Baby Friendly a quality
improvement initiative for the management of transitional neonatal hypoglycaemia Archives of
disease in childhoodFetal and neonatal edition
bull
HYPOGLYCAEligMI
Alternative tilgange
bull Neonatal Hypoglycaeligmi er ikke en egentlig diagnose men en
beskrivelse af en tilstand
bull En tilstand hvor barnets metaboliske tilpasningsevne er reduceret og
DERFOR faringr hypoglycaeligmi
bull Alle nyfoslashdte har en back-up plan i form af alternative energikilder nogle boslashrn dog i
reduceret grad og DE er i risiko for hypoglycaeligmiCornblathM HawdonJM
Controversies regarding definition of neonatal hypoglycemia
suggested operational thresholds Pediatrics 2000 105 5 1141-1145
Der sker rigtig meget lige nu paring det laeliggefaglige omraringde (Win Tin 2014) Nye
forslag er at
bull asymptomatiske boslashrn er hypoglycaeligmiske med et bs lt 20 ogsaring ved naeligste
maringling altsaring over laeligngere tid og ikke kun eacuten vaeligrdi
bull Der maring kun vaeligre eacuten maringling lt 10 behandles straks
bull Ved symptomer skal der ogsaring reageres med det samme v bslt 25
Deacutet er laeliggefaglige beslutninger som vi maringske faringr at se
Hvem er Risikoboslashrn
Halvdelen af boslashrnene i Sugar Baby study
udaf 514 risikoboslashrn havde
51 bs lt 26 20 lt 20
Fordelingen i grupperne er helt ens
bull 79 var asymptomatiske
bull 15 var for traeligtte til at sutte
bull 7 sitrede
Incidence of Neonatal Hypoglycemia in Babies Identified as at Risk
Deborah L Harris
2012 J of Pediatrics
Burde vi taelignke Hvad
er dette barns
specifikke evne til
metabolisk tilpasning
efter foslashdslen og
hvordan stoslashtter vi
barnet bedst paring
naturlig vis i denne
proces og stadig
forebygger skade
Saeligrlige risikoboslashrn
bull IUGR boslashrn kan vaeligre meget uforudsigelige Deres
pancreas kan vaeligre overaktiv og dermed udsende for
meget insulin og pancreas kan vaeligre haeligmmet
bull Saeligrlig de boslashrn der er asymmetriske i deres vaeligkst
Soslashgning af litteratur
En hurtig PubMed soslashgning giver foslashlgende
1Neonatal hypoglycemia 2404
2Breastfeeding 36873
3Colostrum 7435
1+2 70
1+3 3
Early feeding
bull Der er ingen enighed om definition paring Early Feeding
bull Hawdon rdquofoslashrhen sendte boslashrnene hurtigt maeliglken tilbage til den velmenende
afsenderrdquo
bull Early Feeding kan vaeligre tidlig hyppig amning sukkervand modermaeliglk
erstatning dextrosegel Maeligngde
bull Udover amning er der mange modeller og ingen af dem er evidensbaserede
bull I 2015-16 kommer der stadig artikler om neonatal hypoglycaeligmi der ikke
skriver om ernaeligring overhovedet
Modermaeliglkserstatning og hjaeliglpestoffer
De Rooyrsquos studie fra 2002 viser
bull I et prospektivt studie med i alt 165 boslashrn blev boslashrnenes ketogenese
undersoslashgt
bull Deacuten gruppe der er taeligttest paring en af vores maringlgrupper GDM er Large
for Gestational Age boslashrnene Her paringvises det med signifikant forskel
at amning oslashger ketogenesen og at amning + modermaeliglkserstatning
ikke har saring god respons
bull Flaskeboslashrn danner stort set ikke ketonstoffer i starten foslashrst efter 12
timer
Det kan antyde at mme reducerer barnets evne til
modregulering og selvhjaeliglp
At mme har bivirkningersideeffekter der bestemt ikke
er hensigtsmaeligssige naringr vi taler om forebyggelse
Guidelines hvor er vi
Unicef 2013
bull Alle hud mod hud lige efter foslashdslen
bull Amning indenfor den foslashrste time
bull Foslashrste bs tidligst efter 2 timer og foslashr andet maringltid
bull Ved lavt bs (graelignse 26 el 20) ammes igen eller udmalket maeliglk Ved
fortsat lavt bs efter 1 time gives mme i de maeligngder vi kender
Survey af neonatale hypoglykaeligmi guidelines i Australien og New
Zealand vha Unicef(Sundercombe 2014)
bull Kun 9 ud af 22 naeligvner hud mod hud lige efter foslashdslen
bull Kun enkelte naeligvner hjaeliglp til effektiv amning og information om tegn
paring spiselyst
bull Mere end halvdelen anbefaler supplering med mors udmalkede maeliglk
bull Kun 8 ud af 22 sikrer sig samtykke foslashr mme og info til foraeligldre om
aringrsag til suppleringen
Unicef hypoglycemia 2013
Forebyggelse i ammeperspektiv og Baby Friendly
Normoglycaeligmisk tilstand boslashr opnaringes med mindst mulig intervention
Konventionel tilgang
bull 60 mlkgdoslashgn mm el mme oslashges med
20 mlkgdoslashgn x 8(-12)
bull Vallecasein 4060 mme = nedsat
ventrikeltoslashmning
bull Vi maringler stadig 1 t bs
bull Ved lav bs oslashges til 125 eller 150
af maeligngden
bull Glucose-infusion
bull Adskillelse af mor og barn
Individuel tilgangABM Protocol 2014
bull 1-3 mlkg (optil 5 mlkg) gerne hver 2 time
(3-5 mlkg i 2006-udgaven)
bull Hurtig passage af mm alle hjaeliglpestoffer er
med Vallecasein 9010
Bergmann
bull mavesaeligkkens stoslashrrelse lige foslashr foslashdslen
drikker barnet ca 10 ml gang Refererer til
studier der angiver ventiklen til hhv 10 12
15 20 ml
bull Anbefaler smaring hyppige amninger
suppleringer saring barnet ikke stresses og
bruger mere glucose end det tilfoslashres
bull Ward-Platt Laktat er rdquothe good guyrdquo og et
veloxideret velcirkuleret barn har alle
muligheder for at kompensere
bull Antenatal udmalkning af raringmaeliglk til DM-
boslashrn
Forskellen i et forloslashb
DPS
3000 gram
bull 180 ml 1 doslashgn
(60kgdoslashgn)
bull bsdarr oslashges til 225 ml 24
timer
Svaeligrt at faring udmalket dette
som ekstra
ABM
3000 gram
bull 36 ml foslashrste doslashgn
1 mlkg maringltid = 3 x 12
bull 108 ml v 3 ml kgmaringltid
(reduktion paring 40 )
Opnaringeligt at udmalke dette
som ekstra
Mon der er forskel paring
antal amninger
Haringndudmalkning korrektinkorrekt
bull httpswwwyoutubecomwatchv=k6V9xTZAWq0
24
Hvordan forholder vi os til dette
bull Vi kan ikke aeligndre instrukser for hypoglycaeligmi haringndtering det
er en laeliggefaglig opgave kan vi alligevel goslashre en forskel i
profylaktisk oslashjemed
bull Har vi et ansvar for at vaeligre kritiske overfor gamle strategier
ndash og dermed assistere paeligdiatere i forebyggelsesarbejdet
bull Hvordan kan vi balancere forebyggelse og ikke-skade
princippet naringr det ogsaring drejer sig om naturlig ernaeligring mor-
barn kontakt og medicinske interventioner
bull Kan vi med vores viden om colostrum og naturlige
processers effekt aeligndre praksis for disse boslashrn
bull Hvordan kan vi som sundhedsprofessionelle oslashge antallet af
risikoboslashrn der tidligt faringr mors maeliglk selv om det ikke sutter
bull Hvordan vil det aeligndre vores praksisarbejde
bull Hvordan klaeligdes novicen og vi paring til en rdquoWatch and Waitrdquo
tilgang til hypoglycaeligmiforebyggelse
bull POCT eller lab-svar
Mon ikke hypoglycaeligmi forebyggelse kvalitativt kan
komme videre end i 2014
Tak fordi I lyttede
referencerbull CHERTOK IR RAZ I SHOHAM I HADDAD H and WIZNITZER A 2009 Journal of human
nutrition and dietetics the official journal of the British Dietetic Association 22(2) pp 166-169
bull CHRISTESEN HT and ESBERG G 2014-last update Hypoglykaeligmi flowcharts DPS Available
httpvipregionhdkVIPRedaktoer151637nsfvLookupUploadATTACH-RHAP-
9K2D8Y$FILEHypoglykC3A6mi20-20neonatal20Flowcharts20Maj202014pdf [0916
2014]
bull CORDERO L TREUER SH LANDON MB and GABBE SG 1998 Management of infants of
diabetic mothers Archives of Pediatrics amp Adolescent Medicine 152(3) pp 249-254
bull CORNBLATH M HAWDON JM WILLIAMS AF AYNSLEY-GREEN A WARD-PLATT MP
SCHWARTZ R and KALHAN SC 2000 Controversies regarding definition of neonatal
hypoglycemia suggested operational thresholds Pediatrics 105(5) pp 1141-1145
bull CSONT GL GROTH S HOPKINS P and GUILLET R 2014 An evidence-based approach to
breastfeeding neonates at risk for hypoglycemia Journal of obstetric gynecologic and neonatal
nursing JOGNN NAACOG 43(1) pp 71-81
bull DE ROOY L and HAWDON J 2002 Nutritional factors that affect the postnatal metabolic
adaptation of full-term small- and large-for-gestational-age infants Pediatrics 109(3) pp E42
bull DOBSON LZ VIBEKE 2011 God blodsukkerregulering kun for barnets skyld 25(nr 4) pp 36--
47
bull FLORES-LE ROUX JA SAGARRA E BENAIGES D HERNANDEZ-RIVAS E CHILLARON
JJ PUIG DE DOU J MUR A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2012 A
prospective evaluation of neonatal hypoglycaemia in infants of women with gestational diabetes
mellitus Diabetes research and clinical practice 97(2) pp 217-222
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull HARRIS DL WESTON PJ SIGNAL M CHASE JG and HARDING JE 2013 Dextrose gel for neonatal
hypoglycaemia (the Sugar Babies Study) a randomised double-blind placebo-controlled trial Lancet (London
England) 382(9910) pp 2077-2083
bull HERNANDEZ-RIVAS E FLORES-LE ROUX JA BENAIGES D SAGARRA E CHILLARON JJ PAYA A
PUIG-DE DOU J GODAY A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2013 Gestational diabetes in a
multiethnic population of Spain clinical characteristics and perinatal outcomes Diabetes research and clinical
practice 100(2) pp 215-221
bull HOSETH E JOERGENSEN A EBBESEN F and MOELLER M 2000 Blood glucose levels in a population of
healthy breast fed term infants of appropriate size for gestational age Archives of disease in childhoodFetal and
neonatal edition 83(2) pp F117-9
bull JENSEN DM SORENSEN B FEILBERG-JORGENSEN N WESTERGAARD JG and BECK-NIELSEN H
2000 Maternal and perinatal outcomes in 143 Danish women with gestational diabetes mellitus and 143 controls with
a similar risk profile Diabetic medicine a journal of the British Diabetic Association 17(4) pp 281-286
bull MAAYAN-METZGER A LUBIN D and KUINT J 2009 Hypoglycemia rates in the first days of life among term
infants born to diabetic mothers Neonatology 96(2) pp 80-85
bull MAAYAN-METZGER A SCHUSHAN-EISEN I LUBIN D MORAN O KUINT J and MAZKERETH R 2014
Delivery room breastfeeding for prevention of hypoglycaemia in infants of diabetic mothers Fetal and pediatric
pathology 33(1) pp 23-28
bull MCKINLAY CEA 2015 neonatal hypoglycemia and neurodevelopment outcomes at 2 years N Engl J Med(373)
pp 1507-18
bull METZGER BE PERSSON B LOWE LP DYER AR CRUICKSHANK JK DEEROCHANAWONG C
HALLIDAY HL HENNIS AJ LILEY H NG PC COUSTAN DR HADDEN DR HOD M OATS JJ
TRIMBLE ER and HAPO STUDY COOPERATIVE RESEARCH GROUP 2010 Hyperglycemia and adverse
pregnancy outcome study neonatal glycemia Pediatrics 126(6) pp e1545-52
bull ROZANCE PJ and HAY WWJR 2012 Neonatal hypoglycemia--answers but more questions The Journal of
pediatrics 161(5) pp 775-776
bull SARKAR S WATMAN J SEIGEL WM and SCHAEFFER HA 2003 A prospective controlled study of neonatal
morbidities in infants born at 36 weeks or more gestation to Women with diet-controlled gestational diabetes (GDM-
class Al) Journal of perinatology official journal of the California Perinatal Association 23(3) pp 223-228
bull SOLTANI H DICKINSON FM KALK J and PAYNE K 2008 Breast feeding
practices and views among diabetic women a retrospective cohort study Midwifery
24(4) pp 471-479
bull TOZIER P 2013 Colostrum Versus Formula Supplentation for Glucose Stabilization in
Newborns of Diabetic Mothers 42(JOGNN The association of Womens Health
Obstetric and Neonatal Nurses) pp 619-628
bull VAN HOWE RS and STORMS MR 2008 Blood glucose determinations in large for
gestational age infants American Journal of Perinatology 25(5) pp 283-289
bull WIGHT N MARINELLI KA and ACADEMY OF BREASTFEEDING MEDICINE
PROTOCOL COMMITTEE 2006 ABM clinical protocol 1 guidelines for glucose
monitoring and treatment of hypoglycemia in breastfed neonates Breastfeeding
medicine the official journal of the Academy of Breastfeeding Medicine 1(3) pp 178-
184
bull VANHALTREN K and MALHOTRA A 2013 Characteristics of infants at risk of
hypoglycaemia secondary to being infant of a diabetic mother Journal of pediatric
endocrinology amp metabolism JPEM 26(9-10) pp 861-865
bull WIGHT NE 2014 Hypoglycemia in breastfed neonates Breastfeeding medicine the
official journal of the Academy of Breastfeeding Medicine 9(4) pp 173-179
bull DALSGAARD B and ECK K 2013-last update Klinisk retningslinje for
nonfarmakologisk forebyggelse af neonatal hypoglycaeligmi og energitab hos nyfoslashdte af
moslashdre med diaeligtbehandlet gestationel diabetes Available
httpwwwkliniskeretningslinjerdkimages88_gdm_godkendt_010713pdf [0917 2014]
hypoglycaeligmibull
bull BRAGG JJ GREEN R and HOLZMAN IR 2013 Does early enteral feeding prevent
hypoglycemia in small for gestational age neonates Journal of neonatal-perinatal medicine 6(2)
pp 131-135
bull HARRIS DL WESTON PJ and HARDING JE 2014 Lactate rather than ketones may provide
alternative cerebral fuel in hypoglycaemic newborns Archives of disease in childhoodFetal and
neonatal edition
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull LANG TF and HUSSAIN K 2014 Pediatric hypoglycemia Advances in Clinical Chemistry 63
pp 211-245
bull MITANCHEZ D BURGUET A and SIMEONI U 2014 Infants born to mothers with gestational
diabetes mellitus mild neonatal effects a long-term threat to global health The Journal of pediatrics
164(3) pp 445-450
bull SUNDERCOMBE SL RAYNES-GREENOW CH TURNER RM and JEFFERY HE 2014 Do
neonatal hypoglycaemia guidelines in Australia and New Zealand facilitate breast feeding
Midwifery 30(12) pp 1179-1186
bull TAM EW HAEUSSLEIN LA BONIFACIO SL GLASS HC ROGERS EE JEREMY RJ
BARKOVICH AJ and FERRIERO DM 2012 Hypoglycemia is associated with increased risk for
brain injury and adverse neurodevelopmental outcome in neonates at risk for encephalopathy The
Journal of pediatrics 161(1) pp 88-93
bull UNICEF 2013 hypoglycaemia guidance july 2013 UNICEF
Kilder tilfoslashjet 2016
bull AGHDAS K TALAT K and SEPIDEH B 2014 Effect of immediate and continuous mother-infant
skin-to-skin contact on breastfeeding self-efficacy of primiparous women a randomised control trial
Women and birth journal of the Australian College of Midwives 27(1) pp 37-40
bull BEIRANVAND S VALIZADEH F HOSSEINABADI R and POURNIA Y 2014 The Effects of
Skin-to-Skin Contact on Temperature and Breastfeeding Successfulness in Full-Term Newborns
after Cesarean Delivery International journal of pediatrics 2014 pp 846486
bull FENGER-GRON J FENGER-GRON M BLUNCK CH SCHONEMANN-RIGEL H and
WIELANDT HB 2015 Low breastfeeding rates and body mass index in Danish children of women
with gestational diabetes mellitus International breastfeeding journal 10 pp 26-015-0051-8
eCollection 2015
bull JAGIELLO KP and AZULAY CHERTOK IR 2015 Womens Experiences With Early
Breastfeeding After Gestational Diabetes Journal of obstetric gynecologic and neonatal nursing
JOGNN NAACOG 44(4) pp 500-509
bull SAMAYAM P RANGANATHAN PK KOTARI UD and BALASUNDARAM R 2015 Study of
Asymptomatic Hypoglycemia in Full Term Exclusively Breastfed Neonates in First 48 Hours of Life
Journal of clinical and diagnostic research JCDR 9(9) pp SC07-10
bull SOBREVIA L SALSOSO R SAEZ T SANHUEZA C PARDO F and LEIVA A 2015 Insulin
therapy and fetoplacental vascular function in gestational diabetes mellitus Experimental physiology
100(3) pp 231-238
bull STEWART CE SAGE EL and REYNOLDS P 2015 Supporting Baby Friendly a quality
improvement initiative for the management of transitional neonatal hypoglycaemia Archives of
disease in childhoodFetal and neonatal edition
bull
Hvem er Risikoboslashrn
Halvdelen af boslashrnene i Sugar Baby study
udaf 514 risikoboslashrn havde
51 bs lt 26 20 lt 20
Fordelingen i grupperne er helt ens
bull 79 var asymptomatiske
bull 15 var for traeligtte til at sutte
bull 7 sitrede
Incidence of Neonatal Hypoglycemia in Babies Identified as at Risk
Deborah L Harris
2012 J of Pediatrics
Burde vi taelignke Hvad
er dette barns
specifikke evne til
metabolisk tilpasning
efter foslashdslen og
hvordan stoslashtter vi
barnet bedst paring
naturlig vis i denne
proces og stadig
forebygger skade
Saeligrlige risikoboslashrn
bull IUGR boslashrn kan vaeligre meget uforudsigelige Deres
pancreas kan vaeligre overaktiv og dermed udsende for
meget insulin og pancreas kan vaeligre haeligmmet
bull Saeligrlig de boslashrn der er asymmetriske i deres vaeligkst
Soslashgning af litteratur
En hurtig PubMed soslashgning giver foslashlgende
1Neonatal hypoglycemia 2404
2Breastfeeding 36873
3Colostrum 7435
1+2 70
1+3 3
Early feeding
bull Der er ingen enighed om definition paring Early Feeding
bull Hawdon rdquofoslashrhen sendte boslashrnene hurtigt maeliglken tilbage til den velmenende
afsenderrdquo
bull Early Feeding kan vaeligre tidlig hyppig amning sukkervand modermaeliglk
erstatning dextrosegel Maeligngde
bull Udover amning er der mange modeller og ingen af dem er evidensbaserede
bull I 2015-16 kommer der stadig artikler om neonatal hypoglycaeligmi der ikke
skriver om ernaeligring overhovedet
Modermaeliglkserstatning og hjaeliglpestoffer
De Rooyrsquos studie fra 2002 viser
bull I et prospektivt studie med i alt 165 boslashrn blev boslashrnenes ketogenese
undersoslashgt
bull Deacuten gruppe der er taeligttest paring en af vores maringlgrupper GDM er Large
for Gestational Age boslashrnene Her paringvises det med signifikant forskel
at amning oslashger ketogenesen og at amning + modermaeliglkserstatning
ikke har saring god respons
bull Flaskeboslashrn danner stort set ikke ketonstoffer i starten foslashrst efter 12
timer
Det kan antyde at mme reducerer barnets evne til
modregulering og selvhjaeliglp
At mme har bivirkningersideeffekter der bestemt ikke
er hensigtsmaeligssige naringr vi taler om forebyggelse
Guidelines hvor er vi
Unicef 2013
bull Alle hud mod hud lige efter foslashdslen
bull Amning indenfor den foslashrste time
bull Foslashrste bs tidligst efter 2 timer og foslashr andet maringltid
bull Ved lavt bs (graelignse 26 el 20) ammes igen eller udmalket maeliglk Ved
fortsat lavt bs efter 1 time gives mme i de maeligngder vi kender
Survey af neonatale hypoglykaeligmi guidelines i Australien og New
Zealand vha Unicef(Sundercombe 2014)
bull Kun 9 ud af 22 naeligvner hud mod hud lige efter foslashdslen
bull Kun enkelte naeligvner hjaeliglp til effektiv amning og information om tegn
paring spiselyst
bull Mere end halvdelen anbefaler supplering med mors udmalkede maeliglk
bull Kun 8 ud af 22 sikrer sig samtykke foslashr mme og info til foraeligldre om
aringrsag til suppleringen
Unicef hypoglycemia 2013
Forebyggelse i ammeperspektiv og Baby Friendly
Normoglycaeligmisk tilstand boslashr opnaringes med mindst mulig intervention
Konventionel tilgang
bull 60 mlkgdoslashgn mm el mme oslashges med
20 mlkgdoslashgn x 8(-12)
bull Vallecasein 4060 mme = nedsat
ventrikeltoslashmning
bull Vi maringler stadig 1 t bs
bull Ved lav bs oslashges til 125 eller 150
af maeligngden
bull Glucose-infusion
bull Adskillelse af mor og barn
Individuel tilgangABM Protocol 2014
bull 1-3 mlkg (optil 5 mlkg) gerne hver 2 time
(3-5 mlkg i 2006-udgaven)
bull Hurtig passage af mm alle hjaeliglpestoffer er
med Vallecasein 9010
Bergmann
bull mavesaeligkkens stoslashrrelse lige foslashr foslashdslen
drikker barnet ca 10 ml gang Refererer til
studier der angiver ventiklen til hhv 10 12
15 20 ml
bull Anbefaler smaring hyppige amninger
suppleringer saring barnet ikke stresses og
bruger mere glucose end det tilfoslashres
bull Ward-Platt Laktat er rdquothe good guyrdquo og et
veloxideret velcirkuleret barn har alle
muligheder for at kompensere
bull Antenatal udmalkning af raringmaeliglk til DM-
boslashrn
Forskellen i et forloslashb
DPS
3000 gram
bull 180 ml 1 doslashgn
(60kgdoslashgn)
bull bsdarr oslashges til 225 ml 24
timer
Svaeligrt at faring udmalket dette
som ekstra
ABM
3000 gram
bull 36 ml foslashrste doslashgn
1 mlkg maringltid = 3 x 12
bull 108 ml v 3 ml kgmaringltid
(reduktion paring 40 )
Opnaringeligt at udmalke dette
som ekstra
Mon der er forskel paring
antal amninger
Haringndudmalkning korrektinkorrekt
bull httpswwwyoutubecomwatchv=k6V9xTZAWq0
24
Hvordan forholder vi os til dette
bull Vi kan ikke aeligndre instrukser for hypoglycaeligmi haringndtering det
er en laeliggefaglig opgave kan vi alligevel goslashre en forskel i
profylaktisk oslashjemed
bull Har vi et ansvar for at vaeligre kritiske overfor gamle strategier
ndash og dermed assistere paeligdiatere i forebyggelsesarbejdet
bull Hvordan kan vi balancere forebyggelse og ikke-skade
princippet naringr det ogsaring drejer sig om naturlig ernaeligring mor-
barn kontakt og medicinske interventioner
bull Kan vi med vores viden om colostrum og naturlige
processers effekt aeligndre praksis for disse boslashrn
bull Hvordan kan vi som sundhedsprofessionelle oslashge antallet af
risikoboslashrn der tidligt faringr mors maeliglk selv om det ikke sutter
bull Hvordan vil det aeligndre vores praksisarbejde
bull Hvordan klaeligdes novicen og vi paring til en rdquoWatch and Waitrdquo
tilgang til hypoglycaeligmiforebyggelse
bull POCT eller lab-svar
Mon ikke hypoglycaeligmi forebyggelse kvalitativt kan
komme videre end i 2014
Tak fordi I lyttede
referencerbull CHERTOK IR RAZ I SHOHAM I HADDAD H and WIZNITZER A 2009 Journal of human
nutrition and dietetics the official journal of the British Dietetic Association 22(2) pp 166-169
bull CHRISTESEN HT and ESBERG G 2014-last update Hypoglykaeligmi flowcharts DPS Available
httpvipregionhdkVIPRedaktoer151637nsfvLookupUploadATTACH-RHAP-
9K2D8Y$FILEHypoglykC3A6mi20-20neonatal20Flowcharts20Maj202014pdf [0916
2014]
bull CORDERO L TREUER SH LANDON MB and GABBE SG 1998 Management of infants of
diabetic mothers Archives of Pediatrics amp Adolescent Medicine 152(3) pp 249-254
bull CORNBLATH M HAWDON JM WILLIAMS AF AYNSLEY-GREEN A WARD-PLATT MP
SCHWARTZ R and KALHAN SC 2000 Controversies regarding definition of neonatal
hypoglycemia suggested operational thresholds Pediatrics 105(5) pp 1141-1145
bull CSONT GL GROTH S HOPKINS P and GUILLET R 2014 An evidence-based approach to
breastfeeding neonates at risk for hypoglycemia Journal of obstetric gynecologic and neonatal
nursing JOGNN NAACOG 43(1) pp 71-81
bull DE ROOY L and HAWDON J 2002 Nutritional factors that affect the postnatal metabolic
adaptation of full-term small- and large-for-gestational-age infants Pediatrics 109(3) pp E42
bull DOBSON LZ VIBEKE 2011 God blodsukkerregulering kun for barnets skyld 25(nr 4) pp 36--
47
bull FLORES-LE ROUX JA SAGARRA E BENAIGES D HERNANDEZ-RIVAS E CHILLARON
JJ PUIG DE DOU J MUR A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2012 A
prospective evaluation of neonatal hypoglycaemia in infants of women with gestational diabetes
mellitus Diabetes research and clinical practice 97(2) pp 217-222
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull HARRIS DL WESTON PJ SIGNAL M CHASE JG and HARDING JE 2013 Dextrose gel for neonatal
hypoglycaemia (the Sugar Babies Study) a randomised double-blind placebo-controlled trial Lancet (London
England) 382(9910) pp 2077-2083
bull HERNANDEZ-RIVAS E FLORES-LE ROUX JA BENAIGES D SAGARRA E CHILLARON JJ PAYA A
PUIG-DE DOU J GODAY A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2013 Gestational diabetes in a
multiethnic population of Spain clinical characteristics and perinatal outcomes Diabetes research and clinical
practice 100(2) pp 215-221
bull HOSETH E JOERGENSEN A EBBESEN F and MOELLER M 2000 Blood glucose levels in a population of
healthy breast fed term infants of appropriate size for gestational age Archives of disease in childhoodFetal and
neonatal edition 83(2) pp F117-9
bull JENSEN DM SORENSEN B FEILBERG-JORGENSEN N WESTERGAARD JG and BECK-NIELSEN H
2000 Maternal and perinatal outcomes in 143 Danish women with gestational diabetes mellitus and 143 controls with
a similar risk profile Diabetic medicine a journal of the British Diabetic Association 17(4) pp 281-286
bull MAAYAN-METZGER A LUBIN D and KUINT J 2009 Hypoglycemia rates in the first days of life among term
infants born to diabetic mothers Neonatology 96(2) pp 80-85
bull MAAYAN-METZGER A SCHUSHAN-EISEN I LUBIN D MORAN O KUINT J and MAZKERETH R 2014
Delivery room breastfeeding for prevention of hypoglycaemia in infants of diabetic mothers Fetal and pediatric
pathology 33(1) pp 23-28
bull MCKINLAY CEA 2015 neonatal hypoglycemia and neurodevelopment outcomes at 2 years N Engl J Med(373)
pp 1507-18
bull METZGER BE PERSSON B LOWE LP DYER AR CRUICKSHANK JK DEEROCHANAWONG C
HALLIDAY HL HENNIS AJ LILEY H NG PC COUSTAN DR HADDEN DR HOD M OATS JJ
TRIMBLE ER and HAPO STUDY COOPERATIVE RESEARCH GROUP 2010 Hyperglycemia and adverse
pregnancy outcome study neonatal glycemia Pediatrics 126(6) pp e1545-52
bull ROZANCE PJ and HAY WWJR 2012 Neonatal hypoglycemia--answers but more questions The Journal of
pediatrics 161(5) pp 775-776
bull SARKAR S WATMAN J SEIGEL WM and SCHAEFFER HA 2003 A prospective controlled study of neonatal
morbidities in infants born at 36 weeks or more gestation to Women with diet-controlled gestational diabetes (GDM-
class Al) Journal of perinatology official journal of the California Perinatal Association 23(3) pp 223-228
bull SOLTANI H DICKINSON FM KALK J and PAYNE K 2008 Breast feeding
practices and views among diabetic women a retrospective cohort study Midwifery
24(4) pp 471-479
bull TOZIER P 2013 Colostrum Versus Formula Supplentation for Glucose Stabilization in
Newborns of Diabetic Mothers 42(JOGNN The association of Womens Health
Obstetric and Neonatal Nurses) pp 619-628
bull VAN HOWE RS and STORMS MR 2008 Blood glucose determinations in large for
gestational age infants American Journal of Perinatology 25(5) pp 283-289
bull WIGHT N MARINELLI KA and ACADEMY OF BREASTFEEDING MEDICINE
PROTOCOL COMMITTEE 2006 ABM clinical protocol 1 guidelines for glucose
monitoring and treatment of hypoglycemia in breastfed neonates Breastfeeding
medicine the official journal of the Academy of Breastfeeding Medicine 1(3) pp 178-
184
bull VANHALTREN K and MALHOTRA A 2013 Characteristics of infants at risk of
hypoglycaemia secondary to being infant of a diabetic mother Journal of pediatric
endocrinology amp metabolism JPEM 26(9-10) pp 861-865
bull WIGHT NE 2014 Hypoglycemia in breastfed neonates Breastfeeding medicine the
official journal of the Academy of Breastfeeding Medicine 9(4) pp 173-179
bull DALSGAARD B and ECK K 2013-last update Klinisk retningslinje for
nonfarmakologisk forebyggelse af neonatal hypoglycaeligmi og energitab hos nyfoslashdte af
moslashdre med diaeligtbehandlet gestationel diabetes Available
httpwwwkliniskeretningslinjerdkimages88_gdm_godkendt_010713pdf [0917 2014]
hypoglycaeligmibull
bull BRAGG JJ GREEN R and HOLZMAN IR 2013 Does early enteral feeding prevent
hypoglycemia in small for gestational age neonates Journal of neonatal-perinatal medicine 6(2)
pp 131-135
bull HARRIS DL WESTON PJ and HARDING JE 2014 Lactate rather than ketones may provide
alternative cerebral fuel in hypoglycaemic newborns Archives of disease in childhoodFetal and
neonatal edition
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull LANG TF and HUSSAIN K 2014 Pediatric hypoglycemia Advances in Clinical Chemistry 63
pp 211-245
bull MITANCHEZ D BURGUET A and SIMEONI U 2014 Infants born to mothers with gestational
diabetes mellitus mild neonatal effects a long-term threat to global health The Journal of pediatrics
164(3) pp 445-450
bull SUNDERCOMBE SL RAYNES-GREENOW CH TURNER RM and JEFFERY HE 2014 Do
neonatal hypoglycaemia guidelines in Australia and New Zealand facilitate breast feeding
Midwifery 30(12) pp 1179-1186
bull TAM EW HAEUSSLEIN LA BONIFACIO SL GLASS HC ROGERS EE JEREMY RJ
BARKOVICH AJ and FERRIERO DM 2012 Hypoglycemia is associated with increased risk for
brain injury and adverse neurodevelopmental outcome in neonates at risk for encephalopathy The
Journal of pediatrics 161(1) pp 88-93
bull UNICEF 2013 hypoglycaemia guidance july 2013 UNICEF
Kilder tilfoslashjet 2016
bull AGHDAS K TALAT K and SEPIDEH B 2014 Effect of immediate and continuous mother-infant
skin-to-skin contact on breastfeeding self-efficacy of primiparous women a randomised control trial
Women and birth journal of the Australian College of Midwives 27(1) pp 37-40
bull BEIRANVAND S VALIZADEH F HOSSEINABADI R and POURNIA Y 2014 The Effects of
Skin-to-Skin Contact on Temperature and Breastfeeding Successfulness in Full-Term Newborns
after Cesarean Delivery International journal of pediatrics 2014 pp 846486
bull FENGER-GRON J FENGER-GRON M BLUNCK CH SCHONEMANN-RIGEL H and
WIELANDT HB 2015 Low breastfeeding rates and body mass index in Danish children of women
with gestational diabetes mellitus International breastfeeding journal 10 pp 26-015-0051-8
eCollection 2015
bull JAGIELLO KP and AZULAY CHERTOK IR 2015 Womens Experiences With Early
Breastfeeding After Gestational Diabetes Journal of obstetric gynecologic and neonatal nursing
JOGNN NAACOG 44(4) pp 500-509
bull SAMAYAM P RANGANATHAN PK KOTARI UD and BALASUNDARAM R 2015 Study of
Asymptomatic Hypoglycemia in Full Term Exclusively Breastfed Neonates in First 48 Hours of Life
Journal of clinical and diagnostic research JCDR 9(9) pp SC07-10
bull SOBREVIA L SALSOSO R SAEZ T SANHUEZA C PARDO F and LEIVA A 2015 Insulin
therapy and fetoplacental vascular function in gestational diabetes mellitus Experimental physiology
100(3) pp 231-238
bull STEWART CE SAGE EL and REYNOLDS P 2015 Supporting Baby Friendly a quality
improvement initiative for the management of transitional neonatal hypoglycaemia Archives of
disease in childhoodFetal and neonatal edition
bull
Incidence of Neonatal Hypoglycemia in Babies Identified as at Risk
Deborah L Harris
2012 J of Pediatrics
Burde vi taelignke Hvad
er dette barns
specifikke evne til
metabolisk tilpasning
efter foslashdslen og
hvordan stoslashtter vi
barnet bedst paring
naturlig vis i denne
proces og stadig
forebygger skade
Saeligrlige risikoboslashrn
bull IUGR boslashrn kan vaeligre meget uforudsigelige Deres
pancreas kan vaeligre overaktiv og dermed udsende for
meget insulin og pancreas kan vaeligre haeligmmet
bull Saeligrlig de boslashrn der er asymmetriske i deres vaeligkst
Soslashgning af litteratur
En hurtig PubMed soslashgning giver foslashlgende
1Neonatal hypoglycemia 2404
2Breastfeeding 36873
3Colostrum 7435
1+2 70
1+3 3
Early feeding
bull Der er ingen enighed om definition paring Early Feeding
bull Hawdon rdquofoslashrhen sendte boslashrnene hurtigt maeliglken tilbage til den velmenende
afsenderrdquo
bull Early Feeding kan vaeligre tidlig hyppig amning sukkervand modermaeliglk
erstatning dextrosegel Maeligngde
bull Udover amning er der mange modeller og ingen af dem er evidensbaserede
bull I 2015-16 kommer der stadig artikler om neonatal hypoglycaeligmi der ikke
skriver om ernaeligring overhovedet
Modermaeliglkserstatning og hjaeliglpestoffer
De Rooyrsquos studie fra 2002 viser
bull I et prospektivt studie med i alt 165 boslashrn blev boslashrnenes ketogenese
undersoslashgt
bull Deacuten gruppe der er taeligttest paring en af vores maringlgrupper GDM er Large
for Gestational Age boslashrnene Her paringvises det med signifikant forskel
at amning oslashger ketogenesen og at amning + modermaeliglkserstatning
ikke har saring god respons
bull Flaskeboslashrn danner stort set ikke ketonstoffer i starten foslashrst efter 12
timer
Det kan antyde at mme reducerer barnets evne til
modregulering og selvhjaeliglp
At mme har bivirkningersideeffekter der bestemt ikke
er hensigtsmaeligssige naringr vi taler om forebyggelse
Guidelines hvor er vi
Unicef 2013
bull Alle hud mod hud lige efter foslashdslen
bull Amning indenfor den foslashrste time
bull Foslashrste bs tidligst efter 2 timer og foslashr andet maringltid
bull Ved lavt bs (graelignse 26 el 20) ammes igen eller udmalket maeliglk Ved
fortsat lavt bs efter 1 time gives mme i de maeligngder vi kender
Survey af neonatale hypoglykaeligmi guidelines i Australien og New
Zealand vha Unicef(Sundercombe 2014)
bull Kun 9 ud af 22 naeligvner hud mod hud lige efter foslashdslen
bull Kun enkelte naeligvner hjaeliglp til effektiv amning og information om tegn
paring spiselyst
bull Mere end halvdelen anbefaler supplering med mors udmalkede maeliglk
bull Kun 8 ud af 22 sikrer sig samtykke foslashr mme og info til foraeligldre om
aringrsag til suppleringen
Unicef hypoglycemia 2013
Forebyggelse i ammeperspektiv og Baby Friendly
Normoglycaeligmisk tilstand boslashr opnaringes med mindst mulig intervention
Konventionel tilgang
bull 60 mlkgdoslashgn mm el mme oslashges med
20 mlkgdoslashgn x 8(-12)
bull Vallecasein 4060 mme = nedsat
ventrikeltoslashmning
bull Vi maringler stadig 1 t bs
bull Ved lav bs oslashges til 125 eller 150
af maeligngden
bull Glucose-infusion
bull Adskillelse af mor og barn
Individuel tilgangABM Protocol 2014
bull 1-3 mlkg (optil 5 mlkg) gerne hver 2 time
(3-5 mlkg i 2006-udgaven)
bull Hurtig passage af mm alle hjaeliglpestoffer er
med Vallecasein 9010
Bergmann
bull mavesaeligkkens stoslashrrelse lige foslashr foslashdslen
drikker barnet ca 10 ml gang Refererer til
studier der angiver ventiklen til hhv 10 12
15 20 ml
bull Anbefaler smaring hyppige amninger
suppleringer saring barnet ikke stresses og
bruger mere glucose end det tilfoslashres
bull Ward-Platt Laktat er rdquothe good guyrdquo og et
veloxideret velcirkuleret barn har alle
muligheder for at kompensere
bull Antenatal udmalkning af raringmaeliglk til DM-
boslashrn
Forskellen i et forloslashb
DPS
3000 gram
bull 180 ml 1 doslashgn
(60kgdoslashgn)
bull bsdarr oslashges til 225 ml 24
timer
Svaeligrt at faring udmalket dette
som ekstra
ABM
3000 gram
bull 36 ml foslashrste doslashgn
1 mlkg maringltid = 3 x 12
bull 108 ml v 3 ml kgmaringltid
(reduktion paring 40 )
Opnaringeligt at udmalke dette
som ekstra
Mon der er forskel paring
antal amninger
Haringndudmalkning korrektinkorrekt
bull httpswwwyoutubecomwatchv=k6V9xTZAWq0
24
Hvordan forholder vi os til dette
bull Vi kan ikke aeligndre instrukser for hypoglycaeligmi haringndtering det
er en laeliggefaglig opgave kan vi alligevel goslashre en forskel i
profylaktisk oslashjemed
bull Har vi et ansvar for at vaeligre kritiske overfor gamle strategier
ndash og dermed assistere paeligdiatere i forebyggelsesarbejdet
bull Hvordan kan vi balancere forebyggelse og ikke-skade
princippet naringr det ogsaring drejer sig om naturlig ernaeligring mor-
barn kontakt og medicinske interventioner
bull Kan vi med vores viden om colostrum og naturlige
processers effekt aeligndre praksis for disse boslashrn
bull Hvordan kan vi som sundhedsprofessionelle oslashge antallet af
risikoboslashrn der tidligt faringr mors maeliglk selv om det ikke sutter
bull Hvordan vil det aeligndre vores praksisarbejde
bull Hvordan klaeligdes novicen og vi paring til en rdquoWatch and Waitrdquo
tilgang til hypoglycaeligmiforebyggelse
bull POCT eller lab-svar
Mon ikke hypoglycaeligmi forebyggelse kvalitativt kan
komme videre end i 2014
Tak fordi I lyttede
referencerbull CHERTOK IR RAZ I SHOHAM I HADDAD H and WIZNITZER A 2009 Journal of human
nutrition and dietetics the official journal of the British Dietetic Association 22(2) pp 166-169
bull CHRISTESEN HT and ESBERG G 2014-last update Hypoglykaeligmi flowcharts DPS Available
httpvipregionhdkVIPRedaktoer151637nsfvLookupUploadATTACH-RHAP-
9K2D8Y$FILEHypoglykC3A6mi20-20neonatal20Flowcharts20Maj202014pdf [0916
2014]
bull CORDERO L TREUER SH LANDON MB and GABBE SG 1998 Management of infants of
diabetic mothers Archives of Pediatrics amp Adolescent Medicine 152(3) pp 249-254
bull CORNBLATH M HAWDON JM WILLIAMS AF AYNSLEY-GREEN A WARD-PLATT MP
SCHWARTZ R and KALHAN SC 2000 Controversies regarding definition of neonatal
hypoglycemia suggested operational thresholds Pediatrics 105(5) pp 1141-1145
bull CSONT GL GROTH S HOPKINS P and GUILLET R 2014 An evidence-based approach to
breastfeeding neonates at risk for hypoglycemia Journal of obstetric gynecologic and neonatal
nursing JOGNN NAACOG 43(1) pp 71-81
bull DE ROOY L and HAWDON J 2002 Nutritional factors that affect the postnatal metabolic
adaptation of full-term small- and large-for-gestational-age infants Pediatrics 109(3) pp E42
bull DOBSON LZ VIBEKE 2011 God blodsukkerregulering kun for barnets skyld 25(nr 4) pp 36--
47
bull FLORES-LE ROUX JA SAGARRA E BENAIGES D HERNANDEZ-RIVAS E CHILLARON
JJ PUIG DE DOU J MUR A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2012 A
prospective evaluation of neonatal hypoglycaemia in infants of women with gestational diabetes
mellitus Diabetes research and clinical practice 97(2) pp 217-222
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull HARRIS DL WESTON PJ SIGNAL M CHASE JG and HARDING JE 2013 Dextrose gel for neonatal
hypoglycaemia (the Sugar Babies Study) a randomised double-blind placebo-controlled trial Lancet (London
England) 382(9910) pp 2077-2083
bull HERNANDEZ-RIVAS E FLORES-LE ROUX JA BENAIGES D SAGARRA E CHILLARON JJ PAYA A
PUIG-DE DOU J GODAY A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2013 Gestational diabetes in a
multiethnic population of Spain clinical characteristics and perinatal outcomes Diabetes research and clinical
practice 100(2) pp 215-221
bull HOSETH E JOERGENSEN A EBBESEN F and MOELLER M 2000 Blood glucose levels in a population of
healthy breast fed term infants of appropriate size for gestational age Archives of disease in childhoodFetal and
neonatal edition 83(2) pp F117-9
bull JENSEN DM SORENSEN B FEILBERG-JORGENSEN N WESTERGAARD JG and BECK-NIELSEN H
2000 Maternal and perinatal outcomes in 143 Danish women with gestational diabetes mellitus and 143 controls with
a similar risk profile Diabetic medicine a journal of the British Diabetic Association 17(4) pp 281-286
bull MAAYAN-METZGER A LUBIN D and KUINT J 2009 Hypoglycemia rates in the first days of life among term
infants born to diabetic mothers Neonatology 96(2) pp 80-85
bull MAAYAN-METZGER A SCHUSHAN-EISEN I LUBIN D MORAN O KUINT J and MAZKERETH R 2014
Delivery room breastfeeding for prevention of hypoglycaemia in infants of diabetic mothers Fetal and pediatric
pathology 33(1) pp 23-28
bull MCKINLAY CEA 2015 neonatal hypoglycemia and neurodevelopment outcomes at 2 years N Engl J Med(373)
pp 1507-18
bull METZGER BE PERSSON B LOWE LP DYER AR CRUICKSHANK JK DEEROCHANAWONG C
HALLIDAY HL HENNIS AJ LILEY H NG PC COUSTAN DR HADDEN DR HOD M OATS JJ
TRIMBLE ER and HAPO STUDY COOPERATIVE RESEARCH GROUP 2010 Hyperglycemia and adverse
pregnancy outcome study neonatal glycemia Pediatrics 126(6) pp e1545-52
bull ROZANCE PJ and HAY WWJR 2012 Neonatal hypoglycemia--answers but more questions The Journal of
pediatrics 161(5) pp 775-776
bull SARKAR S WATMAN J SEIGEL WM and SCHAEFFER HA 2003 A prospective controlled study of neonatal
morbidities in infants born at 36 weeks or more gestation to Women with diet-controlled gestational diabetes (GDM-
class Al) Journal of perinatology official journal of the California Perinatal Association 23(3) pp 223-228
bull SOLTANI H DICKINSON FM KALK J and PAYNE K 2008 Breast feeding
practices and views among diabetic women a retrospective cohort study Midwifery
24(4) pp 471-479
bull TOZIER P 2013 Colostrum Versus Formula Supplentation for Glucose Stabilization in
Newborns of Diabetic Mothers 42(JOGNN The association of Womens Health
Obstetric and Neonatal Nurses) pp 619-628
bull VAN HOWE RS and STORMS MR 2008 Blood glucose determinations in large for
gestational age infants American Journal of Perinatology 25(5) pp 283-289
bull WIGHT N MARINELLI KA and ACADEMY OF BREASTFEEDING MEDICINE
PROTOCOL COMMITTEE 2006 ABM clinical protocol 1 guidelines for glucose
monitoring and treatment of hypoglycemia in breastfed neonates Breastfeeding
medicine the official journal of the Academy of Breastfeeding Medicine 1(3) pp 178-
184
bull VANHALTREN K and MALHOTRA A 2013 Characteristics of infants at risk of
hypoglycaemia secondary to being infant of a diabetic mother Journal of pediatric
endocrinology amp metabolism JPEM 26(9-10) pp 861-865
bull WIGHT NE 2014 Hypoglycemia in breastfed neonates Breastfeeding medicine the
official journal of the Academy of Breastfeeding Medicine 9(4) pp 173-179
bull DALSGAARD B and ECK K 2013-last update Klinisk retningslinje for
nonfarmakologisk forebyggelse af neonatal hypoglycaeligmi og energitab hos nyfoslashdte af
moslashdre med diaeligtbehandlet gestationel diabetes Available
httpwwwkliniskeretningslinjerdkimages88_gdm_godkendt_010713pdf [0917 2014]
hypoglycaeligmibull
bull BRAGG JJ GREEN R and HOLZMAN IR 2013 Does early enteral feeding prevent
hypoglycemia in small for gestational age neonates Journal of neonatal-perinatal medicine 6(2)
pp 131-135
bull HARRIS DL WESTON PJ and HARDING JE 2014 Lactate rather than ketones may provide
alternative cerebral fuel in hypoglycaemic newborns Archives of disease in childhoodFetal and
neonatal edition
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull LANG TF and HUSSAIN K 2014 Pediatric hypoglycemia Advances in Clinical Chemistry 63
pp 211-245
bull MITANCHEZ D BURGUET A and SIMEONI U 2014 Infants born to mothers with gestational
diabetes mellitus mild neonatal effects a long-term threat to global health The Journal of pediatrics
164(3) pp 445-450
bull SUNDERCOMBE SL RAYNES-GREENOW CH TURNER RM and JEFFERY HE 2014 Do
neonatal hypoglycaemia guidelines in Australia and New Zealand facilitate breast feeding
Midwifery 30(12) pp 1179-1186
bull TAM EW HAEUSSLEIN LA BONIFACIO SL GLASS HC ROGERS EE JEREMY RJ
BARKOVICH AJ and FERRIERO DM 2012 Hypoglycemia is associated with increased risk for
brain injury and adverse neurodevelopmental outcome in neonates at risk for encephalopathy The
Journal of pediatrics 161(1) pp 88-93
bull UNICEF 2013 hypoglycaemia guidance july 2013 UNICEF
Kilder tilfoslashjet 2016
bull AGHDAS K TALAT K and SEPIDEH B 2014 Effect of immediate and continuous mother-infant
skin-to-skin contact on breastfeeding self-efficacy of primiparous women a randomised control trial
Women and birth journal of the Australian College of Midwives 27(1) pp 37-40
bull BEIRANVAND S VALIZADEH F HOSSEINABADI R and POURNIA Y 2014 The Effects of
Skin-to-Skin Contact on Temperature and Breastfeeding Successfulness in Full-Term Newborns
after Cesarean Delivery International journal of pediatrics 2014 pp 846486
bull FENGER-GRON J FENGER-GRON M BLUNCK CH SCHONEMANN-RIGEL H and
WIELANDT HB 2015 Low breastfeeding rates and body mass index in Danish children of women
with gestational diabetes mellitus International breastfeeding journal 10 pp 26-015-0051-8
eCollection 2015
bull JAGIELLO KP and AZULAY CHERTOK IR 2015 Womens Experiences With Early
Breastfeeding After Gestational Diabetes Journal of obstetric gynecologic and neonatal nursing
JOGNN NAACOG 44(4) pp 500-509
bull SAMAYAM P RANGANATHAN PK KOTARI UD and BALASUNDARAM R 2015 Study of
Asymptomatic Hypoglycemia in Full Term Exclusively Breastfed Neonates in First 48 Hours of Life
Journal of clinical and diagnostic research JCDR 9(9) pp SC07-10
bull SOBREVIA L SALSOSO R SAEZ T SANHUEZA C PARDO F and LEIVA A 2015 Insulin
therapy and fetoplacental vascular function in gestational diabetes mellitus Experimental physiology
100(3) pp 231-238
bull STEWART CE SAGE EL and REYNOLDS P 2015 Supporting Baby Friendly a quality
improvement initiative for the management of transitional neonatal hypoglycaemia Archives of
disease in childhoodFetal and neonatal edition
bull
Saeligrlige risikoboslashrn
bull IUGR boslashrn kan vaeligre meget uforudsigelige Deres
pancreas kan vaeligre overaktiv og dermed udsende for
meget insulin og pancreas kan vaeligre haeligmmet
bull Saeligrlig de boslashrn der er asymmetriske i deres vaeligkst
Soslashgning af litteratur
En hurtig PubMed soslashgning giver foslashlgende
1Neonatal hypoglycemia 2404
2Breastfeeding 36873
3Colostrum 7435
1+2 70
1+3 3
Early feeding
bull Der er ingen enighed om definition paring Early Feeding
bull Hawdon rdquofoslashrhen sendte boslashrnene hurtigt maeliglken tilbage til den velmenende
afsenderrdquo
bull Early Feeding kan vaeligre tidlig hyppig amning sukkervand modermaeliglk
erstatning dextrosegel Maeligngde
bull Udover amning er der mange modeller og ingen af dem er evidensbaserede
bull I 2015-16 kommer der stadig artikler om neonatal hypoglycaeligmi der ikke
skriver om ernaeligring overhovedet
Modermaeliglkserstatning og hjaeliglpestoffer
De Rooyrsquos studie fra 2002 viser
bull I et prospektivt studie med i alt 165 boslashrn blev boslashrnenes ketogenese
undersoslashgt
bull Deacuten gruppe der er taeligttest paring en af vores maringlgrupper GDM er Large
for Gestational Age boslashrnene Her paringvises det med signifikant forskel
at amning oslashger ketogenesen og at amning + modermaeliglkserstatning
ikke har saring god respons
bull Flaskeboslashrn danner stort set ikke ketonstoffer i starten foslashrst efter 12
timer
Det kan antyde at mme reducerer barnets evne til
modregulering og selvhjaeliglp
At mme har bivirkningersideeffekter der bestemt ikke
er hensigtsmaeligssige naringr vi taler om forebyggelse
Guidelines hvor er vi
Unicef 2013
bull Alle hud mod hud lige efter foslashdslen
bull Amning indenfor den foslashrste time
bull Foslashrste bs tidligst efter 2 timer og foslashr andet maringltid
bull Ved lavt bs (graelignse 26 el 20) ammes igen eller udmalket maeliglk Ved
fortsat lavt bs efter 1 time gives mme i de maeligngder vi kender
Survey af neonatale hypoglykaeligmi guidelines i Australien og New
Zealand vha Unicef(Sundercombe 2014)
bull Kun 9 ud af 22 naeligvner hud mod hud lige efter foslashdslen
bull Kun enkelte naeligvner hjaeliglp til effektiv amning og information om tegn
paring spiselyst
bull Mere end halvdelen anbefaler supplering med mors udmalkede maeliglk
bull Kun 8 ud af 22 sikrer sig samtykke foslashr mme og info til foraeligldre om
aringrsag til suppleringen
Unicef hypoglycemia 2013
Forebyggelse i ammeperspektiv og Baby Friendly
Normoglycaeligmisk tilstand boslashr opnaringes med mindst mulig intervention
Konventionel tilgang
bull 60 mlkgdoslashgn mm el mme oslashges med
20 mlkgdoslashgn x 8(-12)
bull Vallecasein 4060 mme = nedsat
ventrikeltoslashmning
bull Vi maringler stadig 1 t bs
bull Ved lav bs oslashges til 125 eller 150
af maeligngden
bull Glucose-infusion
bull Adskillelse af mor og barn
Individuel tilgangABM Protocol 2014
bull 1-3 mlkg (optil 5 mlkg) gerne hver 2 time
(3-5 mlkg i 2006-udgaven)
bull Hurtig passage af mm alle hjaeliglpestoffer er
med Vallecasein 9010
Bergmann
bull mavesaeligkkens stoslashrrelse lige foslashr foslashdslen
drikker barnet ca 10 ml gang Refererer til
studier der angiver ventiklen til hhv 10 12
15 20 ml
bull Anbefaler smaring hyppige amninger
suppleringer saring barnet ikke stresses og
bruger mere glucose end det tilfoslashres
bull Ward-Platt Laktat er rdquothe good guyrdquo og et
veloxideret velcirkuleret barn har alle
muligheder for at kompensere
bull Antenatal udmalkning af raringmaeliglk til DM-
boslashrn
Forskellen i et forloslashb
DPS
3000 gram
bull 180 ml 1 doslashgn
(60kgdoslashgn)
bull bsdarr oslashges til 225 ml 24
timer
Svaeligrt at faring udmalket dette
som ekstra
ABM
3000 gram
bull 36 ml foslashrste doslashgn
1 mlkg maringltid = 3 x 12
bull 108 ml v 3 ml kgmaringltid
(reduktion paring 40 )
Opnaringeligt at udmalke dette
som ekstra
Mon der er forskel paring
antal amninger
Haringndudmalkning korrektinkorrekt
bull httpswwwyoutubecomwatchv=k6V9xTZAWq0
24
Hvordan forholder vi os til dette
bull Vi kan ikke aeligndre instrukser for hypoglycaeligmi haringndtering det
er en laeliggefaglig opgave kan vi alligevel goslashre en forskel i
profylaktisk oslashjemed
bull Har vi et ansvar for at vaeligre kritiske overfor gamle strategier
ndash og dermed assistere paeligdiatere i forebyggelsesarbejdet
bull Hvordan kan vi balancere forebyggelse og ikke-skade
princippet naringr det ogsaring drejer sig om naturlig ernaeligring mor-
barn kontakt og medicinske interventioner
bull Kan vi med vores viden om colostrum og naturlige
processers effekt aeligndre praksis for disse boslashrn
bull Hvordan kan vi som sundhedsprofessionelle oslashge antallet af
risikoboslashrn der tidligt faringr mors maeliglk selv om det ikke sutter
bull Hvordan vil det aeligndre vores praksisarbejde
bull Hvordan klaeligdes novicen og vi paring til en rdquoWatch and Waitrdquo
tilgang til hypoglycaeligmiforebyggelse
bull POCT eller lab-svar
Mon ikke hypoglycaeligmi forebyggelse kvalitativt kan
komme videre end i 2014
Tak fordi I lyttede
referencerbull CHERTOK IR RAZ I SHOHAM I HADDAD H and WIZNITZER A 2009 Journal of human
nutrition and dietetics the official journal of the British Dietetic Association 22(2) pp 166-169
bull CHRISTESEN HT and ESBERG G 2014-last update Hypoglykaeligmi flowcharts DPS Available
httpvipregionhdkVIPRedaktoer151637nsfvLookupUploadATTACH-RHAP-
9K2D8Y$FILEHypoglykC3A6mi20-20neonatal20Flowcharts20Maj202014pdf [0916
2014]
bull CORDERO L TREUER SH LANDON MB and GABBE SG 1998 Management of infants of
diabetic mothers Archives of Pediatrics amp Adolescent Medicine 152(3) pp 249-254
bull CORNBLATH M HAWDON JM WILLIAMS AF AYNSLEY-GREEN A WARD-PLATT MP
SCHWARTZ R and KALHAN SC 2000 Controversies regarding definition of neonatal
hypoglycemia suggested operational thresholds Pediatrics 105(5) pp 1141-1145
bull CSONT GL GROTH S HOPKINS P and GUILLET R 2014 An evidence-based approach to
breastfeeding neonates at risk for hypoglycemia Journal of obstetric gynecologic and neonatal
nursing JOGNN NAACOG 43(1) pp 71-81
bull DE ROOY L and HAWDON J 2002 Nutritional factors that affect the postnatal metabolic
adaptation of full-term small- and large-for-gestational-age infants Pediatrics 109(3) pp E42
bull DOBSON LZ VIBEKE 2011 God blodsukkerregulering kun for barnets skyld 25(nr 4) pp 36--
47
bull FLORES-LE ROUX JA SAGARRA E BENAIGES D HERNANDEZ-RIVAS E CHILLARON
JJ PUIG DE DOU J MUR A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2012 A
prospective evaluation of neonatal hypoglycaemia in infants of women with gestational diabetes
mellitus Diabetes research and clinical practice 97(2) pp 217-222
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull HARRIS DL WESTON PJ SIGNAL M CHASE JG and HARDING JE 2013 Dextrose gel for neonatal
hypoglycaemia (the Sugar Babies Study) a randomised double-blind placebo-controlled trial Lancet (London
England) 382(9910) pp 2077-2083
bull HERNANDEZ-RIVAS E FLORES-LE ROUX JA BENAIGES D SAGARRA E CHILLARON JJ PAYA A
PUIG-DE DOU J GODAY A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2013 Gestational diabetes in a
multiethnic population of Spain clinical characteristics and perinatal outcomes Diabetes research and clinical
practice 100(2) pp 215-221
bull HOSETH E JOERGENSEN A EBBESEN F and MOELLER M 2000 Blood glucose levels in a population of
healthy breast fed term infants of appropriate size for gestational age Archives of disease in childhoodFetal and
neonatal edition 83(2) pp F117-9
bull JENSEN DM SORENSEN B FEILBERG-JORGENSEN N WESTERGAARD JG and BECK-NIELSEN H
2000 Maternal and perinatal outcomes in 143 Danish women with gestational diabetes mellitus and 143 controls with
a similar risk profile Diabetic medicine a journal of the British Diabetic Association 17(4) pp 281-286
bull MAAYAN-METZGER A LUBIN D and KUINT J 2009 Hypoglycemia rates in the first days of life among term
infants born to diabetic mothers Neonatology 96(2) pp 80-85
bull MAAYAN-METZGER A SCHUSHAN-EISEN I LUBIN D MORAN O KUINT J and MAZKERETH R 2014
Delivery room breastfeeding for prevention of hypoglycaemia in infants of diabetic mothers Fetal and pediatric
pathology 33(1) pp 23-28
bull MCKINLAY CEA 2015 neonatal hypoglycemia and neurodevelopment outcomes at 2 years N Engl J Med(373)
pp 1507-18
bull METZGER BE PERSSON B LOWE LP DYER AR CRUICKSHANK JK DEEROCHANAWONG C
HALLIDAY HL HENNIS AJ LILEY H NG PC COUSTAN DR HADDEN DR HOD M OATS JJ
TRIMBLE ER and HAPO STUDY COOPERATIVE RESEARCH GROUP 2010 Hyperglycemia and adverse
pregnancy outcome study neonatal glycemia Pediatrics 126(6) pp e1545-52
bull ROZANCE PJ and HAY WWJR 2012 Neonatal hypoglycemia--answers but more questions The Journal of
pediatrics 161(5) pp 775-776
bull SARKAR S WATMAN J SEIGEL WM and SCHAEFFER HA 2003 A prospective controlled study of neonatal
morbidities in infants born at 36 weeks or more gestation to Women with diet-controlled gestational diabetes (GDM-
class Al) Journal of perinatology official journal of the California Perinatal Association 23(3) pp 223-228
bull SOLTANI H DICKINSON FM KALK J and PAYNE K 2008 Breast feeding
practices and views among diabetic women a retrospective cohort study Midwifery
24(4) pp 471-479
bull TOZIER P 2013 Colostrum Versus Formula Supplentation for Glucose Stabilization in
Newborns of Diabetic Mothers 42(JOGNN The association of Womens Health
Obstetric and Neonatal Nurses) pp 619-628
bull VAN HOWE RS and STORMS MR 2008 Blood glucose determinations in large for
gestational age infants American Journal of Perinatology 25(5) pp 283-289
bull WIGHT N MARINELLI KA and ACADEMY OF BREASTFEEDING MEDICINE
PROTOCOL COMMITTEE 2006 ABM clinical protocol 1 guidelines for glucose
monitoring and treatment of hypoglycemia in breastfed neonates Breastfeeding
medicine the official journal of the Academy of Breastfeeding Medicine 1(3) pp 178-
184
bull VANHALTREN K and MALHOTRA A 2013 Characteristics of infants at risk of
hypoglycaemia secondary to being infant of a diabetic mother Journal of pediatric
endocrinology amp metabolism JPEM 26(9-10) pp 861-865
bull WIGHT NE 2014 Hypoglycemia in breastfed neonates Breastfeeding medicine the
official journal of the Academy of Breastfeeding Medicine 9(4) pp 173-179
bull DALSGAARD B and ECK K 2013-last update Klinisk retningslinje for
nonfarmakologisk forebyggelse af neonatal hypoglycaeligmi og energitab hos nyfoslashdte af
moslashdre med diaeligtbehandlet gestationel diabetes Available
httpwwwkliniskeretningslinjerdkimages88_gdm_godkendt_010713pdf [0917 2014]
hypoglycaeligmibull
bull BRAGG JJ GREEN R and HOLZMAN IR 2013 Does early enteral feeding prevent
hypoglycemia in small for gestational age neonates Journal of neonatal-perinatal medicine 6(2)
pp 131-135
bull HARRIS DL WESTON PJ and HARDING JE 2014 Lactate rather than ketones may provide
alternative cerebral fuel in hypoglycaemic newborns Archives of disease in childhoodFetal and
neonatal edition
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull LANG TF and HUSSAIN K 2014 Pediatric hypoglycemia Advances in Clinical Chemistry 63
pp 211-245
bull MITANCHEZ D BURGUET A and SIMEONI U 2014 Infants born to mothers with gestational
diabetes mellitus mild neonatal effects a long-term threat to global health The Journal of pediatrics
164(3) pp 445-450
bull SUNDERCOMBE SL RAYNES-GREENOW CH TURNER RM and JEFFERY HE 2014 Do
neonatal hypoglycaemia guidelines in Australia and New Zealand facilitate breast feeding
Midwifery 30(12) pp 1179-1186
bull TAM EW HAEUSSLEIN LA BONIFACIO SL GLASS HC ROGERS EE JEREMY RJ
BARKOVICH AJ and FERRIERO DM 2012 Hypoglycemia is associated with increased risk for
brain injury and adverse neurodevelopmental outcome in neonates at risk for encephalopathy The
Journal of pediatrics 161(1) pp 88-93
bull UNICEF 2013 hypoglycaemia guidance july 2013 UNICEF
Kilder tilfoslashjet 2016
bull AGHDAS K TALAT K and SEPIDEH B 2014 Effect of immediate and continuous mother-infant
skin-to-skin contact on breastfeeding self-efficacy of primiparous women a randomised control trial
Women and birth journal of the Australian College of Midwives 27(1) pp 37-40
bull BEIRANVAND S VALIZADEH F HOSSEINABADI R and POURNIA Y 2014 The Effects of
Skin-to-Skin Contact on Temperature and Breastfeeding Successfulness in Full-Term Newborns
after Cesarean Delivery International journal of pediatrics 2014 pp 846486
bull FENGER-GRON J FENGER-GRON M BLUNCK CH SCHONEMANN-RIGEL H and
WIELANDT HB 2015 Low breastfeeding rates and body mass index in Danish children of women
with gestational diabetes mellitus International breastfeeding journal 10 pp 26-015-0051-8
eCollection 2015
bull JAGIELLO KP and AZULAY CHERTOK IR 2015 Womens Experiences With Early
Breastfeeding After Gestational Diabetes Journal of obstetric gynecologic and neonatal nursing
JOGNN NAACOG 44(4) pp 500-509
bull SAMAYAM P RANGANATHAN PK KOTARI UD and BALASUNDARAM R 2015 Study of
Asymptomatic Hypoglycemia in Full Term Exclusively Breastfed Neonates in First 48 Hours of Life
Journal of clinical and diagnostic research JCDR 9(9) pp SC07-10
bull SOBREVIA L SALSOSO R SAEZ T SANHUEZA C PARDO F and LEIVA A 2015 Insulin
therapy and fetoplacental vascular function in gestational diabetes mellitus Experimental physiology
100(3) pp 231-238
bull STEWART CE SAGE EL and REYNOLDS P 2015 Supporting Baby Friendly a quality
improvement initiative for the management of transitional neonatal hypoglycaemia Archives of
disease in childhoodFetal and neonatal edition
bull
Soslashgning af litteratur
En hurtig PubMed soslashgning giver foslashlgende
1Neonatal hypoglycemia 2404
2Breastfeeding 36873
3Colostrum 7435
1+2 70
1+3 3
Early feeding
bull Der er ingen enighed om definition paring Early Feeding
bull Hawdon rdquofoslashrhen sendte boslashrnene hurtigt maeliglken tilbage til den velmenende
afsenderrdquo
bull Early Feeding kan vaeligre tidlig hyppig amning sukkervand modermaeliglk
erstatning dextrosegel Maeligngde
bull Udover amning er der mange modeller og ingen af dem er evidensbaserede
bull I 2015-16 kommer der stadig artikler om neonatal hypoglycaeligmi der ikke
skriver om ernaeligring overhovedet
Modermaeliglkserstatning og hjaeliglpestoffer
De Rooyrsquos studie fra 2002 viser
bull I et prospektivt studie med i alt 165 boslashrn blev boslashrnenes ketogenese
undersoslashgt
bull Deacuten gruppe der er taeligttest paring en af vores maringlgrupper GDM er Large
for Gestational Age boslashrnene Her paringvises det med signifikant forskel
at amning oslashger ketogenesen og at amning + modermaeliglkserstatning
ikke har saring god respons
bull Flaskeboslashrn danner stort set ikke ketonstoffer i starten foslashrst efter 12
timer
Det kan antyde at mme reducerer barnets evne til
modregulering og selvhjaeliglp
At mme har bivirkningersideeffekter der bestemt ikke
er hensigtsmaeligssige naringr vi taler om forebyggelse
Guidelines hvor er vi
Unicef 2013
bull Alle hud mod hud lige efter foslashdslen
bull Amning indenfor den foslashrste time
bull Foslashrste bs tidligst efter 2 timer og foslashr andet maringltid
bull Ved lavt bs (graelignse 26 el 20) ammes igen eller udmalket maeliglk Ved
fortsat lavt bs efter 1 time gives mme i de maeligngder vi kender
Survey af neonatale hypoglykaeligmi guidelines i Australien og New
Zealand vha Unicef(Sundercombe 2014)
bull Kun 9 ud af 22 naeligvner hud mod hud lige efter foslashdslen
bull Kun enkelte naeligvner hjaeliglp til effektiv amning og information om tegn
paring spiselyst
bull Mere end halvdelen anbefaler supplering med mors udmalkede maeliglk
bull Kun 8 ud af 22 sikrer sig samtykke foslashr mme og info til foraeligldre om
aringrsag til suppleringen
Unicef hypoglycemia 2013
Forebyggelse i ammeperspektiv og Baby Friendly
Normoglycaeligmisk tilstand boslashr opnaringes med mindst mulig intervention
Konventionel tilgang
bull 60 mlkgdoslashgn mm el mme oslashges med
20 mlkgdoslashgn x 8(-12)
bull Vallecasein 4060 mme = nedsat
ventrikeltoslashmning
bull Vi maringler stadig 1 t bs
bull Ved lav bs oslashges til 125 eller 150
af maeligngden
bull Glucose-infusion
bull Adskillelse af mor og barn
Individuel tilgangABM Protocol 2014
bull 1-3 mlkg (optil 5 mlkg) gerne hver 2 time
(3-5 mlkg i 2006-udgaven)
bull Hurtig passage af mm alle hjaeliglpestoffer er
med Vallecasein 9010
Bergmann
bull mavesaeligkkens stoslashrrelse lige foslashr foslashdslen
drikker barnet ca 10 ml gang Refererer til
studier der angiver ventiklen til hhv 10 12
15 20 ml
bull Anbefaler smaring hyppige amninger
suppleringer saring barnet ikke stresses og
bruger mere glucose end det tilfoslashres
bull Ward-Platt Laktat er rdquothe good guyrdquo og et
veloxideret velcirkuleret barn har alle
muligheder for at kompensere
bull Antenatal udmalkning af raringmaeliglk til DM-
boslashrn
Forskellen i et forloslashb
DPS
3000 gram
bull 180 ml 1 doslashgn
(60kgdoslashgn)
bull bsdarr oslashges til 225 ml 24
timer
Svaeligrt at faring udmalket dette
som ekstra
ABM
3000 gram
bull 36 ml foslashrste doslashgn
1 mlkg maringltid = 3 x 12
bull 108 ml v 3 ml kgmaringltid
(reduktion paring 40 )
Opnaringeligt at udmalke dette
som ekstra
Mon der er forskel paring
antal amninger
Haringndudmalkning korrektinkorrekt
bull httpswwwyoutubecomwatchv=k6V9xTZAWq0
24
Hvordan forholder vi os til dette
bull Vi kan ikke aeligndre instrukser for hypoglycaeligmi haringndtering det
er en laeliggefaglig opgave kan vi alligevel goslashre en forskel i
profylaktisk oslashjemed
bull Har vi et ansvar for at vaeligre kritiske overfor gamle strategier
ndash og dermed assistere paeligdiatere i forebyggelsesarbejdet
bull Hvordan kan vi balancere forebyggelse og ikke-skade
princippet naringr det ogsaring drejer sig om naturlig ernaeligring mor-
barn kontakt og medicinske interventioner
bull Kan vi med vores viden om colostrum og naturlige
processers effekt aeligndre praksis for disse boslashrn
bull Hvordan kan vi som sundhedsprofessionelle oslashge antallet af
risikoboslashrn der tidligt faringr mors maeliglk selv om det ikke sutter
bull Hvordan vil det aeligndre vores praksisarbejde
bull Hvordan klaeligdes novicen og vi paring til en rdquoWatch and Waitrdquo
tilgang til hypoglycaeligmiforebyggelse
bull POCT eller lab-svar
Mon ikke hypoglycaeligmi forebyggelse kvalitativt kan
komme videre end i 2014
Tak fordi I lyttede
referencerbull CHERTOK IR RAZ I SHOHAM I HADDAD H and WIZNITZER A 2009 Journal of human
nutrition and dietetics the official journal of the British Dietetic Association 22(2) pp 166-169
bull CHRISTESEN HT and ESBERG G 2014-last update Hypoglykaeligmi flowcharts DPS Available
httpvipregionhdkVIPRedaktoer151637nsfvLookupUploadATTACH-RHAP-
9K2D8Y$FILEHypoglykC3A6mi20-20neonatal20Flowcharts20Maj202014pdf [0916
2014]
bull CORDERO L TREUER SH LANDON MB and GABBE SG 1998 Management of infants of
diabetic mothers Archives of Pediatrics amp Adolescent Medicine 152(3) pp 249-254
bull CORNBLATH M HAWDON JM WILLIAMS AF AYNSLEY-GREEN A WARD-PLATT MP
SCHWARTZ R and KALHAN SC 2000 Controversies regarding definition of neonatal
hypoglycemia suggested operational thresholds Pediatrics 105(5) pp 1141-1145
bull CSONT GL GROTH S HOPKINS P and GUILLET R 2014 An evidence-based approach to
breastfeeding neonates at risk for hypoglycemia Journal of obstetric gynecologic and neonatal
nursing JOGNN NAACOG 43(1) pp 71-81
bull DE ROOY L and HAWDON J 2002 Nutritional factors that affect the postnatal metabolic
adaptation of full-term small- and large-for-gestational-age infants Pediatrics 109(3) pp E42
bull DOBSON LZ VIBEKE 2011 God blodsukkerregulering kun for barnets skyld 25(nr 4) pp 36--
47
bull FLORES-LE ROUX JA SAGARRA E BENAIGES D HERNANDEZ-RIVAS E CHILLARON
JJ PUIG DE DOU J MUR A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2012 A
prospective evaluation of neonatal hypoglycaemia in infants of women with gestational diabetes
mellitus Diabetes research and clinical practice 97(2) pp 217-222
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull HARRIS DL WESTON PJ SIGNAL M CHASE JG and HARDING JE 2013 Dextrose gel for neonatal
hypoglycaemia (the Sugar Babies Study) a randomised double-blind placebo-controlled trial Lancet (London
England) 382(9910) pp 2077-2083
bull HERNANDEZ-RIVAS E FLORES-LE ROUX JA BENAIGES D SAGARRA E CHILLARON JJ PAYA A
PUIG-DE DOU J GODAY A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2013 Gestational diabetes in a
multiethnic population of Spain clinical characteristics and perinatal outcomes Diabetes research and clinical
practice 100(2) pp 215-221
bull HOSETH E JOERGENSEN A EBBESEN F and MOELLER M 2000 Blood glucose levels in a population of
healthy breast fed term infants of appropriate size for gestational age Archives of disease in childhoodFetal and
neonatal edition 83(2) pp F117-9
bull JENSEN DM SORENSEN B FEILBERG-JORGENSEN N WESTERGAARD JG and BECK-NIELSEN H
2000 Maternal and perinatal outcomes in 143 Danish women with gestational diabetes mellitus and 143 controls with
a similar risk profile Diabetic medicine a journal of the British Diabetic Association 17(4) pp 281-286
bull MAAYAN-METZGER A LUBIN D and KUINT J 2009 Hypoglycemia rates in the first days of life among term
infants born to diabetic mothers Neonatology 96(2) pp 80-85
bull MAAYAN-METZGER A SCHUSHAN-EISEN I LUBIN D MORAN O KUINT J and MAZKERETH R 2014
Delivery room breastfeeding for prevention of hypoglycaemia in infants of diabetic mothers Fetal and pediatric
pathology 33(1) pp 23-28
bull MCKINLAY CEA 2015 neonatal hypoglycemia and neurodevelopment outcomes at 2 years N Engl J Med(373)
pp 1507-18
bull METZGER BE PERSSON B LOWE LP DYER AR CRUICKSHANK JK DEEROCHANAWONG C
HALLIDAY HL HENNIS AJ LILEY H NG PC COUSTAN DR HADDEN DR HOD M OATS JJ
TRIMBLE ER and HAPO STUDY COOPERATIVE RESEARCH GROUP 2010 Hyperglycemia and adverse
pregnancy outcome study neonatal glycemia Pediatrics 126(6) pp e1545-52
bull ROZANCE PJ and HAY WWJR 2012 Neonatal hypoglycemia--answers but more questions The Journal of
pediatrics 161(5) pp 775-776
bull SARKAR S WATMAN J SEIGEL WM and SCHAEFFER HA 2003 A prospective controlled study of neonatal
morbidities in infants born at 36 weeks or more gestation to Women with diet-controlled gestational diabetes (GDM-
class Al) Journal of perinatology official journal of the California Perinatal Association 23(3) pp 223-228
bull SOLTANI H DICKINSON FM KALK J and PAYNE K 2008 Breast feeding
practices and views among diabetic women a retrospective cohort study Midwifery
24(4) pp 471-479
bull TOZIER P 2013 Colostrum Versus Formula Supplentation for Glucose Stabilization in
Newborns of Diabetic Mothers 42(JOGNN The association of Womens Health
Obstetric and Neonatal Nurses) pp 619-628
bull VAN HOWE RS and STORMS MR 2008 Blood glucose determinations in large for
gestational age infants American Journal of Perinatology 25(5) pp 283-289
bull WIGHT N MARINELLI KA and ACADEMY OF BREASTFEEDING MEDICINE
PROTOCOL COMMITTEE 2006 ABM clinical protocol 1 guidelines for glucose
monitoring and treatment of hypoglycemia in breastfed neonates Breastfeeding
medicine the official journal of the Academy of Breastfeeding Medicine 1(3) pp 178-
184
bull VANHALTREN K and MALHOTRA A 2013 Characteristics of infants at risk of
hypoglycaemia secondary to being infant of a diabetic mother Journal of pediatric
endocrinology amp metabolism JPEM 26(9-10) pp 861-865
bull WIGHT NE 2014 Hypoglycemia in breastfed neonates Breastfeeding medicine the
official journal of the Academy of Breastfeeding Medicine 9(4) pp 173-179
bull DALSGAARD B and ECK K 2013-last update Klinisk retningslinje for
nonfarmakologisk forebyggelse af neonatal hypoglycaeligmi og energitab hos nyfoslashdte af
moslashdre med diaeligtbehandlet gestationel diabetes Available
httpwwwkliniskeretningslinjerdkimages88_gdm_godkendt_010713pdf [0917 2014]
hypoglycaeligmibull
bull BRAGG JJ GREEN R and HOLZMAN IR 2013 Does early enteral feeding prevent
hypoglycemia in small for gestational age neonates Journal of neonatal-perinatal medicine 6(2)
pp 131-135
bull HARRIS DL WESTON PJ and HARDING JE 2014 Lactate rather than ketones may provide
alternative cerebral fuel in hypoglycaemic newborns Archives of disease in childhoodFetal and
neonatal edition
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull LANG TF and HUSSAIN K 2014 Pediatric hypoglycemia Advances in Clinical Chemistry 63
pp 211-245
bull MITANCHEZ D BURGUET A and SIMEONI U 2014 Infants born to mothers with gestational
diabetes mellitus mild neonatal effects a long-term threat to global health The Journal of pediatrics
164(3) pp 445-450
bull SUNDERCOMBE SL RAYNES-GREENOW CH TURNER RM and JEFFERY HE 2014 Do
neonatal hypoglycaemia guidelines in Australia and New Zealand facilitate breast feeding
Midwifery 30(12) pp 1179-1186
bull TAM EW HAEUSSLEIN LA BONIFACIO SL GLASS HC ROGERS EE JEREMY RJ
BARKOVICH AJ and FERRIERO DM 2012 Hypoglycemia is associated with increased risk for
brain injury and adverse neurodevelopmental outcome in neonates at risk for encephalopathy The
Journal of pediatrics 161(1) pp 88-93
bull UNICEF 2013 hypoglycaemia guidance july 2013 UNICEF
Kilder tilfoslashjet 2016
bull AGHDAS K TALAT K and SEPIDEH B 2014 Effect of immediate and continuous mother-infant
skin-to-skin contact on breastfeeding self-efficacy of primiparous women a randomised control trial
Women and birth journal of the Australian College of Midwives 27(1) pp 37-40
bull BEIRANVAND S VALIZADEH F HOSSEINABADI R and POURNIA Y 2014 The Effects of
Skin-to-Skin Contact on Temperature and Breastfeeding Successfulness in Full-Term Newborns
after Cesarean Delivery International journal of pediatrics 2014 pp 846486
bull FENGER-GRON J FENGER-GRON M BLUNCK CH SCHONEMANN-RIGEL H and
WIELANDT HB 2015 Low breastfeeding rates and body mass index in Danish children of women
with gestational diabetes mellitus International breastfeeding journal 10 pp 26-015-0051-8
eCollection 2015
bull JAGIELLO KP and AZULAY CHERTOK IR 2015 Womens Experiences With Early
Breastfeeding After Gestational Diabetes Journal of obstetric gynecologic and neonatal nursing
JOGNN NAACOG 44(4) pp 500-509
bull SAMAYAM P RANGANATHAN PK KOTARI UD and BALASUNDARAM R 2015 Study of
Asymptomatic Hypoglycemia in Full Term Exclusively Breastfed Neonates in First 48 Hours of Life
Journal of clinical and diagnostic research JCDR 9(9) pp SC07-10
bull SOBREVIA L SALSOSO R SAEZ T SANHUEZA C PARDO F and LEIVA A 2015 Insulin
therapy and fetoplacental vascular function in gestational diabetes mellitus Experimental physiology
100(3) pp 231-238
bull STEWART CE SAGE EL and REYNOLDS P 2015 Supporting Baby Friendly a quality
improvement initiative for the management of transitional neonatal hypoglycaemia Archives of
disease in childhoodFetal and neonatal edition
bull
Early feeding
bull Der er ingen enighed om definition paring Early Feeding
bull Hawdon rdquofoslashrhen sendte boslashrnene hurtigt maeliglken tilbage til den velmenende
afsenderrdquo
bull Early Feeding kan vaeligre tidlig hyppig amning sukkervand modermaeliglk
erstatning dextrosegel Maeligngde
bull Udover amning er der mange modeller og ingen af dem er evidensbaserede
bull I 2015-16 kommer der stadig artikler om neonatal hypoglycaeligmi der ikke
skriver om ernaeligring overhovedet
Modermaeliglkserstatning og hjaeliglpestoffer
De Rooyrsquos studie fra 2002 viser
bull I et prospektivt studie med i alt 165 boslashrn blev boslashrnenes ketogenese
undersoslashgt
bull Deacuten gruppe der er taeligttest paring en af vores maringlgrupper GDM er Large
for Gestational Age boslashrnene Her paringvises det med signifikant forskel
at amning oslashger ketogenesen og at amning + modermaeliglkserstatning
ikke har saring god respons
bull Flaskeboslashrn danner stort set ikke ketonstoffer i starten foslashrst efter 12
timer
Det kan antyde at mme reducerer barnets evne til
modregulering og selvhjaeliglp
At mme har bivirkningersideeffekter der bestemt ikke
er hensigtsmaeligssige naringr vi taler om forebyggelse
Guidelines hvor er vi
Unicef 2013
bull Alle hud mod hud lige efter foslashdslen
bull Amning indenfor den foslashrste time
bull Foslashrste bs tidligst efter 2 timer og foslashr andet maringltid
bull Ved lavt bs (graelignse 26 el 20) ammes igen eller udmalket maeliglk Ved
fortsat lavt bs efter 1 time gives mme i de maeligngder vi kender
Survey af neonatale hypoglykaeligmi guidelines i Australien og New
Zealand vha Unicef(Sundercombe 2014)
bull Kun 9 ud af 22 naeligvner hud mod hud lige efter foslashdslen
bull Kun enkelte naeligvner hjaeliglp til effektiv amning og information om tegn
paring spiselyst
bull Mere end halvdelen anbefaler supplering med mors udmalkede maeliglk
bull Kun 8 ud af 22 sikrer sig samtykke foslashr mme og info til foraeligldre om
aringrsag til suppleringen
Unicef hypoglycemia 2013
Forebyggelse i ammeperspektiv og Baby Friendly
Normoglycaeligmisk tilstand boslashr opnaringes med mindst mulig intervention
Konventionel tilgang
bull 60 mlkgdoslashgn mm el mme oslashges med
20 mlkgdoslashgn x 8(-12)
bull Vallecasein 4060 mme = nedsat
ventrikeltoslashmning
bull Vi maringler stadig 1 t bs
bull Ved lav bs oslashges til 125 eller 150
af maeligngden
bull Glucose-infusion
bull Adskillelse af mor og barn
Individuel tilgangABM Protocol 2014
bull 1-3 mlkg (optil 5 mlkg) gerne hver 2 time
(3-5 mlkg i 2006-udgaven)
bull Hurtig passage af mm alle hjaeliglpestoffer er
med Vallecasein 9010
Bergmann
bull mavesaeligkkens stoslashrrelse lige foslashr foslashdslen
drikker barnet ca 10 ml gang Refererer til
studier der angiver ventiklen til hhv 10 12
15 20 ml
bull Anbefaler smaring hyppige amninger
suppleringer saring barnet ikke stresses og
bruger mere glucose end det tilfoslashres
bull Ward-Platt Laktat er rdquothe good guyrdquo og et
veloxideret velcirkuleret barn har alle
muligheder for at kompensere
bull Antenatal udmalkning af raringmaeliglk til DM-
boslashrn
Forskellen i et forloslashb
DPS
3000 gram
bull 180 ml 1 doslashgn
(60kgdoslashgn)
bull bsdarr oslashges til 225 ml 24
timer
Svaeligrt at faring udmalket dette
som ekstra
ABM
3000 gram
bull 36 ml foslashrste doslashgn
1 mlkg maringltid = 3 x 12
bull 108 ml v 3 ml kgmaringltid
(reduktion paring 40 )
Opnaringeligt at udmalke dette
som ekstra
Mon der er forskel paring
antal amninger
Haringndudmalkning korrektinkorrekt
bull httpswwwyoutubecomwatchv=k6V9xTZAWq0
24
Hvordan forholder vi os til dette
bull Vi kan ikke aeligndre instrukser for hypoglycaeligmi haringndtering det
er en laeliggefaglig opgave kan vi alligevel goslashre en forskel i
profylaktisk oslashjemed
bull Har vi et ansvar for at vaeligre kritiske overfor gamle strategier
ndash og dermed assistere paeligdiatere i forebyggelsesarbejdet
bull Hvordan kan vi balancere forebyggelse og ikke-skade
princippet naringr det ogsaring drejer sig om naturlig ernaeligring mor-
barn kontakt og medicinske interventioner
bull Kan vi med vores viden om colostrum og naturlige
processers effekt aeligndre praksis for disse boslashrn
bull Hvordan kan vi som sundhedsprofessionelle oslashge antallet af
risikoboslashrn der tidligt faringr mors maeliglk selv om det ikke sutter
bull Hvordan vil det aeligndre vores praksisarbejde
bull Hvordan klaeligdes novicen og vi paring til en rdquoWatch and Waitrdquo
tilgang til hypoglycaeligmiforebyggelse
bull POCT eller lab-svar
Mon ikke hypoglycaeligmi forebyggelse kvalitativt kan
komme videre end i 2014
Tak fordi I lyttede
referencerbull CHERTOK IR RAZ I SHOHAM I HADDAD H and WIZNITZER A 2009 Journal of human
nutrition and dietetics the official journal of the British Dietetic Association 22(2) pp 166-169
bull CHRISTESEN HT and ESBERG G 2014-last update Hypoglykaeligmi flowcharts DPS Available
httpvipregionhdkVIPRedaktoer151637nsfvLookupUploadATTACH-RHAP-
9K2D8Y$FILEHypoglykC3A6mi20-20neonatal20Flowcharts20Maj202014pdf [0916
2014]
bull CORDERO L TREUER SH LANDON MB and GABBE SG 1998 Management of infants of
diabetic mothers Archives of Pediatrics amp Adolescent Medicine 152(3) pp 249-254
bull CORNBLATH M HAWDON JM WILLIAMS AF AYNSLEY-GREEN A WARD-PLATT MP
SCHWARTZ R and KALHAN SC 2000 Controversies regarding definition of neonatal
hypoglycemia suggested operational thresholds Pediatrics 105(5) pp 1141-1145
bull CSONT GL GROTH S HOPKINS P and GUILLET R 2014 An evidence-based approach to
breastfeeding neonates at risk for hypoglycemia Journal of obstetric gynecologic and neonatal
nursing JOGNN NAACOG 43(1) pp 71-81
bull DE ROOY L and HAWDON J 2002 Nutritional factors that affect the postnatal metabolic
adaptation of full-term small- and large-for-gestational-age infants Pediatrics 109(3) pp E42
bull DOBSON LZ VIBEKE 2011 God blodsukkerregulering kun for barnets skyld 25(nr 4) pp 36--
47
bull FLORES-LE ROUX JA SAGARRA E BENAIGES D HERNANDEZ-RIVAS E CHILLARON
JJ PUIG DE DOU J MUR A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2012 A
prospective evaluation of neonatal hypoglycaemia in infants of women with gestational diabetes
mellitus Diabetes research and clinical practice 97(2) pp 217-222
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull HARRIS DL WESTON PJ SIGNAL M CHASE JG and HARDING JE 2013 Dextrose gel for neonatal
hypoglycaemia (the Sugar Babies Study) a randomised double-blind placebo-controlled trial Lancet (London
England) 382(9910) pp 2077-2083
bull HERNANDEZ-RIVAS E FLORES-LE ROUX JA BENAIGES D SAGARRA E CHILLARON JJ PAYA A
PUIG-DE DOU J GODAY A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2013 Gestational diabetes in a
multiethnic population of Spain clinical characteristics and perinatal outcomes Diabetes research and clinical
practice 100(2) pp 215-221
bull HOSETH E JOERGENSEN A EBBESEN F and MOELLER M 2000 Blood glucose levels in a population of
healthy breast fed term infants of appropriate size for gestational age Archives of disease in childhoodFetal and
neonatal edition 83(2) pp F117-9
bull JENSEN DM SORENSEN B FEILBERG-JORGENSEN N WESTERGAARD JG and BECK-NIELSEN H
2000 Maternal and perinatal outcomes in 143 Danish women with gestational diabetes mellitus and 143 controls with
a similar risk profile Diabetic medicine a journal of the British Diabetic Association 17(4) pp 281-286
bull MAAYAN-METZGER A LUBIN D and KUINT J 2009 Hypoglycemia rates in the first days of life among term
infants born to diabetic mothers Neonatology 96(2) pp 80-85
bull MAAYAN-METZGER A SCHUSHAN-EISEN I LUBIN D MORAN O KUINT J and MAZKERETH R 2014
Delivery room breastfeeding for prevention of hypoglycaemia in infants of diabetic mothers Fetal and pediatric
pathology 33(1) pp 23-28
bull MCKINLAY CEA 2015 neonatal hypoglycemia and neurodevelopment outcomes at 2 years N Engl J Med(373)
pp 1507-18
bull METZGER BE PERSSON B LOWE LP DYER AR CRUICKSHANK JK DEEROCHANAWONG C
HALLIDAY HL HENNIS AJ LILEY H NG PC COUSTAN DR HADDEN DR HOD M OATS JJ
TRIMBLE ER and HAPO STUDY COOPERATIVE RESEARCH GROUP 2010 Hyperglycemia and adverse
pregnancy outcome study neonatal glycemia Pediatrics 126(6) pp e1545-52
bull ROZANCE PJ and HAY WWJR 2012 Neonatal hypoglycemia--answers but more questions The Journal of
pediatrics 161(5) pp 775-776
bull SARKAR S WATMAN J SEIGEL WM and SCHAEFFER HA 2003 A prospective controlled study of neonatal
morbidities in infants born at 36 weeks or more gestation to Women with diet-controlled gestational diabetes (GDM-
class Al) Journal of perinatology official journal of the California Perinatal Association 23(3) pp 223-228
bull SOLTANI H DICKINSON FM KALK J and PAYNE K 2008 Breast feeding
practices and views among diabetic women a retrospective cohort study Midwifery
24(4) pp 471-479
bull TOZIER P 2013 Colostrum Versus Formula Supplentation for Glucose Stabilization in
Newborns of Diabetic Mothers 42(JOGNN The association of Womens Health
Obstetric and Neonatal Nurses) pp 619-628
bull VAN HOWE RS and STORMS MR 2008 Blood glucose determinations in large for
gestational age infants American Journal of Perinatology 25(5) pp 283-289
bull WIGHT N MARINELLI KA and ACADEMY OF BREASTFEEDING MEDICINE
PROTOCOL COMMITTEE 2006 ABM clinical protocol 1 guidelines for glucose
monitoring and treatment of hypoglycemia in breastfed neonates Breastfeeding
medicine the official journal of the Academy of Breastfeeding Medicine 1(3) pp 178-
184
bull VANHALTREN K and MALHOTRA A 2013 Characteristics of infants at risk of
hypoglycaemia secondary to being infant of a diabetic mother Journal of pediatric
endocrinology amp metabolism JPEM 26(9-10) pp 861-865
bull WIGHT NE 2014 Hypoglycemia in breastfed neonates Breastfeeding medicine the
official journal of the Academy of Breastfeeding Medicine 9(4) pp 173-179
bull DALSGAARD B and ECK K 2013-last update Klinisk retningslinje for
nonfarmakologisk forebyggelse af neonatal hypoglycaeligmi og energitab hos nyfoslashdte af
moslashdre med diaeligtbehandlet gestationel diabetes Available
httpwwwkliniskeretningslinjerdkimages88_gdm_godkendt_010713pdf [0917 2014]
hypoglycaeligmibull
bull BRAGG JJ GREEN R and HOLZMAN IR 2013 Does early enteral feeding prevent
hypoglycemia in small for gestational age neonates Journal of neonatal-perinatal medicine 6(2)
pp 131-135
bull HARRIS DL WESTON PJ and HARDING JE 2014 Lactate rather than ketones may provide
alternative cerebral fuel in hypoglycaemic newborns Archives of disease in childhoodFetal and
neonatal edition
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull LANG TF and HUSSAIN K 2014 Pediatric hypoglycemia Advances in Clinical Chemistry 63
pp 211-245
bull MITANCHEZ D BURGUET A and SIMEONI U 2014 Infants born to mothers with gestational
diabetes mellitus mild neonatal effects a long-term threat to global health The Journal of pediatrics
164(3) pp 445-450
bull SUNDERCOMBE SL RAYNES-GREENOW CH TURNER RM and JEFFERY HE 2014 Do
neonatal hypoglycaemia guidelines in Australia and New Zealand facilitate breast feeding
Midwifery 30(12) pp 1179-1186
bull TAM EW HAEUSSLEIN LA BONIFACIO SL GLASS HC ROGERS EE JEREMY RJ
BARKOVICH AJ and FERRIERO DM 2012 Hypoglycemia is associated with increased risk for
brain injury and adverse neurodevelopmental outcome in neonates at risk for encephalopathy The
Journal of pediatrics 161(1) pp 88-93
bull UNICEF 2013 hypoglycaemia guidance july 2013 UNICEF
Kilder tilfoslashjet 2016
bull AGHDAS K TALAT K and SEPIDEH B 2014 Effect of immediate and continuous mother-infant
skin-to-skin contact on breastfeeding self-efficacy of primiparous women a randomised control trial
Women and birth journal of the Australian College of Midwives 27(1) pp 37-40
bull BEIRANVAND S VALIZADEH F HOSSEINABADI R and POURNIA Y 2014 The Effects of
Skin-to-Skin Contact on Temperature and Breastfeeding Successfulness in Full-Term Newborns
after Cesarean Delivery International journal of pediatrics 2014 pp 846486
bull FENGER-GRON J FENGER-GRON M BLUNCK CH SCHONEMANN-RIGEL H and
WIELANDT HB 2015 Low breastfeeding rates and body mass index in Danish children of women
with gestational diabetes mellitus International breastfeeding journal 10 pp 26-015-0051-8
eCollection 2015
bull JAGIELLO KP and AZULAY CHERTOK IR 2015 Womens Experiences With Early
Breastfeeding After Gestational Diabetes Journal of obstetric gynecologic and neonatal nursing
JOGNN NAACOG 44(4) pp 500-509
bull SAMAYAM P RANGANATHAN PK KOTARI UD and BALASUNDARAM R 2015 Study of
Asymptomatic Hypoglycemia in Full Term Exclusively Breastfed Neonates in First 48 Hours of Life
Journal of clinical and diagnostic research JCDR 9(9) pp SC07-10
bull SOBREVIA L SALSOSO R SAEZ T SANHUEZA C PARDO F and LEIVA A 2015 Insulin
therapy and fetoplacental vascular function in gestational diabetes mellitus Experimental physiology
100(3) pp 231-238
bull STEWART CE SAGE EL and REYNOLDS P 2015 Supporting Baby Friendly a quality
improvement initiative for the management of transitional neonatal hypoglycaemia Archives of
disease in childhoodFetal and neonatal edition
bull
Modermaeliglkserstatning og hjaeliglpestoffer
De Rooyrsquos studie fra 2002 viser
bull I et prospektivt studie med i alt 165 boslashrn blev boslashrnenes ketogenese
undersoslashgt
bull Deacuten gruppe der er taeligttest paring en af vores maringlgrupper GDM er Large
for Gestational Age boslashrnene Her paringvises det med signifikant forskel
at amning oslashger ketogenesen og at amning + modermaeliglkserstatning
ikke har saring god respons
bull Flaskeboslashrn danner stort set ikke ketonstoffer i starten foslashrst efter 12
timer
Det kan antyde at mme reducerer barnets evne til
modregulering og selvhjaeliglp
At mme har bivirkningersideeffekter der bestemt ikke
er hensigtsmaeligssige naringr vi taler om forebyggelse
Guidelines hvor er vi
Unicef 2013
bull Alle hud mod hud lige efter foslashdslen
bull Amning indenfor den foslashrste time
bull Foslashrste bs tidligst efter 2 timer og foslashr andet maringltid
bull Ved lavt bs (graelignse 26 el 20) ammes igen eller udmalket maeliglk Ved
fortsat lavt bs efter 1 time gives mme i de maeligngder vi kender
Survey af neonatale hypoglykaeligmi guidelines i Australien og New
Zealand vha Unicef(Sundercombe 2014)
bull Kun 9 ud af 22 naeligvner hud mod hud lige efter foslashdslen
bull Kun enkelte naeligvner hjaeliglp til effektiv amning og information om tegn
paring spiselyst
bull Mere end halvdelen anbefaler supplering med mors udmalkede maeliglk
bull Kun 8 ud af 22 sikrer sig samtykke foslashr mme og info til foraeligldre om
aringrsag til suppleringen
Unicef hypoglycemia 2013
Forebyggelse i ammeperspektiv og Baby Friendly
Normoglycaeligmisk tilstand boslashr opnaringes med mindst mulig intervention
Konventionel tilgang
bull 60 mlkgdoslashgn mm el mme oslashges med
20 mlkgdoslashgn x 8(-12)
bull Vallecasein 4060 mme = nedsat
ventrikeltoslashmning
bull Vi maringler stadig 1 t bs
bull Ved lav bs oslashges til 125 eller 150
af maeligngden
bull Glucose-infusion
bull Adskillelse af mor og barn
Individuel tilgangABM Protocol 2014
bull 1-3 mlkg (optil 5 mlkg) gerne hver 2 time
(3-5 mlkg i 2006-udgaven)
bull Hurtig passage af mm alle hjaeliglpestoffer er
med Vallecasein 9010
Bergmann
bull mavesaeligkkens stoslashrrelse lige foslashr foslashdslen
drikker barnet ca 10 ml gang Refererer til
studier der angiver ventiklen til hhv 10 12
15 20 ml
bull Anbefaler smaring hyppige amninger
suppleringer saring barnet ikke stresses og
bruger mere glucose end det tilfoslashres
bull Ward-Platt Laktat er rdquothe good guyrdquo og et
veloxideret velcirkuleret barn har alle
muligheder for at kompensere
bull Antenatal udmalkning af raringmaeliglk til DM-
boslashrn
Forskellen i et forloslashb
DPS
3000 gram
bull 180 ml 1 doslashgn
(60kgdoslashgn)
bull bsdarr oslashges til 225 ml 24
timer
Svaeligrt at faring udmalket dette
som ekstra
ABM
3000 gram
bull 36 ml foslashrste doslashgn
1 mlkg maringltid = 3 x 12
bull 108 ml v 3 ml kgmaringltid
(reduktion paring 40 )
Opnaringeligt at udmalke dette
som ekstra
Mon der er forskel paring
antal amninger
Haringndudmalkning korrektinkorrekt
bull httpswwwyoutubecomwatchv=k6V9xTZAWq0
24
Hvordan forholder vi os til dette
bull Vi kan ikke aeligndre instrukser for hypoglycaeligmi haringndtering det
er en laeliggefaglig opgave kan vi alligevel goslashre en forskel i
profylaktisk oslashjemed
bull Har vi et ansvar for at vaeligre kritiske overfor gamle strategier
ndash og dermed assistere paeligdiatere i forebyggelsesarbejdet
bull Hvordan kan vi balancere forebyggelse og ikke-skade
princippet naringr det ogsaring drejer sig om naturlig ernaeligring mor-
barn kontakt og medicinske interventioner
bull Kan vi med vores viden om colostrum og naturlige
processers effekt aeligndre praksis for disse boslashrn
bull Hvordan kan vi som sundhedsprofessionelle oslashge antallet af
risikoboslashrn der tidligt faringr mors maeliglk selv om det ikke sutter
bull Hvordan vil det aeligndre vores praksisarbejde
bull Hvordan klaeligdes novicen og vi paring til en rdquoWatch and Waitrdquo
tilgang til hypoglycaeligmiforebyggelse
bull POCT eller lab-svar
Mon ikke hypoglycaeligmi forebyggelse kvalitativt kan
komme videre end i 2014
Tak fordi I lyttede
referencerbull CHERTOK IR RAZ I SHOHAM I HADDAD H and WIZNITZER A 2009 Journal of human
nutrition and dietetics the official journal of the British Dietetic Association 22(2) pp 166-169
bull CHRISTESEN HT and ESBERG G 2014-last update Hypoglykaeligmi flowcharts DPS Available
httpvipregionhdkVIPRedaktoer151637nsfvLookupUploadATTACH-RHAP-
9K2D8Y$FILEHypoglykC3A6mi20-20neonatal20Flowcharts20Maj202014pdf [0916
2014]
bull CORDERO L TREUER SH LANDON MB and GABBE SG 1998 Management of infants of
diabetic mothers Archives of Pediatrics amp Adolescent Medicine 152(3) pp 249-254
bull CORNBLATH M HAWDON JM WILLIAMS AF AYNSLEY-GREEN A WARD-PLATT MP
SCHWARTZ R and KALHAN SC 2000 Controversies regarding definition of neonatal
hypoglycemia suggested operational thresholds Pediatrics 105(5) pp 1141-1145
bull CSONT GL GROTH S HOPKINS P and GUILLET R 2014 An evidence-based approach to
breastfeeding neonates at risk for hypoglycemia Journal of obstetric gynecologic and neonatal
nursing JOGNN NAACOG 43(1) pp 71-81
bull DE ROOY L and HAWDON J 2002 Nutritional factors that affect the postnatal metabolic
adaptation of full-term small- and large-for-gestational-age infants Pediatrics 109(3) pp E42
bull DOBSON LZ VIBEKE 2011 God blodsukkerregulering kun for barnets skyld 25(nr 4) pp 36--
47
bull FLORES-LE ROUX JA SAGARRA E BENAIGES D HERNANDEZ-RIVAS E CHILLARON
JJ PUIG DE DOU J MUR A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2012 A
prospective evaluation of neonatal hypoglycaemia in infants of women with gestational diabetes
mellitus Diabetes research and clinical practice 97(2) pp 217-222
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull HARRIS DL WESTON PJ SIGNAL M CHASE JG and HARDING JE 2013 Dextrose gel for neonatal
hypoglycaemia (the Sugar Babies Study) a randomised double-blind placebo-controlled trial Lancet (London
England) 382(9910) pp 2077-2083
bull HERNANDEZ-RIVAS E FLORES-LE ROUX JA BENAIGES D SAGARRA E CHILLARON JJ PAYA A
PUIG-DE DOU J GODAY A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2013 Gestational diabetes in a
multiethnic population of Spain clinical characteristics and perinatal outcomes Diabetes research and clinical
practice 100(2) pp 215-221
bull HOSETH E JOERGENSEN A EBBESEN F and MOELLER M 2000 Blood glucose levels in a population of
healthy breast fed term infants of appropriate size for gestational age Archives of disease in childhoodFetal and
neonatal edition 83(2) pp F117-9
bull JENSEN DM SORENSEN B FEILBERG-JORGENSEN N WESTERGAARD JG and BECK-NIELSEN H
2000 Maternal and perinatal outcomes in 143 Danish women with gestational diabetes mellitus and 143 controls with
a similar risk profile Diabetic medicine a journal of the British Diabetic Association 17(4) pp 281-286
bull MAAYAN-METZGER A LUBIN D and KUINT J 2009 Hypoglycemia rates in the first days of life among term
infants born to diabetic mothers Neonatology 96(2) pp 80-85
bull MAAYAN-METZGER A SCHUSHAN-EISEN I LUBIN D MORAN O KUINT J and MAZKERETH R 2014
Delivery room breastfeeding for prevention of hypoglycaemia in infants of diabetic mothers Fetal and pediatric
pathology 33(1) pp 23-28
bull MCKINLAY CEA 2015 neonatal hypoglycemia and neurodevelopment outcomes at 2 years N Engl J Med(373)
pp 1507-18
bull METZGER BE PERSSON B LOWE LP DYER AR CRUICKSHANK JK DEEROCHANAWONG C
HALLIDAY HL HENNIS AJ LILEY H NG PC COUSTAN DR HADDEN DR HOD M OATS JJ
TRIMBLE ER and HAPO STUDY COOPERATIVE RESEARCH GROUP 2010 Hyperglycemia and adverse
pregnancy outcome study neonatal glycemia Pediatrics 126(6) pp e1545-52
bull ROZANCE PJ and HAY WWJR 2012 Neonatal hypoglycemia--answers but more questions The Journal of
pediatrics 161(5) pp 775-776
bull SARKAR S WATMAN J SEIGEL WM and SCHAEFFER HA 2003 A prospective controlled study of neonatal
morbidities in infants born at 36 weeks or more gestation to Women with diet-controlled gestational diabetes (GDM-
class Al) Journal of perinatology official journal of the California Perinatal Association 23(3) pp 223-228
bull SOLTANI H DICKINSON FM KALK J and PAYNE K 2008 Breast feeding
practices and views among diabetic women a retrospective cohort study Midwifery
24(4) pp 471-479
bull TOZIER P 2013 Colostrum Versus Formula Supplentation for Glucose Stabilization in
Newborns of Diabetic Mothers 42(JOGNN The association of Womens Health
Obstetric and Neonatal Nurses) pp 619-628
bull VAN HOWE RS and STORMS MR 2008 Blood glucose determinations in large for
gestational age infants American Journal of Perinatology 25(5) pp 283-289
bull WIGHT N MARINELLI KA and ACADEMY OF BREASTFEEDING MEDICINE
PROTOCOL COMMITTEE 2006 ABM clinical protocol 1 guidelines for glucose
monitoring and treatment of hypoglycemia in breastfed neonates Breastfeeding
medicine the official journal of the Academy of Breastfeeding Medicine 1(3) pp 178-
184
bull VANHALTREN K and MALHOTRA A 2013 Characteristics of infants at risk of
hypoglycaemia secondary to being infant of a diabetic mother Journal of pediatric
endocrinology amp metabolism JPEM 26(9-10) pp 861-865
bull WIGHT NE 2014 Hypoglycemia in breastfed neonates Breastfeeding medicine the
official journal of the Academy of Breastfeeding Medicine 9(4) pp 173-179
bull DALSGAARD B and ECK K 2013-last update Klinisk retningslinje for
nonfarmakologisk forebyggelse af neonatal hypoglycaeligmi og energitab hos nyfoslashdte af
moslashdre med diaeligtbehandlet gestationel diabetes Available
httpwwwkliniskeretningslinjerdkimages88_gdm_godkendt_010713pdf [0917 2014]
hypoglycaeligmibull
bull BRAGG JJ GREEN R and HOLZMAN IR 2013 Does early enteral feeding prevent
hypoglycemia in small for gestational age neonates Journal of neonatal-perinatal medicine 6(2)
pp 131-135
bull HARRIS DL WESTON PJ and HARDING JE 2014 Lactate rather than ketones may provide
alternative cerebral fuel in hypoglycaemic newborns Archives of disease in childhoodFetal and
neonatal edition
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull LANG TF and HUSSAIN K 2014 Pediatric hypoglycemia Advances in Clinical Chemistry 63
pp 211-245
bull MITANCHEZ D BURGUET A and SIMEONI U 2014 Infants born to mothers with gestational
diabetes mellitus mild neonatal effects a long-term threat to global health The Journal of pediatrics
164(3) pp 445-450
bull SUNDERCOMBE SL RAYNES-GREENOW CH TURNER RM and JEFFERY HE 2014 Do
neonatal hypoglycaemia guidelines in Australia and New Zealand facilitate breast feeding
Midwifery 30(12) pp 1179-1186
bull TAM EW HAEUSSLEIN LA BONIFACIO SL GLASS HC ROGERS EE JEREMY RJ
BARKOVICH AJ and FERRIERO DM 2012 Hypoglycemia is associated with increased risk for
brain injury and adverse neurodevelopmental outcome in neonates at risk for encephalopathy The
Journal of pediatrics 161(1) pp 88-93
bull UNICEF 2013 hypoglycaemia guidance july 2013 UNICEF
Kilder tilfoslashjet 2016
bull AGHDAS K TALAT K and SEPIDEH B 2014 Effect of immediate and continuous mother-infant
skin-to-skin contact on breastfeeding self-efficacy of primiparous women a randomised control trial
Women and birth journal of the Australian College of Midwives 27(1) pp 37-40
bull BEIRANVAND S VALIZADEH F HOSSEINABADI R and POURNIA Y 2014 The Effects of
Skin-to-Skin Contact on Temperature and Breastfeeding Successfulness in Full-Term Newborns
after Cesarean Delivery International journal of pediatrics 2014 pp 846486
bull FENGER-GRON J FENGER-GRON M BLUNCK CH SCHONEMANN-RIGEL H and
WIELANDT HB 2015 Low breastfeeding rates and body mass index in Danish children of women
with gestational diabetes mellitus International breastfeeding journal 10 pp 26-015-0051-8
eCollection 2015
bull JAGIELLO KP and AZULAY CHERTOK IR 2015 Womens Experiences With Early
Breastfeeding After Gestational Diabetes Journal of obstetric gynecologic and neonatal nursing
JOGNN NAACOG 44(4) pp 500-509
bull SAMAYAM P RANGANATHAN PK KOTARI UD and BALASUNDARAM R 2015 Study of
Asymptomatic Hypoglycemia in Full Term Exclusively Breastfed Neonates in First 48 Hours of Life
Journal of clinical and diagnostic research JCDR 9(9) pp SC07-10
bull SOBREVIA L SALSOSO R SAEZ T SANHUEZA C PARDO F and LEIVA A 2015 Insulin
therapy and fetoplacental vascular function in gestational diabetes mellitus Experimental physiology
100(3) pp 231-238
bull STEWART CE SAGE EL and REYNOLDS P 2015 Supporting Baby Friendly a quality
improvement initiative for the management of transitional neonatal hypoglycaemia Archives of
disease in childhoodFetal and neonatal edition
bull
Guidelines hvor er vi
Unicef 2013
bull Alle hud mod hud lige efter foslashdslen
bull Amning indenfor den foslashrste time
bull Foslashrste bs tidligst efter 2 timer og foslashr andet maringltid
bull Ved lavt bs (graelignse 26 el 20) ammes igen eller udmalket maeliglk Ved
fortsat lavt bs efter 1 time gives mme i de maeligngder vi kender
Survey af neonatale hypoglykaeligmi guidelines i Australien og New
Zealand vha Unicef(Sundercombe 2014)
bull Kun 9 ud af 22 naeligvner hud mod hud lige efter foslashdslen
bull Kun enkelte naeligvner hjaeliglp til effektiv amning og information om tegn
paring spiselyst
bull Mere end halvdelen anbefaler supplering med mors udmalkede maeliglk
bull Kun 8 ud af 22 sikrer sig samtykke foslashr mme og info til foraeligldre om
aringrsag til suppleringen
Unicef hypoglycemia 2013
Forebyggelse i ammeperspektiv og Baby Friendly
Normoglycaeligmisk tilstand boslashr opnaringes med mindst mulig intervention
Konventionel tilgang
bull 60 mlkgdoslashgn mm el mme oslashges med
20 mlkgdoslashgn x 8(-12)
bull Vallecasein 4060 mme = nedsat
ventrikeltoslashmning
bull Vi maringler stadig 1 t bs
bull Ved lav bs oslashges til 125 eller 150
af maeligngden
bull Glucose-infusion
bull Adskillelse af mor og barn
Individuel tilgangABM Protocol 2014
bull 1-3 mlkg (optil 5 mlkg) gerne hver 2 time
(3-5 mlkg i 2006-udgaven)
bull Hurtig passage af mm alle hjaeliglpestoffer er
med Vallecasein 9010
Bergmann
bull mavesaeligkkens stoslashrrelse lige foslashr foslashdslen
drikker barnet ca 10 ml gang Refererer til
studier der angiver ventiklen til hhv 10 12
15 20 ml
bull Anbefaler smaring hyppige amninger
suppleringer saring barnet ikke stresses og
bruger mere glucose end det tilfoslashres
bull Ward-Platt Laktat er rdquothe good guyrdquo og et
veloxideret velcirkuleret barn har alle
muligheder for at kompensere
bull Antenatal udmalkning af raringmaeliglk til DM-
boslashrn
Forskellen i et forloslashb
DPS
3000 gram
bull 180 ml 1 doslashgn
(60kgdoslashgn)
bull bsdarr oslashges til 225 ml 24
timer
Svaeligrt at faring udmalket dette
som ekstra
ABM
3000 gram
bull 36 ml foslashrste doslashgn
1 mlkg maringltid = 3 x 12
bull 108 ml v 3 ml kgmaringltid
(reduktion paring 40 )
Opnaringeligt at udmalke dette
som ekstra
Mon der er forskel paring
antal amninger
Haringndudmalkning korrektinkorrekt
bull httpswwwyoutubecomwatchv=k6V9xTZAWq0
24
Hvordan forholder vi os til dette
bull Vi kan ikke aeligndre instrukser for hypoglycaeligmi haringndtering det
er en laeliggefaglig opgave kan vi alligevel goslashre en forskel i
profylaktisk oslashjemed
bull Har vi et ansvar for at vaeligre kritiske overfor gamle strategier
ndash og dermed assistere paeligdiatere i forebyggelsesarbejdet
bull Hvordan kan vi balancere forebyggelse og ikke-skade
princippet naringr det ogsaring drejer sig om naturlig ernaeligring mor-
barn kontakt og medicinske interventioner
bull Kan vi med vores viden om colostrum og naturlige
processers effekt aeligndre praksis for disse boslashrn
bull Hvordan kan vi som sundhedsprofessionelle oslashge antallet af
risikoboslashrn der tidligt faringr mors maeliglk selv om det ikke sutter
bull Hvordan vil det aeligndre vores praksisarbejde
bull Hvordan klaeligdes novicen og vi paring til en rdquoWatch and Waitrdquo
tilgang til hypoglycaeligmiforebyggelse
bull POCT eller lab-svar
Mon ikke hypoglycaeligmi forebyggelse kvalitativt kan
komme videre end i 2014
Tak fordi I lyttede
referencerbull CHERTOK IR RAZ I SHOHAM I HADDAD H and WIZNITZER A 2009 Journal of human
nutrition and dietetics the official journal of the British Dietetic Association 22(2) pp 166-169
bull CHRISTESEN HT and ESBERG G 2014-last update Hypoglykaeligmi flowcharts DPS Available
httpvipregionhdkVIPRedaktoer151637nsfvLookupUploadATTACH-RHAP-
9K2D8Y$FILEHypoglykC3A6mi20-20neonatal20Flowcharts20Maj202014pdf [0916
2014]
bull CORDERO L TREUER SH LANDON MB and GABBE SG 1998 Management of infants of
diabetic mothers Archives of Pediatrics amp Adolescent Medicine 152(3) pp 249-254
bull CORNBLATH M HAWDON JM WILLIAMS AF AYNSLEY-GREEN A WARD-PLATT MP
SCHWARTZ R and KALHAN SC 2000 Controversies regarding definition of neonatal
hypoglycemia suggested operational thresholds Pediatrics 105(5) pp 1141-1145
bull CSONT GL GROTH S HOPKINS P and GUILLET R 2014 An evidence-based approach to
breastfeeding neonates at risk for hypoglycemia Journal of obstetric gynecologic and neonatal
nursing JOGNN NAACOG 43(1) pp 71-81
bull DE ROOY L and HAWDON J 2002 Nutritional factors that affect the postnatal metabolic
adaptation of full-term small- and large-for-gestational-age infants Pediatrics 109(3) pp E42
bull DOBSON LZ VIBEKE 2011 God blodsukkerregulering kun for barnets skyld 25(nr 4) pp 36--
47
bull FLORES-LE ROUX JA SAGARRA E BENAIGES D HERNANDEZ-RIVAS E CHILLARON
JJ PUIG DE DOU J MUR A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2012 A
prospective evaluation of neonatal hypoglycaemia in infants of women with gestational diabetes
mellitus Diabetes research and clinical practice 97(2) pp 217-222
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull HARRIS DL WESTON PJ SIGNAL M CHASE JG and HARDING JE 2013 Dextrose gel for neonatal
hypoglycaemia (the Sugar Babies Study) a randomised double-blind placebo-controlled trial Lancet (London
England) 382(9910) pp 2077-2083
bull HERNANDEZ-RIVAS E FLORES-LE ROUX JA BENAIGES D SAGARRA E CHILLARON JJ PAYA A
PUIG-DE DOU J GODAY A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2013 Gestational diabetes in a
multiethnic population of Spain clinical characteristics and perinatal outcomes Diabetes research and clinical
practice 100(2) pp 215-221
bull HOSETH E JOERGENSEN A EBBESEN F and MOELLER M 2000 Blood glucose levels in a population of
healthy breast fed term infants of appropriate size for gestational age Archives of disease in childhoodFetal and
neonatal edition 83(2) pp F117-9
bull JENSEN DM SORENSEN B FEILBERG-JORGENSEN N WESTERGAARD JG and BECK-NIELSEN H
2000 Maternal and perinatal outcomes in 143 Danish women with gestational diabetes mellitus and 143 controls with
a similar risk profile Diabetic medicine a journal of the British Diabetic Association 17(4) pp 281-286
bull MAAYAN-METZGER A LUBIN D and KUINT J 2009 Hypoglycemia rates in the first days of life among term
infants born to diabetic mothers Neonatology 96(2) pp 80-85
bull MAAYAN-METZGER A SCHUSHAN-EISEN I LUBIN D MORAN O KUINT J and MAZKERETH R 2014
Delivery room breastfeeding for prevention of hypoglycaemia in infants of diabetic mothers Fetal and pediatric
pathology 33(1) pp 23-28
bull MCKINLAY CEA 2015 neonatal hypoglycemia and neurodevelopment outcomes at 2 years N Engl J Med(373)
pp 1507-18
bull METZGER BE PERSSON B LOWE LP DYER AR CRUICKSHANK JK DEEROCHANAWONG C
HALLIDAY HL HENNIS AJ LILEY H NG PC COUSTAN DR HADDEN DR HOD M OATS JJ
TRIMBLE ER and HAPO STUDY COOPERATIVE RESEARCH GROUP 2010 Hyperglycemia and adverse
pregnancy outcome study neonatal glycemia Pediatrics 126(6) pp e1545-52
bull ROZANCE PJ and HAY WWJR 2012 Neonatal hypoglycemia--answers but more questions The Journal of
pediatrics 161(5) pp 775-776
bull SARKAR S WATMAN J SEIGEL WM and SCHAEFFER HA 2003 A prospective controlled study of neonatal
morbidities in infants born at 36 weeks or more gestation to Women with diet-controlled gestational diabetes (GDM-
class Al) Journal of perinatology official journal of the California Perinatal Association 23(3) pp 223-228
bull SOLTANI H DICKINSON FM KALK J and PAYNE K 2008 Breast feeding
practices and views among diabetic women a retrospective cohort study Midwifery
24(4) pp 471-479
bull TOZIER P 2013 Colostrum Versus Formula Supplentation for Glucose Stabilization in
Newborns of Diabetic Mothers 42(JOGNN The association of Womens Health
Obstetric and Neonatal Nurses) pp 619-628
bull VAN HOWE RS and STORMS MR 2008 Blood glucose determinations in large for
gestational age infants American Journal of Perinatology 25(5) pp 283-289
bull WIGHT N MARINELLI KA and ACADEMY OF BREASTFEEDING MEDICINE
PROTOCOL COMMITTEE 2006 ABM clinical protocol 1 guidelines for glucose
monitoring and treatment of hypoglycemia in breastfed neonates Breastfeeding
medicine the official journal of the Academy of Breastfeeding Medicine 1(3) pp 178-
184
bull VANHALTREN K and MALHOTRA A 2013 Characteristics of infants at risk of
hypoglycaemia secondary to being infant of a diabetic mother Journal of pediatric
endocrinology amp metabolism JPEM 26(9-10) pp 861-865
bull WIGHT NE 2014 Hypoglycemia in breastfed neonates Breastfeeding medicine the
official journal of the Academy of Breastfeeding Medicine 9(4) pp 173-179
bull DALSGAARD B and ECK K 2013-last update Klinisk retningslinje for
nonfarmakologisk forebyggelse af neonatal hypoglycaeligmi og energitab hos nyfoslashdte af
moslashdre med diaeligtbehandlet gestationel diabetes Available
httpwwwkliniskeretningslinjerdkimages88_gdm_godkendt_010713pdf [0917 2014]
hypoglycaeligmibull
bull BRAGG JJ GREEN R and HOLZMAN IR 2013 Does early enteral feeding prevent
hypoglycemia in small for gestational age neonates Journal of neonatal-perinatal medicine 6(2)
pp 131-135
bull HARRIS DL WESTON PJ and HARDING JE 2014 Lactate rather than ketones may provide
alternative cerebral fuel in hypoglycaemic newborns Archives of disease in childhoodFetal and
neonatal edition
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull LANG TF and HUSSAIN K 2014 Pediatric hypoglycemia Advances in Clinical Chemistry 63
pp 211-245
bull MITANCHEZ D BURGUET A and SIMEONI U 2014 Infants born to mothers with gestational
diabetes mellitus mild neonatal effects a long-term threat to global health The Journal of pediatrics
164(3) pp 445-450
bull SUNDERCOMBE SL RAYNES-GREENOW CH TURNER RM and JEFFERY HE 2014 Do
neonatal hypoglycaemia guidelines in Australia and New Zealand facilitate breast feeding
Midwifery 30(12) pp 1179-1186
bull TAM EW HAEUSSLEIN LA BONIFACIO SL GLASS HC ROGERS EE JEREMY RJ
BARKOVICH AJ and FERRIERO DM 2012 Hypoglycemia is associated with increased risk for
brain injury and adverse neurodevelopmental outcome in neonates at risk for encephalopathy The
Journal of pediatrics 161(1) pp 88-93
bull UNICEF 2013 hypoglycaemia guidance july 2013 UNICEF
Kilder tilfoslashjet 2016
bull AGHDAS K TALAT K and SEPIDEH B 2014 Effect of immediate and continuous mother-infant
skin-to-skin contact on breastfeeding self-efficacy of primiparous women a randomised control trial
Women and birth journal of the Australian College of Midwives 27(1) pp 37-40
bull BEIRANVAND S VALIZADEH F HOSSEINABADI R and POURNIA Y 2014 The Effects of
Skin-to-Skin Contact on Temperature and Breastfeeding Successfulness in Full-Term Newborns
after Cesarean Delivery International journal of pediatrics 2014 pp 846486
bull FENGER-GRON J FENGER-GRON M BLUNCK CH SCHONEMANN-RIGEL H and
WIELANDT HB 2015 Low breastfeeding rates and body mass index in Danish children of women
with gestational diabetes mellitus International breastfeeding journal 10 pp 26-015-0051-8
eCollection 2015
bull JAGIELLO KP and AZULAY CHERTOK IR 2015 Womens Experiences With Early
Breastfeeding After Gestational Diabetes Journal of obstetric gynecologic and neonatal nursing
JOGNN NAACOG 44(4) pp 500-509
bull SAMAYAM P RANGANATHAN PK KOTARI UD and BALASUNDARAM R 2015 Study of
Asymptomatic Hypoglycemia in Full Term Exclusively Breastfed Neonates in First 48 Hours of Life
Journal of clinical and diagnostic research JCDR 9(9) pp SC07-10
bull SOBREVIA L SALSOSO R SAEZ T SANHUEZA C PARDO F and LEIVA A 2015 Insulin
therapy and fetoplacental vascular function in gestational diabetes mellitus Experimental physiology
100(3) pp 231-238
bull STEWART CE SAGE EL and REYNOLDS P 2015 Supporting Baby Friendly a quality
improvement initiative for the management of transitional neonatal hypoglycaemia Archives of
disease in childhoodFetal and neonatal edition
bull
Unicef hypoglycemia 2013
Forebyggelse i ammeperspektiv og Baby Friendly
Normoglycaeligmisk tilstand boslashr opnaringes med mindst mulig intervention
Konventionel tilgang
bull 60 mlkgdoslashgn mm el mme oslashges med
20 mlkgdoslashgn x 8(-12)
bull Vallecasein 4060 mme = nedsat
ventrikeltoslashmning
bull Vi maringler stadig 1 t bs
bull Ved lav bs oslashges til 125 eller 150
af maeligngden
bull Glucose-infusion
bull Adskillelse af mor og barn
Individuel tilgangABM Protocol 2014
bull 1-3 mlkg (optil 5 mlkg) gerne hver 2 time
(3-5 mlkg i 2006-udgaven)
bull Hurtig passage af mm alle hjaeliglpestoffer er
med Vallecasein 9010
Bergmann
bull mavesaeligkkens stoslashrrelse lige foslashr foslashdslen
drikker barnet ca 10 ml gang Refererer til
studier der angiver ventiklen til hhv 10 12
15 20 ml
bull Anbefaler smaring hyppige amninger
suppleringer saring barnet ikke stresses og
bruger mere glucose end det tilfoslashres
bull Ward-Platt Laktat er rdquothe good guyrdquo og et
veloxideret velcirkuleret barn har alle
muligheder for at kompensere
bull Antenatal udmalkning af raringmaeliglk til DM-
boslashrn
Forskellen i et forloslashb
DPS
3000 gram
bull 180 ml 1 doslashgn
(60kgdoslashgn)
bull bsdarr oslashges til 225 ml 24
timer
Svaeligrt at faring udmalket dette
som ekstra
ABM
3000 gram
bull 36 ml foslashrste doslashgn
1 mlkg maringltid = 3 x 12
bull 108 ml v 3 ml kgmaringltid
(reduktion paring 40 )
Opnaringeligt at udmalke dette
som ekstra
Mon der er forskel paring
antal amninger
Haringndudmalkning korrektinkorrekt
bull httpswwwyoutubecomwatchv=k6V9xTZAWq0
24
Hvordan forholder vi os til dette
bull Vi kan ikke aeligndre instrukser for hypoglycaeligmi haringndtering det
er en laeliggefaglig opgave kan vi alligevel goslashre en forskel i
profylaktisk oslashjemed
bull Har vi et ansvar for at vaeligre kritiske overfor gamle strategier
ndash og dermed assistere paeligdiatere i forebyggelsesarbejdet
bull Hvordan kan vi balancere forebyggelse og ikke-skade
princippet naringr det ogsaring drejer sig om naturlig ernaeligring mor-
barn kontakt og medicinske interventioner
bull Kan vi med vores viden om colostrum og naturlige
processers effekt aeligndre praksis for disse boslashrn
bull Hvordan kan vi som sundhedsprofessionelle oslashge antallet af
risikoboslashrn der tidligt faringr mors maeliglk selv om det ikke sutter
bull Hvordan vil det aeligndre vores praksisarbejde
bull Hvordan klaeligdes novicen og vi paring til en rdquoWatch and Waitrdquo
tilgang til hypoglycaeligmiforebyggelse
bull POCT eller lab-svar
Mon ikke hypoglycaeligmi forebyggelse kvalitativt kan
komme videre end i 2014
Tak fordi I lyttede
referencerbull CHERTOK IR RAZ I SHOHAM I HADDAD H and WIZNITZER A 2009 Journal of human
nutrition and dietetics the official journal of the British Dietetic Association 22(2) pp 166-169
bull CHRISTESEN HT and ESBERG G 2014-last update Hypoglykaeligmi flowcharts DPS Available
httpvipregionhdkVIPRedaktoer151637nsfvLookupUploadATTACH-RHAP-
9K2D8Y$FILEHypoglykC3A6mi20-20neonatal20Flowcharts20Maj202014pdf [0916
2014]
bull CORDERO L TREUER SH LANDON MB and GABBE SG 1998 Management of infants of
diabetic mothers Archives of Pediatrics amp Adolescent Medicine 152(3) pp 249-254
bull CORNBLATH M HAWDON JM WILLIAMS AF AYNSLEY-GREEN A WARD-PLATT MP
SCHWARTZ R and KALHAN SC 2000 Controversies regarding definition of neonatal
hypoglycemia suggested operational thresholds Pediatrics 105(5) pp 1141-1145
bull CSONT GL GROTH S HOPKINS P and GUILLET R 2014 An evidence-based approach to
breastfeeding neonates at risk for hypoglycemia Journal of obstetric gynecologic and neonatal
nursing JOGNN NAACOG 43(1) pp 71-81
bull DE ROOY L and HAWDON J 2002 Nutritional factors that affect the postnatal metabolic
adaptation of full-term small- and large-for-gestational-age infants Pediatrics 109(3) pp E42
bull DOBSON LZ VIBEKE 2011 God blodsukkerregulering kun for barnets skyld 25(nr 4) pp 36--
47
bull FLORES-LE ROUX JA SAGARRA E BENAIGES D HERNANDEZ-RIVAS E CHILLARON
JJ PUIG DE DOU J MUR A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2012 A
prospective evaluation of neonatal hypoglycaemia in infants of women with gestational diabetes
mellitus Diabetes research and clinical practice 97(2) pp 217-222
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull HARRIS DL WESTON PJ SIGNAL M CHASE JG and HARDING JE 2013 Dextrose gel for neonatal
hypoglycaemia (the Sugar Babies Study) a randomised double-blind placebo-controlled trial Lancet (London
England) 382(9910) pp 2077-2083
bull HERNANDEZ-RIVAS E FLORES-LE ROUX JA BENAIGES D SAGARRA E CHILLARON JJ PAYA A
PUIG-DE DOU J GODAY A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2013 Gestational diabetes in a
multiethnic population of Spain clinical characteristics and perinatal outcomes Diabetes research and clinical
practice 100(2) pp 215-221
bull HOSETH E JOERGENSEN A EBBESEN F and MOELLER M 2000 Blood glucose levels in a population of
healthy breast fed term infants of appropriate size for gestational age Archives of disease in childhoodFetal and
neonatal edition 83(2) pp F117-9
bull JENSEN DM SORENSEN B FEILBERG-JORGENSEN N WESTERGAARD JG and BECK-NIELSEN H
2000 Maternal and perinatal outcomes in 143 Danish women with gestational diabetes mellitus and 143 controls with
a similar risk profile Diabetic medicine a journal of the British Diabetic Association 17(4) pp 281-286
bull MAAYAN-METZGER A LUBIN D and KUINT J 2009 Hypoglycemia rates in the first days of life among term
infants born to diabetic mothers Neonatology 96(2) pp 80-85
bull MAAYAN-METZGER A SCHUSHAN-EISEN I LUBIN D MORAN O KUINT J and MAZKERETH R 2014
Delivery room breastfeeding for prevention of hypoglycaemia in infants of diabetic mothers Fetal and pediatric
pathology 33(1) pp 23-28
bull MCKINLAY CEA 2015 neonatal hypoglycemia and neurodevelopment outcomes at 2 years N Engl J Med(373)
pp 1507-18
bull METZGER BE PERSSON B LOWE LP DYER AR CRUICKSHANK JK DEEROCHANAWONG C
HALLIDAY HL HENNIS AJ LILEY H NG PC COUSTAN DR HADDEN DR HOD M OATS JJ
TRIMBLE ER and HAPO STUDY COOPERATIVE RESEARCH GROUP 2010 Hyperglycemia and adverse
pregnancy outcome study neonatal glycemia Pediatrics 126(6) pp e1545-52
bull ROZANCE PJ and HAY WWJR 2012 Neonatal hypoglycemia--answers but more questions The Journal of
pediatrics 161(5) pp 775-776
bull SARKAR S WATMAN J SEIGEL WM and SCHAEFFER HA 2003 A prospective controlled study of neonatal
morbidities in infants born at 36 weeks or more gestation to Women with diet-controlled gestational diabetes (GDM-
class Al) Journal of perinatology official journal of the California Perinatal Association 23(3) pp 223-228
bull SOLTANI H DICKINSON FM KALK J and PAYNE K 2008 Breast feeding
practices and views among diabetic women a retrospective cohort study Midwifery
24(4) pp 471-479
bull TOZIER P 2013 Colostrum Versus Formula Supplentation for Glucose Stabilization in
Newborns of Diabetic Mothers 42(JOGNN The association of Womens Health
Obstetric and Neonatal Nurses) pp 619-628
bull VAN HOWE RS and STORMS MR 2008 Blood glucose determinations in large for
gestational age infants American Journal of Perinatology 25(5) pp 283-289
bull WIGHT N MARINELLI KA and ACADEMY OF BREASTFEEDING MEDICINE
PROTOCOL COMMITTEE 2006 ABM clinical protocol 1 guidelines for glucose
monitoring and treatment of hypoglycemia in breastfed neonates Breastfeeding
medicine the official journal of the Academy of Breastfeeding Medicine 1(3) pp 178-
184
bull VANHALTREN K and MALHOTRA A 2013 Characteristics of infants at risk of
hypoglycaemia secondary to being infant of a diabetic mother Journal of pediatric
endocrinology amp metabolism JPEM 26(9-10) pp 861-865
bull WIGHT NE 2014 Hypoglycemia in breastfed neonates Breastfeeding medicine the
official journal of the Academy of Breastfeeding Medicine 9(4) pp 173-179
bull DALSGAARD B and ECK K 2013-last update Klinisk retningslinje for
nonfarmakologisk forebyggelse af neonatal hypoglycaeligmi og energitab hos nyfoslashdte af
moslashdre med diaeligtbehandlet gestationel diabetes Available
httpwwwkliniskeretningslinjerdkimages88_gdm_godkendt_010713pdf [0917 2014]
hypoglycaeligmibull
bull BRAGG JJ GREEN R and HOLZMAN IR 2013 Does early enteral feeding prevent
hypoglycemia in small for gestational age neonates Journal of neonatal-perinatal medicine 6(2)
pp 131-135
bull HARRIS DL WESTON PJ and HARDING JE 2014 Lactate rather than ketones may provide
alternative cerebral fuel in hypoglycaemic newborns Archives of disease in childhoodFetal and
neonatal edition
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull LANG TF and HUSSAIN K 2014 Pediatric hypoglycemia Advances in Clinical Chemistry 63
pp 211-245
bull MITANCHEZ D BURGUET A and SIMEONI U 2014 Infants born to mothers with gestational
diabetes mellitus mild neonatal effects a long-term threat to global health The Journal of pediatrics
164(3) pp 445-450
bull SUNDERCOMBE SL RAYNES-GREENOW CH TURNER RM and JEFFERY HE 2014 Do
neonatal hypoglycaemia guidelines in Australia and New Zealand facilitate breast feeding
Midwifery 30(12) pp 1179-1186
bull TAM EW HAEUSSLEIN LA BONIFACIO SL GLASS HC ROGERS EE JEREMY RJ
BARKOVICH AJ and FERRIERO DM 2012 Hypoglycemia is associated with increased risk for
brain injury and adverse neurodevelopmental outcome in neonates at risk for encephalopathy The
Journal of pediatrics 161(1) pp 88-93
bull UNICEF 2013 hypoglycaemia guidance july 2013 UNICEF
Kilder tilfoslashjet 2016
bull AGHDAS K TALAT K and SEPIDEH B 2014 Effect of immediate and continuous mother-infant
skin-to-skin contact on breastfeeding self-efficacy of primiparous women a randomised control trial
Women and birth journal of the Australian College of Midwives 27(1) pp 37-40
bull BEIRANVAND S VALIZADEH F HOSSEINABADI R and POURNIA Y 2014 The Effects of
Skin-to-Skin Contact on Temperature and Breastfeeding Successfulness in Full-Term Newborns
after Cesarean Delivery International journal of pediatrics 2014 pp 846486
bull FENGER-GRON J FENGER-GRON M BLUNCK CH SCHONEMANN-RIGEL H and
WIELANDT HB 2015 Low breastfeeding rates and body mass index in Danish children of women
with gestational diabetes mellitus International breastfeeding journal 10 pp 26-015-0051-8
eCollection 2015
bull JAGIELLO KP and AZULAY CHERTOK IR 2015 Womens Experiences With Early
Breastfeeding After Gestational Diabetes Journal of obstetric gynecologic and neonatal nursing
JOGNN NAACOG 44(4) pp 500-509
bull SAMAYAM P RANGANATHAN PK KOTARI UD and BALASUNDARAM R 2015 Study of
Asymptomatic Hypoglycemia in Full Term Exclusively Breastfed Neonates in First 48 Hours of Life
Journal of clinical and diagnostic research JCDR 9(9) pp SC07-10
bull SOBREVIA L SALSOSO R SAEZ T SANHUEZA C PARDO F and LEIVA A 2015 Insulin
therapy and fetoplacental vascular function in gestational diabetes mellitus Experimental physiology
100(3) pp 231-238
bull STEWART CE SAGE EL and REYNOLDS P 2015 Supporting Baby Friendly a quality
improvement initiative for the management of transitional neonatal hypoglycaemia Archives of
disease in childhoodFetal and neonatal edition
bull
Forebyggelse i ammeperspektiv og Baby Friendly
Normoglycaeligmisk tilstand boslashr opnaringes med mindst mulig intervention
Konventionel tilgang
bull 60 mlkgdoslashgn mm el mme oslashges med
20 mlkgdoslashgn x 8(-12)
bull Vallecasein 4060 mme = nedsat
ventrikeltoslashmning
bull Vi maringler stadig 1 t bs
bull Ved lav bs oslashges til 125 eller 150
af maeligngden
bull Glucose-infusion
bull Adskillelse af mor og barn
Individuel tilgangABM Protocol 2014
bull 1-3 mlkg (optil 5 mlkg) gerne hver 2 time
(3-5 mlkg i 2006-udgaven)
bull Hurtig passage af mm alle hjaeliglpestoffer er
med Vallecasein 9010
Bergmann
bull mavesaeligkkens stoslashrrelse lige foslashr foslashdslen
drikker barnet ca 10 ml gang Refererer til
studier der angiver ventiklen til hhv 10 12
15 20 ml
bull Anbefaler smaring hyppige amninger
suppleringer saring barnet ikke stresses og
bruger mere glucose end det tilfoslashres
bull Ward-Platt Laktat er rdquothe good guyrdquo og et
veloxideret velcirkuleret barn har alle
muligheder for at kompensere
bull Antenatal udmalkning af raringmaeliglk til DM-
boslashrn
Forskellen i et forloslashb
DPS
3000 gram
bull 180 ml 1 doslashgn
(60kgdoslashgn)
bull bsdarr oslashges til 225 ml 24
timer
Svaeligrt at faring udmalket dette
som ekstra
ABM
3000 gram
bull 36 ml foslashrste doslashgn
1 mlkg maringltid = 3 x 12
bull 108 ml v 3 ml kgmaringltid
(reduktion paring 40 )
Opnaringeligt at udmalke dette
som ekstra
Mon der er forskel paring
antal amninger
Haringndudmalkning korrektinkorrekt
bull httpswwwyoutubecomwatchv=k6V9xTZAWq0
24
Hvordan forholder vi os til dette
bull Vi kan ikke aeligndre instrukser for hypoglycaeligmi haringndtering det
er en laeliggefaglig opgave kan vi alligevel goslashre en forskel i
profylaktisk oslashjemed
bull Har vi et ansvar for at vaeligre kritiske overfor gamle strategier
ndash og dermed assistere paeligdiatere i forebyggelsesarbejdet
bull Hvordan kan vi balancere forebyggelse og ikke-skade
princippet naringr det ogsaring drejer sig om naturlig ernaeligring mor-
barn kontakt og medicinske interventioner
bull Kan vi med vores viden om colostrum og naturlige
processers effekt aeligndre praksis for disse boslashrn
bull Hvordan kan vi som sundhedsprofessionelle oslashge antallet af
risikoboslashrn der tidligt faringr mors maeliglk selv om det ikke sutter
bull Hvordan vil det aeligndre vores praksisarbejde
bull Hvordan klaeligdes novicen og vi paring til en rdquoWatch and Waitrdquo
tilgang til hypoglycaeligmiforebyggelse
bull POCT eller lab-svar
Mon ikke hypoglycaeligmi forebyggelse kvalitativt kan
komme videre end i 2014
Tak fordi I lyttede
referencerbull CHERTOK IR RAZ I SHOHAM I HADDAD H and WIZNITZER A 2009 Journal of human
nutrition and dietetics the official journal of the British Dietetic Association 22(2) pp 166-169
bull CHRISTESEN HT and ESBERG G 2014-last update Hypoglykaeligmi flowcharts DPS Available
httpvipregionhdkVIPRedaktoer151637nsfvLookupUploadATTACH-RHAP-
9K2D8Y$FILEHypoglykC3A6mi20-20neonatal20Flowcharts20Maj202014pdf [0916
2014]
bull CORDERO L TREUER SH LANDON MB and GABBE SG 1998 Management of infants of
diabetic mothers Archives of Pediatrics amp Adolescent Medicine 152(3) pp 249-254
bull CORNBLATH M HAWDON JM WILLIAMS AF AYNSLEY-GREEN A WARD-PLATT MP
SCHWARTZ R and KALHAN SC 2000 Controversies regarding definition of neonatal
hypoglycemia suggested operational thresholds Pediatrics 105(5) pp 1141-1145
bull CSONT GL GROTH S HOPKINS P and GUILLET R 2014 An evidence-based approach to
breastfeeding neonates at risk for hypoglycemia Journal of obstetric gynecologic and neonatal
nursing JOGNN NAACOG 43(1) pp 71-81
bull DE ROOY L and HAWDON J 2002 Nutritional factors that affect the postnatal metabolic
adaptation of full-term small- and large-for-gestational-age infants Pediatrics 109(3) pp E42
bull DOBSON LZ VIBEKE 2011 God blodsukkerregulering kun for barnets skyld 25(nr 4) pp 36--
47
bull FLORES-LE ROUX JA SAGARRA E BENAIGES D HERNANDEZ-RIVAS E CHILLARON
JJ PUIG DE DOU J MUR A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2012 A
prospective evaluation of neonatal hypoglycaemia in infants of women with gestational diabetes
mellitus Diabetes research and clinical practice 97(2) pp 217-222
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull HARRIS DL WESTON PJ SIGNAL M CHASE JG and HARDING JE 2013 Dextrose gel for neonatal
hypoglycaemia (the Sugar Babies Study) a randomised double-blind placebo-controlled trial Lancet (London
England) 382(9910) pp 2077-2083
bull HERNANDEZ-RIVAS E FLORES-LE ROUX JA BENAIGES D SAGARRA E CHILLARON JJ PAYA A
PUIG-DE DOU J GODAY A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2013 Gestational diabetes in a
multiethnic population of Spain clinical characteristics and perinatal outcomes Diabetes research and clinical
practice 100(2) pp 215-221
bull HOSETH E JOERGENSEN A EBBESEN F and MOELLER M 2000 Blood glucose levels in a population of
healthy breast fed term infants of appropriate size for gestational age Archives of disease in childhoodFetal and
neonatal edition 83(2) pp F117-9
bull JENSEN DM SORENSEN B FEILBERG-JORGENSEN N WESTERGAARD JG and BECK-NIELSEN H
2000 Maternal and perinatal outcomes in 143 Danish women with gestational diabetes mellitus and 143 controls with
a similar risk profile Diabetic medicine a journal of the British Diabetic Association 17(4) pp 281-286
bull MAAYAN-METZGER A LUBIN D and KUINT J 2009 Hypoglycemia rates in the first days of life among term
infants born to diabetic mothers Neonatology 96(2) pp 80-85
bull MAAYAN-METZGER A SCHUSHAN-EISEN I LUBIN D MORAN O KUINT J and MAZKERETH R 2014
Delivery room breastfeeding for prevention of hypoglycaemia in infants of diabetic mothers Fetal and pediatric
pathology 33(1) pp 23-28
bull MCKINLAY CEA 2015 neonatal hypoglycemia and neurodevelopment outcomes at 2 years N Engl J Med(373)
pp 1507-18
bull METZGER BE PERSSON B LOWE LP DYER AR CRUICKSHANK JK DEEROCHANAWONG C
HALLIDAY HL HENNIS AJ LILEY H NG PC COUSTAN DR HADDEN DR HOD M OATS JJ
TRIMBLE ER and HAPO STUDY COOPERATIVE RESEARCH GROUP 2010 Hyperglycemia and adverse
pregnancy outcome study neonatal glycemia Pediatrics 126(6) pp e1545-52
bull ROZANCE PJ and HAY WWJR 2012 Neonatal hypoglycemia--answers but more questions The Journal of
pediatrics 161(5) pp 775-776
bull SARKAR S WATMAN J SEIGEL WM and SCHAEFFER HA 2003 A prospective controlled study of neonatal
morbidities in infants born at 36 weeks or more gestation to Women with diet-controlled gestational diabetes (GDM-
class Al) Journal of perinatology official journal of the California Perinatal Association 23(3) pp 223-228
bull SOLTANI H DICKINSON FM KALK J and PAYNE K 2008 Breast feeding
practices and views among diabetic women a retrospective cohort study Midwifery
24(4) pp 471-479
bull TOZIER P 2013 Colostrum Versus Formula Supplentation for Glucose Stabilization in
Newborns of Diabetic Mothers 42(JOGNN The association of Womens Health
Obstetric and Neonatal Nurses) pp 619-628
bull VAN HOWE RS and STORMS MR 2008 Blood glucose determinations in large for
gestational age infants American Journal of Perinatology 25(5) pp 283-289
bull WIGHT N MARINELLI KA and ACADEMY OF BREASTFEEDING MEDICINE
PROTOCOL COMMITTEE 2006 ABM clinical protocol 1 guidelines for glucose
monitoring and treatment of hypoglycemia in breastfed neonates Breastfeeding
medicine the official journal of the Academy of Breastfeeding Medicine 1(3) pp 178-
184
bull VANHALTREN K and MALHOTRA A 2013 Characteristics of infants at risk of
hypoglycaemia secondary to being infant of a diabetic mother Journal of pediatric
endocrinology amp metabolism JPEM 26(9-10) pp 861-865
bull WIGHT NE 2014 Hypoglycemia in breastfed neonates Breastfeeding medicine the
official journal of the Academy of Breastfeeding Medicine 9(4) pp 173-179
bull DALSGAARD B and ECK K 2013-last update Klinisk retningslinje for
nonfarmakologisk forebyggelse af neonatal hypoglycaeligmi og energitab hos nyfoslashdte af
moslashdre med diaeligtbehandlet gestationel diabetes Available
httpwwwkliniskeretningslinjerdkimages88_gdm_godkendt_010713pdf [0917 2014]
hypoglycaeligmibull
bull BRAGG JJ GREEN R and HOLZMAN IR 2013 Does early enteral feeding prevent
hypoglycemia in small for gestational age neonates Journal of neonatal-perinatal medicine 6(2)
pp 131-135
bull HARRIS DL WESTON PJ and HARDING JE 2014 Lactate rather than ketones may provide
alternative cerebral fuel in hypoglycaemic newborns Archives of disease in childhoodFetal and
neonatal edition
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull LANG TF and HUSSAIN K 2014 Pediatric hypoglycemia Advances in Clinical Chemistry 63
pp 211-245
bull MITANCHEZ D BURGUET A and SIMEONI U 2014 Infants born to mothers with gestational
diabetes mellitus mild neonatal effects a long-term threat to global health The Journal of pediatrics
164(3) pp 445-450
bull SUNDERCOMBE SL RAYNES-GREENOW CH TURNER RM and JEFFERY HE 2014 Do
neonatal hypoglycaemia guidelines in Australia and New Zealand facilitate breast feeding
Midwifery 30(12) pp 1179-1186
bull TAM EW HAEUSSLEIN LA BONIFACIO SL GLASS HC ROGERS EE JEREMY RJ
BARKOVICH AJ and FERRIERO DM 2012 Hypoglycemia is associated with increased risk for
brain injury and adverse neurodevelopmental outcome in neonates at risk for encephalopathy The
Journal of pediatrics 161(1) pp 88-93
bull UNICEF 2013 hypoglycaemia guidance july 2013 UNICEF
Kilder tilfoslashjet 2016
bull AGHDAS K TALAT K and SEPIDEH B 2014 Effect of immediate and continuous mother-infant
skin-to-skin contact on breastfeeding self-efficacy of primiparous women a randomised control trial
Women and birth journal of the Australian College of Midwives 27(1) pp 37-40
bull BEIRANVAND S VALIZADEH F HOSSEINABADI R and POURNIA Y 2014 The Effects of
Skin-to-Skin Contact on Temperature and Breastfeeding Successfulness in Full-Term Newborns
after Cesarean Delivery International journal of pediatrics 2014 pp 846486
bull FENGER-GRON J FENGER-GRON M BLUNCK CH SCHONEMANN-RIGEL H and
WIELANDT HB 2015 Low breastfeeding rates and body mass index in Danish children of women
with gestational diabetes mellitus International breastfeeding journal 10 pp 26-015-0051-8
eCollection 2015
bull JAGIELLO KP and AZULAY CHERTOK IR 2015 Womens Experiences With Early
Breastfeeding After Gestational Diabetes Journal of obstetric gynecologic and neonatal nursing
JOGNN NAACOG 44(4) pp 500-509
bull SAMAYAM P RANGANATHAN PK KOTARI UD and BALASUNDARAM R 2015 Study of
Asymptomatic Hypoglycemia in Full Term Exclusively Breastfed Neonates in First 48 Hours of Life
Journal of clinical and diagnostic research JCDR 9(9) pp SC07-10
bull SOBREVIA L SALSOSO R SAEZ T SANHUEZA C PARDO F and LEIVA A 2015 Insulin
therapy and fetoplacental vascular function in gestational diabetes mellitus Experimental physiology
100(3) pp 231-238
bull STEWART CE SAGE EL and REYNOLDS P 2015 Supporting Baby Friendly a quality
improvement initiative for the management of transitional neonatal hypoglycaemia Archives of
disease in childhoodFetal and neonatal edition
bull
Forskellen i et forloslashb
DPS
3000 gram
bull 180 ml 1 doslashgn
(60kgdoslashgn)
bull bsdarr oslashges til 225 ml 24
timer
Svaeligrt at faring udmalket dette
som ekstra
ABM
3000 gram
bull 36 ml foslashrste doslashgn
1 mlkg maringltid = 3 x 12
bull 108 ml v 3 ml kgmaringltid
(reduktion paring 40 )
Opnaringeligt at udmalke dette
som ekstra
Mon der er forskel paring
antal amninger
Haringndudmalkning korrektinkorrekt
bull httpswwwyoutubecomwatchv=k6V9xTZAWq0
24
Hvordan forholder vi os til dette
bull Vi kan ikke aeligndre instrukser for hypoglycaeligmi haringndtering det
er en laeliggefaglig opgave kan vi alligevel goslashre en forskel i
profylaktisk oslashjemed
bull Har vi et ansvar for at vaeligre kritiske overfor gamle strategier
ndash og dermed assistere paeligdiatere i forebyggelsesarbejdet
bull Hvordan kan vi balancere forebyggelse og ikke-skade
princippet naringr det ogsaring drejer sig om naturlig ernaeligring mor-
barn kontakt og medicinske interventioner
bull Kan vi med vores viden om colostrum og naturlige
processers effekt aeligndre praksis for disse boslashrn
bull Hvordan kan vi som sundhedsprofessionelle oslashge antallet af
risikoboslashrn der tidligt faringr mors maeliglk selv om det ikke sutter
bull Hvordan vil det aeligndre vores praksisarbejde
bull Hvordan klaeligdes novicen og vi paring til en rdquoWatch and Waitrdquo
tilgang til hypoglycaeligmiforebyggelse
bull POCT eller lab-svar
Mon ikke hypoglycaeligmi forebyggelse kvalitativt kan
komme videre end i 2014
Tak fordi I lyttede
referencerbull CHERTOK IR RAZ I SHOHAM I HADDAD H and WIZNITZER A 2009 Journal of human
nutrition and dietetics the official journal of the British Dietetic Association 22(2) pp 166-169
bull CHRISTESEN HT and ESBERG G 2014-last update Hypoglykaeligmi flowcharts DPS Available
httpvipregionhdkVIPRedaktoer151637nsfvLookupUploadATTACH-RHAP-
9K2D8Y$FILEHypoglykC3A6mi20-20neonatal20Flowcharts20Maj202014pdf [0916
2014]
bull CORDERO L TREUER SH LANDON MB and GABBE SG 1998 Management of infants of
diabetic mothers Archives of Pediatrics amp Adolescent Medicine 152(3) pp 249-254
bull CORNBLATH M HAWDON JM WILLIAMS AF AYNSLEY-GREEN A WARD-PLATT MP
SCHWARTZ R and KALHAN SC 2000 Controversies regarding definition of neonatal
hypoglycemia suggested operational thresholds Pediatrics 105(5) pp 1141-1145
bull CSONT GL GROTH S HOPKINS P and GUILLET R 2014 An evidence-based approach to
breastfeeding neonates at risk for hypoglycemia Journal of obstetric gynecologic and neonatal
nursing JOGNN NAACOG 43(1) pp 71-81
bull DE ROOY L and HAWDON J 2002 Nutritional factors that affect the postnatal metabolic
adaptation of full-term small- and large-for-gestational-age infants Pediatrics 109(3) pp E42
bull DOBSON LZ VIBEKE 2011 God blodsukkerregulering kun for barnets skyld 25(nr 4) pp 36--
47
bull FLORES-LE ROUX JA SAGARRA E BENAIGES D HERNANDEZ-RIVAS E CHILLARON
JJ PUIG DE DOU J MUR A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2012 A
prospective evaluation of neonatal hypoglycaemia in infants of women with gestational diabetes
mellitus Diabetes research and clinical practice 97(2) pp 217-222
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull HARRIS DL WESTON PJ SIGNAL M CHASE JG and HARDING JE 2013 Dextrose gel for neonatal
hypoglycaemia (the Sugar Babies Study) a randomised double-blind placebo-controlled trial Lancet (London
England) 382(9910) pp 2077-2083
bull HERNANDEZ-RIVAS E FLORES-LE ROUX JA BENAIGES D SAGARRA E CHILLARON JJ PAYA A
PUIG-DE DOU J GODAY A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2013 Gestational diabetes in a
multiethnic population of Spain clinical characteristics and perinatal outcomes Diabetes research and clinical
practice 100(2) pp 215-221
bull HOSETH E JOERGENSEN A EBBESEN F and MOELLER M 2000 Blood glucose levels in a population of
healthy breast fed term infants of appropriate size for gestational age Archives of disease in childhoodFetal and
neonatal edition 83(2) pp F117-9
bull JENSEN DM SORENSEN B FEILBERG-JORGENSEN N WESTERGAARD JG and BECK-NIELSEN H
2000 Maternal and perinatal outcomes in 143 Danish women with gestational diabetes mellitus and 143 controls with
a similar risk profile Diabetic medicine a journal of the British Diabetic Association 17(4) pp 281-286
bull MAAYAN-METZGER A LUBIN D and KUINT J 2009 Hypoglycemia rates in the first days of life among term
infants born to diabetic mothers Neonatology 96(2) pp 80-85
bull MAAYAN-METZGER A SCHUSHAN-EISEN I LUBIN D MORAN O KUINT J and MAZKERETH R 2014
Delivery room breastfeeding for prevention of hypoglycaemia in infants of diabetic mothers Fetal and pediatric
pathology 33(1) pp 23-28
bull MCKINLAY CEA 2015 neonatal hypoglycemia and neurodevelopment outcomes at 2 years N Engl J Med(373)
pp 1507-18
bull METZGER BE PERSSON B LOWE LP DYER AR CRUICKSHANK JK DEEROCHANAWONG C
HALLIDAY HL HENNIS AJ LILEY H NG PC COUSTAN DR HADDEN DR HOD M OATS JJ
TRIMBLE ER and HAPO STUDY COOPERATIVE RESEARCH GROUP 2010 Hyperglycemia and adverse
pregnancy outcome study neonatal glycemia Pediatrics 126(6) pp e1545-52
bull ROZANCE PJ and HAY WWJR 2012 Neonatal hypoglycemia--answers but more questions The Journal of
pediatrics 161(5) pp 775-776
bull SARKAR S WATMAN J SEIGEL WM and SCHAEFFER HA 2003 A prospective controlled study of neonatal
morbidities in infants born at 36 weeks or more gestation to Women with diet-controlled gestational diabetes (GDM-
class Al) Journal of perinatology official journal of the California Perinatal Association 23(3) pp 223-228
bull SOLTANI H DICKINSON FM KALK J and PAYNE K 2008 Breast feeding
practices and views among diabetic women a retrospective cohort study Midwifery
24(4) pp 471-479
bull TOZIER P 2013 Colostrum Versus Formula Supplentation for Glucose Stabilization in
Newborns of Diabetic Mothers 42(JOGNN The association of Womens Health
Obstetric and Neonatal Nurses) pp 619-628
bull VAN HOWE RS and STORMS MR 2008 Blood glucose determinations in large for
gestational age infants American Journal of Perinatology 25(5) pp 283-289
bull WIGHT N MARINELLI KA and ACADEMY OF BREASTFEEDING MEDICINE
PROTOCOL COMMITTEE 2006 ABM clinical protocol 1 guidelines for glucose
monitoring and treatment of hypoglycemia in breastfed neonates Breastfeeding
medicine the official journal of the Academy of Breastfeeding Medicine 1(3) pp 178-
184
bull VANHALTREN K and MALHOTRA A 2013 Characteristics of infants at risk of
hypoglycaemia secondary to being infant of a diabetic mother Journal of pediatric
endocrinology amp metabolism JPEM 26(9-10) pp 861-865
bull WIGHT NE 2014 Hypoglycemia in breastfed neonates Breastfeeding medicine the
official journal of the Academy of Breastfeeding Medicine 9(4) pp 173-179
bull DALSGAARD B and ECK K 2013-last update Klinisk retningslinje for
nonfarmakologisk forebyggelse af neonatal hypoglycaeligmi og energitab hos nyfoslashdte af
moslashdre med diaeligtbehandlet gestationel diabetes Available
httpwwwkliniskeretningslinjerdkimages88_gdm_godkendt_010713pdf [0917 2014]
hypoglycaeligmibull
bull BRAGG JJ GREEN R and HOLZMAN IR 2013 Does early enteral feeding prevent
hypoglycemia in small for gestational age neonates Journal of neonatal-perinatal medicine 6(2)
pp 131-135
bull HARRIS DL WESTON PJ and HARDING JE 2014 Lactate rather than ketones may provide
alternative cerebral fuel in hypoglycaemic newborns Archives of disease in childhoodFetal and
neonatal edition
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull LANG TF and HUSSAIN K 2014 Pediatric hypoglycemia Advances in Clinical Chemistry 63
pp 211-245
bull MITANCHEZ D BURGUET A and SIMEONI U 2014 Infants born to mothers with gestational
diabetes mellitus mild neonatal effects a long-term threat to global health The Journal of pediatrics
164(3) pp 445-450
bull SUNDERCOMBE SL RAYNES-GREENOW CH TURNER RM and JEFFERY HE 2014 Do
neonatal hypoglycaemia guidelines in Australia and New Zealand facilitate breast feeding
Midwifery 30(12) pp 1179-1186
bull TAM EW HAEUSSLEIN LA BONIFACIO SL GLASS HC ROGERS EE JEREMY RJ
BARKOVICH AJ and FERRIERO DM 2012 Hypoglycemia is associated with increased risk for
brain injury and adverse neurodevelopmental outcome in neonates at risk for encephalopathy The
Journal of pediatrics 161(1) pp 88-93
bull UNICEF 2013 hypoglycaemia guidance july 2013 UNICEF
Kilder tilfoslashjet 2016
bull AGHDAS K TALAT K and SEPIDEH B 2014 Effect of immediate and continuous mother-infant
skin-to-skin contact on breastfeeding self-efficacy of primiparous women a randomised control trial
Women and birth journal of the Australian College of Midwives 27(1) pp 37-40
bull BEIRANVAND S VALIZADEH F HOSSEINABADI R and POURNIA Y 2014 The Effects of
Skin-to-Skin Contact on Temperature and Breastfeeding Successfulness in Full-Term Newborns
after Cesarean Delivery International journal of pediatrics 2014 pp 846486
bull FENGER-GRON J FENGER-GRON M BLUNCK CH SCHONEMANN-RIGEL H and
WIELANDT HB 2015 Low breastfeeding rates and body mass index in Danish children of women
with gestational diabetes mellitus International breastfeeding journal 10 pp 26-015-0051-8
eCollection 2015
bull JAGIELLO KP and AZULAY CHERTOK IR 2015 Womens Experiences With Early
Breastfeeding After Gestational Diabetes Journal of obstetric gynecologic and neonatal nursing
JOGNN NAACOG 44(4) pp 500-509
bull SAMAYAM P RANGANATHAN PK KOTARI UD and BALASUNDARAM R 2015 Study of
Asymptomatic Hypoglycemia in Full Term Exclusively Breastfed Neonates in First 48 Hours of Life
Journal of clinical and diagnostic research JCDR 9(9) pp SC07-10
bull SOBREVIA L SALSOSO R SAEZ T SANHUEZA C PARDO F and LEIVA A 2015 Insulin
therapy and fetoplacental vascular function in gestational diabetes mellitus Experimental physiology
100(3) pp 231-238
bull STEWART CE SAGE EL and REYNOLDS P 2015 Supporting Baby Friendly a quality
improvement initiative for the management of transitional neonatal hypoglycaemia Archives of
disease in childhoodFetal and neonatal edition
bull
Haringndudmalkning korrektinkorrekt
bull httpswwwyoutubecomwatchv=k6V9xTZAWq0
24
Hvordan forholder vi os til dette
bull Vi kan ikke aeligndre instrukser for hypoglycaeligmi haringndtering det
er en laeliggefaglig opgave kan vi alligevel goslashre en forskel i
profylaktisk oslashjemed
bull Har vi et ansvar for at vaeligre kritiske overfor gamle strategier
ndash og dermed assistere paeligdiatere i forebyggelsesarbejdet
bull Hvordan kan vi balancere forebyggelse og ikke-skade
princippet naringr det ogsaring drejer sig om naturlig ernaeligring mor-
barn kontakt og medicinske interventioner
bull Kan vi med vores viden om colostrum og naturlige
processers effekt aeligndre praksis for disse boslashrn
bull Hvordan kan vi som sundhedsprofessionelle oslashge antallet af
risikoboslashrn der tidligt faringr mors maeliglk selv om det ikke sutter
bull Hvordan vil det aeligndre vores praksisarbejde
bull Hvordan klaeligdes novicen og vi paring til en rdquoWatch and Waitrdquo
tilgang til hypoglycaeligmiforebyggelse
bull POCT eller lab-svar
Mon ikke hypoglycaeligmi forebyggelse kvalitativt kan
komme videre end i 2014
Tak fordi I lyttede
referencerbull CHERTOK IR RAZ I SHOHAM I HADDAD H and WIZNITZER A 2009 Journal of human
nutrition and dietetics the official journal of the British Dietetic Association 22(2) pp 166-169
bull CHRISTESEN HT and ESBERG G 2014-last update Hypoglykaeligmi flowcharts DPS Available
httpvipregionhdkVIPRedaktoer151637nsfvLookupUploadATTACH-RHAP-
9K2D8Y$FILEHypoglykC3A6mi20-20neonatal20Flowcharts20Maj202014pdf [0916
2014]
bull CORDERO L TREUER SH LANDON MB and GABBE SG 1998 Management of infants of
diabetic mothers Archives of Pediatrics amp Adolescent Medicine 152(3) pp 249-254
bull CORNBLATH M HAWDON JM WILLIAMS AF AYNSLEY-GREEN A WARD-PLATT MP
SCHWARTZ R and KALHAN SC 2000 Controversies regarding definition of neonatal
hypoglycemia suggested operational thresholds Pediatrics 105(5) pp 1141-1145
bull CSONT GL GROTH S HOPKINS P and GUILLET R 2014 An evidence-based approach to
breastfeeding neonates at risk for hypoglycemia Journal of obstetric gynecologic and neonatal
nursing JOGNN NAACOG 43(1) pp 71-81
bull DE ROOY L and HAWDON J 2002 Nutritional factors that affect the postnatal metabolic
adaptation of full-term small- and large-for-gestational-age infants Pediatrics 109(3) pp E42
bull DOBSON LZ VIBEKE 2011 God blodsukkerregulering kun for barnets skyld 25(nr 4) pp 36--
47
bull FLORES-LE ROUX JA SAGARRA E BENAIGES D HERNANDEZ-RIVAS E CHILLARON
JJ PUIG DE DOU J MUR A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2012 A
prospective evaluation of neonatal hypoglycaemia in infants of women with gestational diabetes
mellitus Diabetes research and clinical practice 97(2) pp 217-222
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull HARRIS DL WESTON PJ SIGNAL M CHASE JG and HARDING JE 2013 Dextrose gel for neonatal
hypoglycaemia (the Sugar Babies Study) a randomised double-blind placebo-controlled trial Lancet (London
England) 382(9910) pp 2077-2083
bull HERNANDEZ-RIVAS E FLORES-LE ROUX JA BENAIGES D SAGARRA E CHILLARON JJ PAYA A
PUIG-DE DOU J GODAY A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2013 Gestational diabetes in a
multiethnic population of Spain clinical characteristics and perinatal outcomes Diabetes research and clinical
practice 100(2) pp 215-221
bull HOSETH E JOERGENSEN A EBBESEN F and MOELLER M 2000 Blood glucose levels in a population of
healthy breast fed term infants of appropriate size for gestational age Archives of disease in childhoodFetal and
neonatal edition 83(2) pp F117-9
bull JENSEN DM SORENSEN B FEILBERG-JORGENSEN N WESTERGAARD JG and BECK-NIELSEN H
2000 Maternal and perinatal outcomes in 143 Danish women with gestational diabetes mellitus and 143 controls with
a similar risk profile Diabetic medicine a journal of the British Diabetic Association 17(4) pp 281-286
bull MAAYAN-METZGER A LUBIN D and KUINT J 2009 Hypoglycemia rates in the first days of life among term
infants born to diabetic mothers Neonatology 96(2) pp 80-85
bull MAAYAN-METZGER A SCHUSHAN-EISEN I LUBIN D MORAN O KUINT J and MAZKERETH R 2014
Delivery room breastfeeding for prevention of hypoglycaemia in infants of diabetic mothers Fetal and pediatric
pathology 33(1) pp 23-28
bull MCKINLAY CEA 2015 neonatal hypoglycemia and neurodevelopment outcomes at 2 years N Engl J Med(373)
pp 1507-18
bull METZGER BE PERSSON B LOWE LP DYER AR CRUICKSHANK JK DEEROCHANAWONG C
HALLIDAY HL HENNIS AJ LILEY H NG PC COUSTAN DR HADDEN DR HOD M OATS JJ
TRIMBLE ER and HAPO STUDY COOPERATIVE RESEARCH GROUP 2010 Hyperglycemia and adverse
pregnancy outcome study neonatal glycemia Pediatrics 126(6) pp e1545-52
bull ROZANCE PJ and HAY WWJR 2012 Neonatal hypoglycemia--answers but more questions The Journal of
pediatrics 161(5) pp 775-776
bull SARKAR S WATMAN J SEIGEL WM and SCHAEFFER HA 2003 A prospective controlled study of neonatal
morbidities in infants born at 36 weeks or more gestation to Women with diet-controlled gestational diabetes (GDM-
class Al) Journal of perinatology official journal of the California Perinatal Association 23(3) pp 223-228
bull SOLTANI H DICKINSON FM KALK J and PAYNE K 2008 Breast feeding
practices and views among diabetic women a retrospective cohort study Midwifery
24(4) pp 471-479
bull TOZIER P 2013 Colostrum Versus Formula Supplentation for Glucose Stabilization in
Newborns of Diabetic Mothers 42(JOGNN The association of Womens Health
Obstetric and Neonatal Nurses) pp 619-628
bull VAN HOWE RS and STORMS MR 2008 Blood glucose determinations in large for
gestational age infants American Journal of Perinatology 25(5) pp 283-289
bull WIGHT N MARINELLI KA and ACADEMY OF BREASTFEEDING MEDICINE
PROTOCOL COMMITTEE 2006 ABM clinical protocol 1 guidelines for glucose
monitoring and treatment of hypoglycemia in breastfed neonates Breastfeeding
medicine the official journal of the Academy of Breastfeeding Medicine 1(3) pp 178-
184
bull VANHALTREN K and MALHOTRA A 2013 Characteristics of infants at risk of
hypoglycaemia secondary to being infant of a diabetic mother Journal of pediatric
endocrinology amp metabolism JPEM 26(9-10) pp 861-865
bull WIGHT NE 2014 Hypoglycemia in breastfed neonates Breastfeeding medicine the
official journal of the Academy of Breastfeeding Medicine 9(4) pp 173-179
bull DALSGAARD B and ECK K 2013-last update Klinisk retningslinje for
nonfarmakologisk forebyggelse af neonatal hypoglycaeligmi og energitab hos nyfoslashdte af
moslashdre med diaeligtbehandlet gestationel diabetes Available
httpwwwkliniskeretningslinjerdkimages88_gdm_godkendt_010713pdf [0917 2014]
hypoglycaeligmibull
bull BRAGG JJ GREEN R and HOLZMAN IR 2013 Does early enteral feeding prevent
hypoglycemia in small for gestational age neonates Journal of neonatal-perinatal medicine 6(2)
pp 131-135
bull HARRIS DL WESTON PJ and HARDING JE 2014 Lactate rather than ketones may provide
alternative cerebral fuel in hypoglycaemic newborns Archives of disease in childhoodFetal and
neonatal edition
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull LANG TF and HUSSAIN K 2014 Pediatric hypoglycemia Advances in Clinical Chemistry 63
pp 211-245
bull MITANCHEZ D BURGUET A and SIMEONI U 2014 Infants born to mothers with gestational
diabetes mellitus mild neonatal effects a long-term threat to global health The Journal of pediatrics
164(3) pp 445-450
bull SUNDERCOMBE SL RAYNES-GREENOW CH TURNER RM and JEFFERY HE 2014 Do
neonatal hypoglycaemia guidelines in Australia and New Zealand facilitate breast feeding
Midwifery 30(12) pp 1179-1186
bull TAM EW HAEUSSLEIN LA BONIFACIO SL GLASS HC ROGERS EE JEREMY RJ
BARKOVICH AJ and FERRIERO DM 2012 Hypoglycemia is associated with increased risk for
brain injury and adverse neurodevelopmental outcome in neonates at risk for encephalopathy The
Journal of pediatrics 161(1) pp 88-93
bull UNICEF 2013 hypoglycaemia guidance july 2013 UNICEF
Kilder tilfoslashjet 2016
bull AGHDAS K TALAT K and SEPIDEH B 2014 Effect of immediate and continuous mother-infant
skin-to-skin contact on breastfeeding self-efficacy of primiparous women a randomised control trial
Women and birth journal of the Australian College of Midwives 27(1) pp 37-40
bull BEIRANVAND S VALIZADEH F HOSSEINABADI R and POURNIA Y 2014 The Effects of
Skin-to-Skin Contact on Temperature and Breastfeeding Successfulness in Full-Term Newborns
after Cesarean Delivery International journal of pediatrics 2014 pp 846486
bull FENGER-GRON J FENGER-GRON M BLUNCK CH SCHONEMANN-RIGEL H and
WIELANDT HB 2015 Low breastfeeding rates and body mass index in Danish children of women
with gestational diabetes mellitus International breastfeeding journal 10 pp 26-015-0051-8
eCollection 2015
bull JAGIELLO KP and AZULAY CHERTOK IR 2015 Womens Experiences With Early
Breastfeeding After Gestational Diabetes Journal of obstetric gynecologic and neonatal nursing
JOGNN NAACOG 44(4) pp 500-509
bull SAMAYAM P RANGANATHAN PK KOTARI UD and BALASUNDARAM R 2015 Study of
Asymptomatic Hypoglycemia in Full Term Exclusively Breastfed Neonates in First 48 Hours of Life
Journal of clinical and diagnostic research JCDR 9(9) pp SC07-10
bull SOBREVIA L SALSOSO R SAEZ T SANHUEZA C PARDO F and LEIVA A 2015 Insulin
therapy and fetoplacental vascular function in gestational diabetes mellitus Experimental physiology
100(3) pp 231-238
bull STEWART CE SAGE EL and REYNOLDS P 2015 Supporting Baby Friendly a quality
improvement initiative for the management of transitional neonatal hypoglycaemia Archives of
disease in childhoodFetal and neonatal edition
bull
Hvordan forholder vi os til dette
bull Vi kan ikke aeligndre instrukser for hypoglycaeligmi haringndtering det
er en laeliggefaglig opgave kan vi alligevel goslashre en forskel i
profylaktisk oslashjemed
bull Har vi et ansvar for at vaeligre kritiske overfor gamle strategier
ndash og dermed assistere paeligdiatere i forebyggelsesarbejdet
bull Hvordan kan vi balancere forebyggelse og ikke-skade
princippet naringr det ogsaring drejer sig om naturlig ernaeligring mor-
barn kontakt og medicinske interventioner
bull Kan vi med vores viden om colostrum og naturlige
processers effekt aeligndre praksis for disse boslashrn
bull Hvordan kan vi som sundhedsprofessionelle oslashge antallet af
risikoboslashrn der tidligt faringr mors maeliglk selv om det ikke sutter
bull Hvordan vil det aeligndre vores praksisarbejde
bull Hvordan klaeligdes novicen og vi paring til en rdquoWatch and Waitrdquo
tilgang til hypoglycaeligmiforebyggelse
bull POCT eller lab-svar
Mon ikke hypoglycaeligmi forebyggelse kvalitativt kan
komme videre end i 2014
Tak fordi I lyttede
referencerbull CHERTOK IR RAZ I SHOHAM I HADDAD H and WIZNITZER A 2009 Journal of human
nutrition and dietetics the official journal of the British Dietetic Association 22(2) pp 166-169
bull CHRISTESEN HT and ESBERG G 2014-last update Hypoglykaeligmi flowcharts DPS Available
httpvipregionhdkVIPRedaktoer151637nsfvLookupUploadATTACH-RHAP-
9K2D8Y$FILEHypoglykC3A6mi20-20neonatal20Flowcharts20Maj202014pdf [0916
2014]
bull CORDERO L TREUER SH LANDON MB and GABBE SG 1998 Management of infants of
diabetic mothers Archives of Pediatrics amp Adolescent Medicine 152(3) pp 249-254
bull CORNBLATH M HAWDON JM WILLIAMS AF AYNSLEY-GREEN A WARD-PLATT MP
SCHWARTZ R and KALHAN SC 2000 Controversies regarding definition of neonatal
hypoglycemia suggested operational thresholds Pediatrics 105(5) pp 1141-1145
bull CSONT GL GROTH S HOPKINS P and GUILLET R 2014 An evidence-based approach to
breastfeeding neonates at risk for hypoglycemia Journal of obstetric gynecologic and neonatal
nursing JOGNN NAACOG 43(1) pp 71-81
bull DE ROOY L and HAWDON J 2002 Nutritional factors that affect the postnatal metabolic
adaptation of full-term small- and large-for-gestational-age infants Pediatrics 109(3) pp E42
bull DOBSON LZ VIBEKE 2011 God blodsukkerregulering kun for barnets skyld 25(nr 4) pp 36--
47
bull FLORES-LE ROUX JA SAGARRA E BENAIGES D HERNANDEZ-RIVAS E CHILLARON
JJ PUIG DE DOU J MUR A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2012 A
prospective evaluation of neonatal hypoglycaemia in infants of women with gestational diabetes
mellitus Diabetes research and clinical practice 97(2) pp 217-222
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull HARRIS DL WESTON PJ SIGNAL M CHASE JG and HARDING JE 2013 Dextrose gel for neonatal
hypoglycaemia (the Sugar Babies Study) a randomised double-blind placebo-controlled trial Lancet (London
England) 382(9910) pp 2077-2083
bull HERNANDEZ-RIVAS E FLORES-LE ROUX JA BENAIGES D SAGARRA E CHILLARON JJ PAYA A
PUIG-DE DOU J GODAY A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2013 Gestational diabetes in a
multiethnic population of Spain clinical characteristics and perinatal outcomes Diabetes research and clinical
practice 100(2) pp 215-221
bull HOSETH E JOERGENSEN A EBBESEN F and MOELLER M 2000 Blood glucose levels in a population of
healthy breast fed term infants of appropriate size for gestational age Archives of disease in childhoodFetal and
neonatal edition 83(2) pp F117-9
bull JENSEN DM SORENSEN B FEILBERG-JORGENSEN N WESTERGAARD JG and BECK-NIELSEN H
2000 Maternal and perinatal outcomes in 143 Danish women with gestational diabetes mellitus and 143 controls with
a similar risk profile Diabetic medicine a journal of the British Diabetic Association 17(4) pp 281-286
bull MAAYAN-METZGER A LUBIN D and KUINT J 2009 Hypoglycemia rates in the first days of life among term
infants born to diabetic mothers Neonatology 96(2) pp 80-85
bull MAAYAN-METZGER A SCHUSHAN-EISEN I LUBIN D MORAN O KUINT J and MAZKERETH R 2014
Delivery room breastfeeding for prevention of hypoglycaemia in infants of diabetic mothers Fetal and pediatric
pathology 33(1) pp 23-28
bull MCKINLAY CEA 2015 neonatal hypoglycemia and neurodevelopment outcomes at 2 years N Engl J Med(373)
pp 1507-18
bull METZGER BE PERSSON B LOWE LP DYER AR CRUICKSHANK JK DEEROCHANAWONG C
HALLIDAY HL HENNIS AJ LILEY H NG PC COUSTAN DR HADDEN DR HOD M OATS JJ
TRIMBLE ER and HAPO STUDY COOPERATIVE RESEARCH GROUP 2010 Hyperglycemia and adverse
pregnancy outcome study neonatal glycemia Pediatrics 126(6) pp e1545-52
bull ROZANCE PJ and HAY WWJR 2012 Neonatal hypoglycemia--answers but more questions The Journal of
pediatrics 161(5) pp 775-776
bull SARKAR S WATMAN J SEIGEL WM and SCHAEFFER HA 2003 A prospective controlled study of neonatal
morbidities in infants born at 36 weeks or more gestation to Women with diet-controlled gestational diabetes (GDM-
class Al) Journal of perinatology official journal of the California Perinatal Association 23(3) pp 223-228
bull SOLTANI H DICKINSON FM KALK J and PAYNE K 2008 Breast feeding
practices and views among diabetic women a retrospective cohort study Midwifery
24(4) pp 471-479
bull TOZIER P 2013 Colostrum Versus Formula Supplentation for Glucose Stabilization in
Newborns of Diabetic Mothers 42(JOGNN The association of Womens Health
Obstetric and Neonatal Nurses) pp 619-628
bull VAN HOWE RS and STORMS MR 2008 Blood glucose determinations in large for
gestational age infants American Journal of Perinatology 25(5) pp 283-289
bull WIGHT N MARINELLI KA and ACADEMY OF BREASTFEEDING MEDICINE
PROTOCOL COMMITTEE 2006 ABM clinical protocol 1 guidelines for glucose
monitoring and treatment of hypoglycemia in breastfed neonates Breastfeeding
medicine the official journal of the Academy of Breastfeeding Medicine 1(3) pp 178-
184
bull VANHALTREN K and MALHOTRA A 2013 Characteristics of infants at risk of
hypoglycaemia secondary to being infant of a diabetic mother Journal of pediatric
endocrinology amp metabolism JPEM 26(9-10) pp 861-865
bull WIGHT NE 2014 Hypoglycemia in breastfed neonates Breastfeeding medicine the
official journal of the Academy of Breastfeeding Medicine 9(4) pp 173-179
bull DALSGAARD B and ECK K 2013-last update Klinisk retningslinje for
nonfarmakologisk forebyggelse af neonatal hypoglycaeligmi og energitab hos nyfoslashdte af
moslashdre med diaeligtbehandlet gestationel diabetes Available
httpwwwkliniskeretningslinjerdkimages88_gdm_godkendt_010713pdf [0917 2014]
hypoglycaeligmibull
bull BRAGG JJ GREEN R and HOLZMAN IR 2013 Does early enteral feeding prevent
hypoglycemia in small for gestational age neonates Journal of neonatal-perinatal medicine 6(2)
pp 131-135
bull HARRIS DL WESTON PJ and HARDING JE 2014 Lactate rather than ketones may provide
alternative cerebral fuel in hypoglycaemic newborns Archives of disease in childhoodFetal and
neonatal edition
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull LANG TF and HUSSAIN K 2014 Pediatric hypoglycemia Advances in Clinical Chemistry 63
pp 211-245
bull MITANCHEZ D BURGUET A and SIMEONI U 2014 Infants born to mothers with gestational
diabetes mellitus mild neonatal effects a long-term threat to global health The Journal of pediatrics
164(3) pp 445-450
bull SUNDERCOMBE SL RAYNES-GREENOW CH TURNER RM and JEFFERY HE 2014 Do
neonatal hypoglycaemia guidelines in Australia and New Zealand facilitate breast feeding
Midwifery 30(12) pp 1179-1186
bull TAM EW HAEUSSLEIN LA BONIFACIO SL GLASS HC ROGERS EE JEREMY RJ
BARKOVICH AJ and FERRIERO DM 2012 Hypoglycemia is associated with increased risk for
brain injury and adverse neurodevelopmental outcome in neonates at risk for encephalopathy The
Journal of pediatrics 161(1) pp 88-93
bull UNICEF 2013 hypoglycaemia guidance july 2013 UNICEF
Kilder tilfoslashjet 2016
bull AGHDAS K TALAT K and SEPIDEH B 2014 Effect of immediate and continuous mother-infant
skin-to-skin contact on breastfeeding self-efficacy of primiparous women a randomised control trial
Women and birth journal of the Australian College of Midwives 27(1) pp 37-40
bull BEIRANVAND S VALIZADEH F HOSSEINABADI R and POURNIA Y 2014 The Effects of
Skin-to-Skin Contact on Temperature and Breastfeeding Successfulness in Full-Term Newborns
after Cesarean Delivery International journal of pediatrics 2014 pp 846486
bull FENGER-GRON J FENGER-GRON M BLUNCK CH SCHONEMANN-RIGEL H and
WIELANDT HB 2015 Low breastfeeding rates and body mass index in Danish children of women
with gestational diabetes mellitus International breastfeeding journal 10 pp 26-015-0051-8
eCollection 2015
bull JAGIELLO KP and AZULAY CHERTOK IR 2015 Womens Experiences With Early
Breastfeeding After Gestational Diabetes Journal of obstetric gynecologic and neonatal nursing
JOGNN NAACOG 44(4) pp 500-509
bull SAMAYAM P RANGANATHAN PK KOTARI UD and BALASUNDARAM R 2015 Study of
Asymptomatic Hypoglycemia in Full Term Exclusively Breastfed Neonates in First 48 Hours of Life
Journal of clinical and diagnostic research JCDR 9(9) pp SC07-10
bull SOBREVIA L SALSOSO R SAEZ T SANHUEZA C PARDO F and LEIVA A 2015 Insulin
therapy and fetoplacental vascular function in gestational diabetes mellitus Experimental physiology
100(3) pp 231-238
bull STEWART CE SAGE EL and REYNOLDS P 2015 Supporting Baby Friendly a quality
improvement initiative for the management of transitional neonatal hypoglycaemia Archives of
disease in childhoodFetal and neonatal edition
bull
Mon ikke hypoglycaeligmi forebyggelse kvalitativt kan
komme videre end i 2014
Tak fordi I lyttede
referencerbull CHERTOK IR RAZ I SHOHAM I HADDAD H and WIZNITZER A 2009 Journal of human
nutrition and dietetics the official journal of the British Dietetic Association 22(2) pp 166-169
bull CHRISTESEN HT and ESBERG G 2014-last update Hypoglykaeligmi flowcharts DPS Available
httpvipregionhdkVIPRedaktoer151637nsfvLookupUploadATTACH-RHAP-
9K2D8Y$FILEHypoglykC3A6mi20-20neonatal20Flowcharts20Maj202014pdf [0916
2014]
bull CORDERO L TREUER SH LANDON MB and GABBE SG 1998 Management of infants of
diabetic mothers Archives of Pediatrics amp Adolescent Medicine 152(3) pp 249-254
bull CORNBLATH M HAWDON JM WILLIAMS AF AYNSLEY-GREEN A WARD-PLATT MP
SCHWARTZ R and KALHAN SC 2000 Controversies regarding definition of neonatal
hypoglycemia suggested operational thresholds Pediatrics 105(5) pp 1141-1145
bull CSONT GL GROTH S HOPKINS P and GUILLET R 2014 An evidence-based approach to
breastfeeding neonates at risk for hypoglycemia Journal of obstetric gynecologic and neonatal
nursing JOGNN NAACOG 43(1) pp 71-81
bull DE ROOY L and HAWDON J 2002 Nutritional factors that affect the postnatal metabolic
adaptation of full-term small- and large-for-gestational-age infants Pediatrics 109(3) pp E42
bull DOBSON LZ VIBEKE 2011 God blodsukkerregulering kun for barnets skyld 25(nr 4) pp 36--
47
bull FLORES-LE ROUX JA SAGARRA E BENAIGES D HERNANDEZ-RIVAS E CHILLARON
JJ PUIG DE DOU J MUR A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2012 A
prospective evaluation of neonatal hypoglycaemia in infants of women with gestational diabetes
mellitus Diabetes research and clinical practice 97(2) pp 217-222
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull HARRIS DL WESTON PJ SIGNAL M CHASE JG and HARDING JE 2013 Dextrose gel for neonatal
hypoglycaemia (the Sugar Babies Study) a randomised double-blind placebo-controlled trial Lancet (London
England) 382(9910) pp 2077-2083
bull HERNANDEZ-RIVAS E FLORES-LE ROUX JA BENAIGES D SAGARRA E CHILLARON JJ PAYA A
PUIG-DE DOU J GODAY A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2013 Gestational diabetes in a
multiethnic population of Spain clinical characteristics and perinatal outcomes Diabetes research and clinical
practice 100(2) pp 215-221
bull HOSETH E JOERGENSEN A EBBESEN F and MOELLER M 2000 Blood glucose levels in a population of
healthy breast fed term infants of appropriate size for gestational age Archives of disease in childhoodFetal and
neonatal edition 83(2) pp F117-9
bull JENSEN DM SORENSEN B FEILBERG-JORGENSEN N WESTERGAARD JG and BECK-NIELSEN H
2000 Maternal and perinatal outcomes in 143 Danish women with gestational diabetes mellitus and 143 controls with
a similar risk profile Diabetic medicine a journal of the British Diabetic Association 17(4) pp 281-286
bull MAAYAN-METZGER A LUBIN D and KUINT J 2009 Hypoglycemia rates in the first days of life among term
infants born to diabetic mothers Neonatology 96(2) pp 80-85
bull MAAYAN-METZGER A SCHUSHAN-EISEN I LUBIN D MORAN O KUINT J and MAZKERETH R 2014
Delivery room breastfeeding for prevention of hypoglycaemia in infants of diabetic mothers Fetal and pediatric
pathology 33(1) pp 23-28
bull MCKINLAY CEA 2015 neonatal hypoglycemia and neurodevelopment outcomes at 2 years N Engl J Med(373)
pp 1507-18
bull METZGER BE PERSSON B LOWE LP DYER AR CRUICKSHANK JK DEEROCHANAWONG C
HALLIDAY HL HENNIS AJ LILEY H NG PC COUSTAN DR HADDEN DR HOD M OATS JJ
TRIMBLE ER and HAPO STUDY COOPERATIVE RESEARCH GROUP 2010 Hyperglycemia and adverse
pregnancy outcome study neonatal glycemia Pediatrics 126(6) pp e1545-52
bull ROZANCE PJ and HAY WWJR 2012 Neonatal hypoglycemia--answers but more questions The Journal of
pediatrics 161(5) pp 775-776
bull SARKAR S WATMAN J SEIGEL WM and SCHAEFFER HA 2003 A prospective controlled study of neonatal
morbidities in infants born at 36 weeks or more gestation to Women with diet-controlled gestational diabetes (GDM-
class Al) Journal of perinatology official journal of the California Perinatal Association 23(3) pp 223-228
bull SOLTANI H DICKINSON FM KALK J and PAYNE K 2008 Breast feeding
practices and views among diabetic women a retrospective cohort study Midwifery
24(4) pp 471-479
bull TOZIER P 2013 Colostrum Versus Formula Supplentation for Glucose Stabilization in
Newborns of Diabetic Mothers 42(JOGNN The association of Womens Health
Obstetric and Neonatal Nurses) pp 619-628
bull VAN HOWE RS and STORMS MR 2008 Blood glucose determinations in large for
gestational age infants American Journal of Perinatology 25(5) pp 283-289
bull WIGHT N MARINELLI KA and ACADEMY OF BREASTFEEDING MEDICINE
PROTOCOL COMMITTEE 2006 ABM clinical protocol 1 guidelines for glucose
monitoring and treatment of hypoglycemia in breastfed neonates Breastfeeding
medicine the official journal of the Academy of Breastfeeding Medicine 1(3) pp 178-
184
bull VANHALTREN K and MALHOTRA A 2013 Characteristics of infants at risk of
hypoglycaemia secondary to being infant of a diabetic mother Journal of pediatric
endocrinology amp metabolism JPEM 26(9-10) pp 861-865
bull WIGHT NE 2014 Hypoglycemia in breastfed neonates Breastfeeding medicine the
official journal of the Academy of Breastfeeding Medicine 9(4) pp 173-179
bull DALSGAARD B and ECK K 2013-last update Klinisk retningslinje for
nonfarmakologisk forebyggelse af neonatal hypoglycaeligmi og energitab hos nyfoslashdte af
moslashdre med diaeligtbehandlet gestationel diabetes Available
httpwwwkliniskeretningslinjerdkimages88_gdm_godkendt_010713pdf [0917 2014]
hypoglycaeligmibull
bull BRAGG JJ GREEN R and HOLZMAN IR 2013 Does early enteral feeding prevent
hypoglycemia in small for gestational age neonates Journal of neonatal-perinatal medicine 6(2)
pp 131-135
bull HARRIS DL WESTON PJ and HARDING JE 2014 Lactate rather than ketones may provide
alternative cerebral fuel in hypoglycaemic newborns Archives of disease in childhoodFetal and
neonatal edition
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull LANG TF and HUSSAIN K 2014 Pediatric hypoglycemia Advances in Clinical Chemistry 63
pp 211-245
bull MITANCHEZ D BURGUET A and SIMEONI U 2014 Infants born to mothers with gestational
diabetes mellitus mild neonatal effects a long-term threat to global health The Journal of pediatrics
164(3) pp 445-450
bull SUNDERCOMBE SL RAYNES-GREENOW CH TURNER RM and JEFFERY HE 2014 Do
neonatal hypoglycaemia guidelines in Australia and New Zealand facilitate breast feeding
Midwifery 30(12) pp 1179-1186
bull TAM EW HAEUSSLEIN LA BONIFACIO SL GLASS HC ROGERS EE JEREMY RJ
BARKOVICH AJ and FERRIERO DM 2012 Hypoglycemia is associated with increased risk for
brain injury and adverse neurodevelopmental outcome in neonates at risk for encephalopathy The
Journal of pediatrics 161(1) pp 88-93
bull UNICEF 2013 hypoglycaemia guidance july 2013 UNICEF
Kilder tilfoslashjet 2016
bull AGHDAS K TALAT K and SEPIDEH B 2014 Effect of immediate and continuous mother-infant
skin-to-skin contact on breastfeeding self-efficacy of primiparous women a randomised control trial
Women and birth journal of the Australian College of Midwives 27(1) pp 37-40
bull BEIRANVAND S VALIZADEH F HOSSEINABADI R and POURNIA Y 2014 The Effects of
Skin-to-Skin Contact on Temperature and Breastfeeding Successfulness in Full-Term Newborns
after Cesarean Delivery International journal of pediatrics 2014 pp 846486
bull FENGER-GRON J FENGER-GRON M BLUNCK CH SCHONEMANN-RIGEL H and
WIELANDT HB 2015 Low breastfeeding rates and body mass index in Danish children of women
with gestational diabetes mellitus International breastfeeding journal 10 pp 26-015-0051-8
eCollection 2015
bull JAGIELLO KP and AZULAY CHERTOK IR 2015 Womens Experiences With Early
Breastfeeding After Gestational Diabetes Journal of obstetric gynecologic and neonatal nursing
JOGNN NAACOG 44(4) pp 500-509
bull SAMAYAM P RANGANATHAN PK KOTARI UD and BALASUNDARAM R 2015 Study of
Asymptomatic Hypoglycemia in Full Term Exclusively Breastfed Neonates in First 48 Hours of Life
Journal of clinical and diagnostic research JCDR 9(9) pp SC07-10
bull SOBREVIA L SALSOSO R SAEZ T SANHUEZA C PARDO F and LEIVA A 2015 Insulin
therapy and fetoplacental vascular function in gestational diabetes mellitus Experimental physiology
100(3) pp 231-238
bull STEWART CE SAGE EL and REYNOLDS P 2015 Supporting Baby Friendly a quality
improvement initiative for the management of transitional neonatal hypoglycaemia Archives of
disease in childhoodFetal and neonatal edition
bull
Tak fordi I lyttede
referencerbull CHERTOK IR RAZ I SHOHAM I HADDAD H and WIZNITZER A 2009 Journal of human
nutrition and dietetics the official journal of the British Dietetic Association 22(2) pp 166-169
bull CHRISTESEN HT and ESBERG G 2014-last update Hypoglykaeligmi flowcharts DPS Available
httpvipregionhdkVIPRedaktoer151637nsfvLookupUploadATTACH-RHAP-
9K2D8Y$FILEHypoglykC3A6mi20-20neonatal20Flowcharts20Maj202014pdf [0916
2014]
bull CORDERO L TREUER SH LANDON MB and GABBE SG 1998 Management of infants of
diabetic mothers Archives of Pediatrics amp Adolescent Medicine 152(3) pp 249-254
bull CORNBLATH M HAWDON JM WILLIAMS AF AYNSLEY-GREEN A WARD-PLATT MP
SCHWARTZ R and KALHAN SC 2000 Controversies regarding definition of neonatal
hypoglycemia suggested operational thresholds Pediatrics 105(5) pp 1141-1145
bull CSONT GL GROTH S HOPKINS P and GUILLET R 2014 An evidence-based approach to
breastfeeding neonates at risk for hypoglycemia Journal of obstetric gynecologic and neonatal
nursing JOGNN NAACOG 43(1) pp 71-81
bull DE ROOY L and HAWDON J 2002 Nutritional factors that affect the postnatal metabolic
adaptation of full-term small- and large-for-gestational-age infants Pediatrics 109(3) pp E42
bull DOBSON LZ VIBEKE 2011 God blodsukkerregulering kun for barnets skyld 25(nr 4) pp 36--
47
bull FLORES-LE ROUX JA SAGARRA E BENAIGES D HERNANDEZ-RIVAS E CHILLARON
JJ PUIG DE DOU J MUR A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2012 A
prospective evaluation of neonatal hypoglycaemia in infants of women with gestational diabetes
mellitus Diabetes research and clinical practice 97(2) pp 217-222
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull HARRIS DL WESTON PJ SIGNAL M CHASE JG and HARDING JE 2013 Dextrose gel for neonatal
hypoglycaemia (the Sugar Babies Study) a randomised double-blind placebo-controlled trial Lancet (London
England) 382(9910) pp 2077-2083
bull HERNANDEZ-RIVAS E FLORES-LE ROUX JA BENAIGES D SAGARRA E CHILLARON JJ PAYA A
PUIG-DE DOU J GODAY A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2013 Gestational diabetes in a
multiethnic population of Spain clinical characteristics and perinatal outcomes Diabetes research and clinical
practice 100(2) pp 215-221
bull HOSETH E JOERGENSEN A EBBESEN F and MOELLER M 2000 Blood glucose levels in a population of
healthy breast fed term infants of appropriate size for gestational age Archives of disease in childhoodFetal and
neonatal edition 83(2) pp F117-9
bull JENSEN DM SORENSEN B FEILBERG-JORGENSEN N WESTERGAARD JG and BECK-NIELSEN H
2000 Maternal and perinatal outcomes in 143 Danish women with gestational diabetes mellitus and 143 controls with
a similar risk profile Diabetic medicine a journal of the British Diabetic Association 17(4) pp 281-286
bull MAAYAN-METZGER A LUBIN D and KUINT J 2009 Hypoglycemia rates in the first days of life among term
infants born to diabetic mothers Neonatology 96(2) pp 80-85
bull MAAYAN-METZGER A SCHUSHAN-EISEN I LUBIN D MORAN O KUINT J and MAZKERETH R 2014
Delivery room breastfeeding for prevention of hypoglycaemia in infants of diabetic mothers Fetal and pediatric
pathology 33(1) pp 23-28
bull MCKINLAY CEA 2015 neonatal hypoglycemia and neurodevelopment outcomes at 2 years N Engl J Med(373)
pp 1507-18
bull METZGER BE PERSSON B LOWE LP DYER AR CRUICKSHANK JK DEEROCHANAWONG C
HALLIDAY HL HENNIS AJ LILEY H NG PC COUSTAN DR HADDEN DR HOD M OATS JJ
TRIMBLE ER and HAPO STUDY COOPERATIVE RESEARCH GROUP 2010 Hyperglycemia and adverse
pregnancy outcome study neonatal glycemia Pediatrics 126(6) pp e1545-52
bull ROZANCE PJ and HAY WWJR 2012 Neonatal hypoglycemia--answers but more questions The Journal of
pediatrics 161(5) pp 775-776
bull SARKAR S WATMAN J SEIGEL WM and SCHAEFFER HA 2003 A prospective controlled study of neonatal
morbidities in infants born at 36 weeks or more gestation to Women with diet-controlled gestational diabetes (GDM-
class Al) Journal of perinatology official journal of the California Perinatal Association 23(3) pp 223-228
bull SOLTANI H DICKINSON FM KALK J and PAYNE K 2008 Breast feeding
practices and views among diabetic women a retrospective cohort study Midwifery
24(4) pp 471-479
bull TOZIER P 2013 Colostrum Versus Formula Supplentation for Glucose Stabilization in
Newborns of Diabetic Mothers 42(JOGNN The association of Womens Health
Obstetric and Neonatal Nurses) pp 619-628
bull VAN HOWE RS and STORMS MR 2008 Blood glucose determinations in large for
gestational age infants American Journal of Perinatology 25(5) pp 283-289
bull WIGHT N MARINELLI KA and ACADEMY OF BREASTFEEDING MEDICINE
PROTOCOL COMMITTEE 2006 ABM clinical protocol 1 guidelines for glucose
monitoring and treatment of hypoglycemia in breastfed neonates Breastfeeding
medicine the official journal of the Academy of Breastfeeding Medicine 1(3) pp 178-
184
bull VANHALTREN K and MALHOTRA A 2013 Characteristics of infants at risk of
hypoglycaemia secondary to being infant of a diabetic mother Journal of pediatric
endocrinology amp metabolism JPEM 26(9-10) pp 861-865
bull WIGHT NE 2014 Hypoglycemia in breastfed neonates Breastfeeding medicine the
official journal of the Academy of Breastfeeding Medicine 9(4) pp 173-179
bull DALSGAARD B and ECK K 2013-last update Klinisk retningslinje for
nonfarmakologisk forebyggelse af neonatal hypoglycaeligmi og energitab hos nyfoslashdte af
moslashdre med diaeligtbehandlet gestationel diabetes Available
httpwwwkliniskeretningslinjerdkimages88_gdm_godkendt_010713pdf [0917 2014]
hypoglycaeligmibull
bull BRAGG JJ GREEN R and HOLZMAN IR 2013 Does early enteral feeding prevent
hypoglycemia in small for gestational age neonates Journal of neonatal-perinatal medicine 6(2)
pp 131-135
bull HARRIS DL WESTON PJ and HARDING JE 2014 Lactate rather than ketones may provide
alternative cerebral fuel in hypoglycaemic newborns Archives of disease in childhoodFetal and
neonatal edition
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull LANG TF and HUSSAIN K 2014 Pediatric hypoglycemia Advances in Clinical Chemistry 63
pp 211-245
bull MITANCHEZ D BURGUET A and SIMEONI U 2014 Infants born to mothers with gestational
diabetes mellitus mild neonatal effects a long-term threat to global health The Journal of pediatrics
164(3) pp 445-450
bull SUNDERCOMBE SL RAYNES-GREENOW CH TURNER RM and JEFFERY HE 2014 Do
neonatal hypoglycaemia guidelines in Australia and New Zealand facilitate breast feeding
Midwifery 30(12) pp 1179-1186
bull TAM EW HAEUSSLEIN LA BONIFACIO SL GLASS HC ROGERS EE JEREMY RJ
BARKOVICH AJ and FERRIERO DM 2012 Hypoglycemia is associated with increased risk for
brain injury and adverse neurodevelopmental outcome in neonates at risk for encephalopathy The
Journal of pediatrics 161(1) pp 88-93
bull UNICEF 2013 hypoglycaemia guidance july 2013 UNICEF
Kilder tilfoslashjet 2016
bull AGHDAS K TALAT K and SEPIDEH B 2014 Effect of immediate and continuous mother-infant
skin-to-skin contact on breastfeeding self-efficacy of primiparous women a randomised control trial
Women and birth journal of the Australian College of Midwives 27(1) pp 37-40
bull BEIRANVAND S VALIZADEH F HOSSEINABADI R and POURNIA Y 2014 The Effects of
Skin-to-Skin Contact on Temperature and Breastfeeding Successfulness in Full-Term Newborns
after Cesarean Delivery International journal of pediatrics 2014 pp 846486
bull FENGER-GRON J FENGER-GRON M BLUNCK CH SCHONEMANN-RIGEL H and
WIELANDT HB 2015 Low breastfeeding rates and body mass index in Danish children of women
with gestational diabetes mellitus International breastfeeding journal 10 pp 26-015-0051-8
eCollection 2015
bull JAGIELLO KP and AZULAY CHERTOK IR 2015 Womens Experiences With Early
Breastfeeding After Gestational Diabetes Journal of obstetric gynecologic and neonatal nursing
JOGNN NAACOG 44(4) pp 500-509
bull SAMAYAM P RANGANATHAN PK KOTARI UD and BALASUNDARAM R 2015 Study of
Asymptomatic Hypoglycemia in Full Term Exclusively Breastfed Neonates in First 48 Hours of Life
Journal of clinical and diagnostic research JCDR 9(9) pp SC07-10
bull SOBREVIA L SALSOSO R SAEZ T SANHUEZA C PARDO F and LEIVA A 2015 Insulin
therapy and fetoplacental vascular function in gestational diabetes mellitus Experimental physiology
100(3) pp 231-238
bull STEWART CE SAGE EL and REYNOLDS P 2015 Supporting Baby Friendly a quality
improvement initiative for the management of transitional neonatal hypoglycaemia Archives of
disease in childhoodFetal and neonatal edition
bull
referencerbull CHERTOK IR RAZ I SHOHAM I HADDAD H and WIZNITZER A 2009 Journal of human
nutrition and dietetics the official journal of the British Dietetic Association 22(2) pp 166-169
bull CHRISTESEN HT and ESBERG G 2014-last update Hypoglykaeligmi flowcharts DPS Available
httpvipregionhdkVIPRedaktoer151637nsfvLookupUploadATTACH-RHAP-
9K2D8Y$FILEHypoglykC3A6mi20-20neonatal20Flowcharts20Maj202014pdf [0916
2014]
bull CORDERO L TREUER SH LANDON MB and GABBE SG 1998 Management of infants of
diabetic mothers Archives of Pediatrics amp Adolescent Medicine 152(3) pp 249-254
bull CORNBLATH M HAWDON JM WILLIAMS AF AYNSLEY-GREEN A WARD-PLATT MP
SCHWARTZ R and KALHAN SC 2000 Controversies regarding definition of neonatal
hypoglycemia suggested operational thresholds Pediatrics 105(5) pp 1141-1145
bull CSONT GL GROTH S HOPKINS P and GUILLET R 2014 An evidence-based approach to
breastfeeding neonates at risk for hypoglycemia Journal of obstetric gynecologic and neonatal
nursing JOGNN NAACOG 43(1) pp 71-81
bull DE ROOY L and HAWDON J 2002 Nutritional factors that affect the postnatal metabolic
adaptation of full-term small- and large-for-gestational-age infants Pediatrics 109(3) pp E42
bull DOBSON LZ VIBEKE 2011 God blodsukkerregulering kun for barnets skyld 25(nr 4) pp 36--
47
bull FLORES-LE ROUX JA SAGARRA E BENAIGES D HERNANDEZ-RIVAS E CHILLARON
JJ PUIG DE DOU J MUR A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2012 A
prospective evaluation of neonatal hypoglycaemia in infants of women with gestational diabetes
mellitus Diabetes research and clinical practice 97(2) pp 217-222
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull HARRIS DL WESTON PJ SIGNAL M CHASE JG and HARDING JE 2013 Dextrose gel for neonatal
hypoglycaemia (the Sugar Babies Study) a randomised double-blind placebo-controlled trial Lancet (London
England) 382(9910) pp 2077-2083
bull HERNANDEZ-RIVAS E FLORES-LE ROUX JA BENAIGES D SAGARRA E CHILLARON JJ PAYA A
PUIG-DE DOU J GODAY A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2013 Gestational diabetes in a
multiethnic population of Spain clinical characteristics and perinatal outcomes Diabetes research and clinical
practice 100(2) pp 215-221
bull HOSETH E JOERGENSEN A EBBESEN F and MOELLER M 2000 Blood glucose levels in a population of
healthy breast fed term infants of appropriate size for gestational age Archives of disease in childhoodFetal and
neonatal edition 83(2) pp F117-9
bull JENSEN DM SORENSEN B FEILBERG-JORGENSEN N WESTERGAARD JG and BECK-NIELSEN H
2000 Maternal and perinatal outcomes in 143 Danish women with gestational diabetes mellitus and 143 controls with
a similar risk profile Diabetic medicine a journal of the British Diabetic Association 17(4) pp 281-286
bull MAAYAN-METZGER A LUBIN D and KUINT J 2009 Hypoglycemia rates in the first days of life among term
infants born to diabetic mothers Neonatology 96(2) pp 80-85
bull MAAYAN-METZGER A SCHUSHAN-EISEN I LUBIN D MORAN O KUINT J and MAZKERETH R 2014
Delivery room breastfeeding for prevention of hypoglycaemia in infants of diabetic mothers Fetal and pediatric
pathology 33(1) pp 23-28
bull MCKINLAY CEA 2015 neonatal hypoglycemia and neurodevelopment outcomes at 2 years N Engl J Med(373)
pp 1507-18
bull METZGER BE PERSSON B LOWE LP DYER AR CRUICKSHANK JK DEEROCHANAWONG C
HALLIDAY HL HENNIS AJ LILEY H NG PC COUSTAN DR HADDEN DR HOD M OATS JJ
TRIMBLE ER and HAPO STUDY COOPERATIVE RESEARCH GROUP 2010 Hyperglycemia and adverse
pregnancy outcome study neonatal glycemia Pediatrics 126(6) pp e1545-52
bull ROZANCE PJ and HAY WWJR 2012 Neonatal hypoglycemia--answers but more questions The Journal of
pediatrics 161(5) pp 775-776
bull SARKAR S WATMAN J SEIGEL WM and SCHAEFFER HA 2003 A prospective controlled study of neonatal
morbidities in infants born at 36 weeks or more gestation to Women with diet-controlled gestational diabetes (GDM-
class Al) Journal of perinatology official journal of the California Perinatal Association 23(3) pp 223-228
bull SOLTANI H DICKINSON FM KALK J and PAYNE K 2008 Breast feeding
practices and views among diabetic women a retrospective cohort study Midwifery
24(4) pp 471-479
bull TOZIER P 2013 Colostrum Versus Formula Supplentation for Glucose Stabilization in
Newborns of Diabetic Mothers 42(JOGNN The association of Womens Health
Obstetric and Neonatal Nurses) pp 619-628
bull VAN HOWE RS and STORMS MR 2008 Blood glucose determinations in large for
gestational age infants American Journal of Perinatology 25(5) pp 283-289
bull WIGHT N MARINELLI KA and ACADEMY OF BREASTFEEDING MEDICINE
PROTOCOL COMMITTEE 2006 ABM clinical protocol 1 guidelines for glucose
monitoring and treatment of hypoglycemia in breastfed neonates Breastfeeding
medicine the official journal of the Academy of Breastfeeding Medicine 1(3) pp 178-
184
bull VANHALTREN K and MALHOTRA A 2013 Characteristics of infants at risk of
hypoglycaemia secondary to being infant of a diabetic mother Journal of pediatric
endocrinology amp metabolism JPEM 26(9-10) pp 861-865
bull WIGHT NE 2014 Hypoglycemia in breastfed neonates Breastfeeding medicine the
official journal of the Academy of Breastfeeding Medicine 9(4) pp 173-179
bull DALSGAARD B and ECK K 2013-last update Klinisk retningslinje for
nonfarmakologisk forebyggelse af neonatal hypoglycaeligmi og energitab hos nyfoslashdte af
moslashdre med diaeligtbehandlet gestationel diabetes Available
httpwwwkliniskeretningslinjerdkimages88_gdm_godkendt_010713pdf [0917 2014]
hypoglycaeligmibull
bull BRAGG JJ GREEN R and HOLZMAN IR 2013 Does early enteral feeding prevent
hypoglycemia in small for gestational age neonates Journal of neonatal-perinatal medicine 6(2)
pp 131-135
bull HARRIS DL WESTON PJ and HARDING JE 2014 Lactate rather than ketones may provide
alternative cerebral fuel in hypoglycaemic newborns Archives of disease in childhoodFetal and
neonatal edition
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull LANG TF and HUSSAIN K 2014 Pediatric hypoglycemia Advances in Clinical Chemistry 63
pp 211-245
bull MITANCHEZ D BURGUET A and SIMEONI U 2014 Infants born to mothers with gestational
diabetes mellitus mild neonatal effects a long-term threat to global health The Journal of pediatrics
164(3) pp 445-450
bull SUNDERCOMBE SL RAYNES-GREENOW CH TURNER RM and JEFFERY HE 2014 Do
neonatal hypoglycaemia guidelines in Australia and New Zealand facilitate breast feeding
Midwifery 30(12) pp 1179-1186
bull TAM EW HAEUSSLEIN LA BONIFACIO SL GLASS HC ROGERS EE JEREMY RJ
BARKOVICH AJ and FERRIERO DM 2012 Hypoglycemia is associated with increased risk for
brain injury and adverse neurodevelopmental outcome in neonates at risk for encephalopathy The
Journal of pediatrics 161(1) pp 88-93
bull UNICEF 2013 hypoglycaemia guidance july 2013 UNICEF
Kilder tilfoslashjet 2016
bull AGHDAS K TALAT K and SEPIDEH B 2014 Effect of immediate and continuous mother-infant
skin-to-skin contact on breastfeeding self-efficacy of primiparous women a randomised control trial
Women and birth journal of the Australian College of Midwives 27(1) pp 37-40
bull BEIRANVAND S VALIZADEH F HOSSEINABADI R and POURNIA Y 2014 The Effects of
Skin-to-Skin Contact on Temperature and Breastfeeding Successfulness in Full-Term Newborns
after Cesarean Delivery International journal of pediatrics 2014 pp 846486
bull FENGER-GRON J FENGER-GRON M BLUNCK CH SCHONEMANN-RIGEL H and
WIELANDT HB 2015 Low breastfeeding rates and body mass index in Danish children of women
with gestational diabetes mellitus International breastfeeding journal 10 pp 26-015-0051-8
eCollection 2015
bull JAGIELLO KP and AZULAY CHERTOK IR 2015 Womens Experiences With Early
Breastfeeding After Gestational Diabetes Journal of obstetric gynecologic and neonatal nursing
JOGNN NAACOG 44(4) pp 500-509
bull SAMAYAM P RANGANATHAN PK KOTARI UD and BALASUNDARAM R 2015 Study of
Asymptomatic Hypoglycemia in Full Term Exclusively Breastfed Neonates in First 48 Hours of Life
Journal of clinical and diagnostic research JCDR 9(9) pp SC07-10
bull SOBREVIA L SALSOSO R SAEZ T SANHUEZA C PARDO F and LEIVA A 2015 Insulin
therapy and fetoplacental vascular function in gestational diabetes mellitus Experimental physiology
100(3) pp 231-238
bull STEWART CE SAGE EL and REYNOLDS P 2015 Supporting Baby Friendly a quality
improvement initiative for the management of transitional neonatal hypoglycaemia Archives of
disease in childhoodFetal and neonatal edition
bull
bull HARRIS DL WESTON PJ SIGNAL M CHASE JG and HARDING JE 2013 Dextrose gel for neonatal
hypoglycaemia (the Sugar Babies Study) a randomised double-blind placebo-controlled trial Lancet (London
England) 382(9910) pp 2077-2083
bull HERNANDEZ-RIVAS E FLORES-LE ROUX JA BENAIGES D SAGARRA E CHILLARON JJ PAYA A
PUIG-DE DOU J GODAY A LOPEZ-VILCHEZ MA and PEDRO-BOTET J 2013 Gestational diabetes in a
multiethnic population of Spain clinical characteristics and perinatal outcomes Diabetes research and clinical
practice 100(2) pp 215-221
bull HOSETH E JOERGENSEN A EBBESEN F and MOELLER M 2000 Blood glucose levels in a population of
healthy breast fed term infants of appropriate size for gestational age Archives of disease in childhoodFetal and
neonatal edition 83(2) pp F117-9
bull JENSEN DM SORENSEN B FEILBERG-JORGENSEN N WESTERGAARD JG and BECK-NIELSEN H
2000 Maternal and perinatal outcomes in 143 Danish women with gestational diabetes mellitus and 143 controls with
a similar risk profile Diabetic medicine a journal of the British Diabetic Association 17(4) pp 281-286
bull MAAYAN-METZGER A LUBIN D and KUINT J 2009 Hypoglycemia rates in the first days of life among term
infants born to diabetic mothers Neonatology 96(2) pp 80-85
bull MAAYAN-METZGER A SCHUSHAN-EISEN I LUBIN D MORAN O KUINT J and MAZKERETH R 2014
Delivery room breastfeeding for prevention of hypoglycaemia in infants of diabetic mothers Fetal and pediatric
pathology 33(1) pp 23-28
bull MCKINLAY CEA 2015 neonatal hypoglycemia and neurodevelopment outcomes at 2 years N Engl J Med(373)
pp 1507-18
bull METZGER BE PERSSON B LOWE LP DYER AR CRUICKSHANK JK DEEROCHANAWONG C
HALLIDAY HL HENNIS AJ LILEY H NG PC COUSTAN DR HADDEN DR HOD M OATS JJ
TRIMBLE ER and HAPO STUDY COOPERATIVE RESEARCH GROUP 2010 Hyperglycemia and adverse
pregnancy outcome study neonatal glycemia Pediatrics 126(6) pp e1545-52
bull ROZANCE PJ and HAY WWJR 2012 Neonatal hypoglycemia--answers but more questions The Journal of
pediatrics 161(5) pp 775-776
bull SARKAR S WATMAN J SEIGEL WM and SCHAEFFER HA 2003 A prospective controlled study of neonatal
morbidities in infants born at 36 weeks or more gestation to Women with diet-controlled gestational diabetes (GDM-
class Al) Journal of perinatology official journal of the California Perinatal Association 23(3) pp 223-228
bull SOLTANI H DICKINSON FM KALK J and PAYNE K 2008 Breast feeding
practices and views among diabetic women a retrospective cohort study Midwifery
24(4) pp 471-479
bull TOZIER P 2013 Colostrum Versus Formula Supplentation for Glucose Stabilization in
Newborns of Diabetic Mothers 42(JOGNN The association of Womens Health
Obstetric and Neonatal Nurses) pp 619-628
bull VAN HOWE RS and STORMS MR 2008 Blood glucose determinations in large for
gestational age infants American Journal of Perinatology 25(5) pp 283-289
bull WIGHT N MARINELLI KA and ACADEMY OF BREASTFEEDING MEDICINE
PROTOCOL COMMITTEE 2006 ABM clinical protocol 1 guidelines for glucose
monitoring and treatment of hypoglycemia in breastfed neonates Breastfeeding
medicine the official journal of the Academy of Breastfeeding Medicine 1(3) pp 178-
184
bull VANHALTREN K and MALHOTRA A 2013 Characteristics of infants at risk of
hypoglycaemia secondary to being infant of a diabetic mother Journal of pediatric
endocrinology amp metabolism JPEM 26(9-10) pp 861-865
bull WIGHT NE 2014 Hypoglycemia in breastfed neonates Breastfeeding medicine the
official journal of the Academy of Breastfeeding Medicine 9(4) pp 173-179
bull DALSGAARD B and ECK K 2013-last update Klinisk retningslinje for
nonfarmakologisk forebyggelse af neonatal hypoglycaeligmi og energitab hos nyfoslashdte af
moslashdre med diaeligtbehandlet gestationel diabetes Available
httpwwwkliniskeretningslinjerdkimages88_gdm_godkendt_010713pdf [0917 2014]
hypoglycaeligmibull
bull BRAGG JJ GREEN R and HOLZMAN IR 2013 Does early enteral feeding prevent
hypoglycemia in small for gestational age neonates Journal of neonatal-perinatal medicine 6(2)
pp 131-135
bull HARRIS DL WESTON PJ and HARDING JE 2014 Lactate rather than ketones may provide
alternative cerebral fuel in hypoglycaemic newborns Archives of disease in childhoodFetal and
neonatal edition
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull LANG TF and HUSSAIN K 2014 Pediatric hypoglycemia Advances in Clinical Chemistry 63
pp 211-245
bull MITANCHEZ D BURGUET A and SIMEONI U 2014 Infants born to mothers with gestational
diabetes mellitus mild neonatal effects a long-term threat to global health The Journal of pediatrics
164(3) pp 445-450
bull SUNDERCOMBE SL RAYNES-GREENOW CH TURNER RM and JEFFERY HE 2014 Do
neonatal hypoglycaemia guidelines in Australia and New Zealand facilitate breast feeding
Midwifery 30(12) pp 1179-1186
bull TAM EW HAEUSSLEIN LA BONIFACIO SL GLASS HC ROGERS EE JEREMY RJ
BARKOVICH AJ and FERRIERO DM 2012 Hypoglycemia is associated with increased risk for
brain injury and adverse neurodevelopmental outcome in neonates at risk for encephalopathy The
Journal of pediatrics 161(1) pp 88-93
bull UNICEF 2013 hypoglycaemia guidance july 2013 UNICEF
Kilder tilfoslashjet 2016
bull AGHDAS K TALAT K and SEPIDEH B 2014 Effect of immediate and continuous mother-infant
skin-to-skin contact on breastfeeding self-efficacy of primiparous women a randomised control trial
Women and birth journal of the Australian College of Midwives 27(1) pp 37-40
bull BEIRANVAND S VALIZADEH F HOSSEINABADI R and POURNIA Y 2014 The Effects of
Skin-to-Skin Contact on Temperature and Breastfeeding Successfulness in Full-Term Newborns
after Cesarean Delivery International journal of pediatrics 2014 pp 846486
bull FENGER-GRON J FENGER-GRON M BLUNCK CH SCHONEMANN-RIGEL H and
WIELANDT HB 2015 Low breastfeeding rates and body mass index in Danish children of women
with gestational diabetes mellitus International breastfeeding journal 10 pp 26-015-0051-8
eCollection 2015
bull JAGIELLO KP and AZULAY CHERTOK IR 2015 Womens Experiences With Early
Breastfeeding After Gestational Diabetes Journal of obstetric gynecologic and neonatal nursing
JOGNN NAACOG 44(4) pp 500-509
bull SAMAYAM P RANGANATHAN PK KOTARI UD and BALASUNDARAM R 2015 Study of
Asymptomatic Hypoglycemia in Full Term Exclusively Breastfed Neonates in First 48 Hours of Life
Journal of clinical and diagnostic research JCDR 9(9) pp SC07-10
bull SOBREVIA L SALSOSO R SAEZ T SANHUEZA C PARDO F and LEIVA A 2015 Insulin
therapy and fetoplacental vascular function in gestational diabetes mellitus Experimental physiology
100(3) pp 231-238
bull STEWART CE SAGE EL and REYNOLDS P 2015 Supporting Baby Friendly a quality
improvement initiative for the management of transitional neonatal hypoglycaemia Archives of
disease in childhoodFetal and neonatal edition
bull
bull SOLTANI H DICKINSON FM KALK J and PAYNE K 2008 Breast feeding
practices and views among diabetic women a retrospective cohort study Midwifery
24(4) pp 471-479
bull TOZIER P 2013 Colostrum Versus Formula Supplentation for Glucose Stabilization in
Newborns of Diabetic Mothers 42(JOGNN The association of Womens Health
Obstetric and Neonatal Nurses) pp 619-628
bull VAN HOWE RS and STORMS MR 2008 Blood glucose determinations in large for
gestational age infants American Journal of Perinatology 25(5) pp 283-289
bull WIGHT N MARINELLI KA and ACADEMY OF BREASTFEEDING MEDICINE
PROTOCOL COMMITTEE 2006 ABM clinical protocol 1 guidelines for glucose
monitoring and treatment of hypoglycemia in breastfed neonates Breastfeeding
medicine the official journal of the Academy of Breastfeeding Medicine 1(3) pp 178-
184
bull VANHALTREN K and MALHOTRA A 2013 Characteristics of infants at risk of
hypoglycaemia secondary to being infant of a diabetic mother Journal of pediatric
endocrinology amp metabolism JPEM 26(9-10) pp 861-865
bull WIGHT NE 2014 Hypoglycemia in breastfed neonates Breastfeeding medicine the
official journal of the Academy of Breastfeeding Medicine 9(4) pp 173-179
bull DALSGAARD B and ECK K 2013-last update Klinisk retningslinje for
nonfarmakologisk forebyggelse af neonatal hypoglycaeligmi og energitab hos nyfoslashdte af
moslashdre med diaeligtbehandlet gestationel diabetes Available
httpwwwkliniskeretningslinjerdkimages88_gdm_godkendt_010713pdf [0917 2014]
hypoglycaeligmibull
bull BRAGG JJ GREEN R and HOLZMAN IR 2013 Does early enteral feeding prevent
hypoglycemia in small for gestational age neonates Journal of neonatal-perinatal medicine 6(2)
pp 131-135
bull HARRIS DL WESTON PJ and HARDING JE 2014 Lactate rather than ketones may provide
alternative cerebral fuel in hypoglycaemic newborns Archives of disease in childhoodFetal and
neonatal edition
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull LANG TF and HUSSAIN K 2014 Pediatric hypoglycemia Advances in Clinical Chemistry 63
pp 211-245
bull MITANCHEZ D BURGUET A and SIMEONI U 2014 Infants born to mothers with gestational
diabetes mellitus mild neonatal effects a long-term threat to global health The Journal of pediatrics
164(3) pp 445-450
bull SUNDERCOMBE SL RAYNES-GREENOW CH TURNER RM and JEFFERY HE 2014 Do
neonatal hypoglycaemia guidelines in Australia and New Zealand facilitate breast feeding
Midwifery 30(12) pp 1179-1186
bull TAM EW HAEUSSLEIN LA BONIFACIO SL GLASS HC ROGERS EE JEREMY RJ
BARKOVICH AJ and FERRIERO DM 2012 Hypoglycemia is associated with increased risk for
brain injury and adverse neurodevelopmental outcome in neonates at risk for encephalopathy The
Journal of pediatrics 161(1) pp 88-93
bull UNICEF 2013 hypoglycaemia guidance july 2013 UNICEF
Kilder tilfoslashjet 2016
bull AGHDAS K TALAT K and SEPIDEH B 2014 Effect of immediate and continuous mother-infant
skin-to-skin contact on breastfeeding self-efficacy of primiparous women a randomised control trial
Women and birth journal of the Australian College of Midwives 27(1) pp 37-40
bull BEIRANVAND S VALIZADEH F HOSSEINABADI R and POURNIA Y 2014 The Effects of
Skin-to-Skin Contact on Temperature and Breastfeeding Successfulness in Full-Term Newborns
after Cesarean Delivery International journal of pediatrics 2014 pp 846486
bull FENGER-GRON J FENGER-GRON M BLUNCK CH SCHONEMANN-RIGEL H and
WIELANDT HB 2015 Low breastfeeding rates and body mass index in Danish children of women
with gestational diabetes mellitus International breastfeeding journal 10 pp 26-015-0051-8
eCollection 2015
bull JAGIELLO KP and AZULAY CHERTOK IR 2015 Womens Experiences With Early
Breastfeeding After Gestational Diabetes Journal of obstetric gynecologic and neonatal nursing
JOGNN NAACOG 44(4) pp 500-509
bull SAMAYAM P RANGANATHAN PK KOTARI UD and BALASUNDARAM R 2015 Study of
Asymptomatic Hypoglycemia in Full Term Exclusively Breastfed Neonates in First 48 Hours of Life
Journal of clinical and diagnostic research JCDR 9(9) pp SC07-10
bull SOBREVIA L SALSOSO R SAEZ T SANHUEZA C PARDO F and LEIVA A 2015 Insulin
therapy and fetoplacental vascular function in gestational diabetes mellitus Experimental physiology
100(3) pp 231-238
bull STEWART CE SAGE EL and REYNOLDS P 2015 Supporting Baby Friendly a quality
improvement initiative for the management of transitional neonatal hypoglycaemia Archives of
disease in childhoodFetal and neonatal edition
bull
hypoglycaeligmibull
bull BRAGG JJ GREEN R and HOLZMAN IR 2013 Does early enteral feeding prevent
hypoglycemia in small for gestational age neonates Journal of neonatal-perinatal medicine 6(2)
pp 131-135
bull HARRIS DL WESTON PJ and HARDING JE 2014 Lactate rather than ketones may provide
alternative cerebral fuel in hypoglycaemic newborns Archives of disease in childhoodFetal and
neonatal edition
bull HARRIS DL WESTON PJ and HARDING JE 2012 Incidence of neonatal hypoglycemia in
babies identified as at risk The Journal of pediatrics 161(5) pp 787-791
bull LANG TF and HUSSAIN K 2014 Pediatric hypoglycemia Advances in Clinical Chemistry 63
pp 211-245
bull MITANCHEZ D BURGUET A and SIMEONI U 2014 Infants born to mothers with gestational
diabetes mellitus mild neonatal effects a long-term threat to global health The Journal of pediatrics
164(3) pp 445-450
bull SUNDERCOMBE SL RAYNES-GREENOW CH TURNER RM and JEFFERY HE 2014 Do
neonatal hypoglycaemia guidelines in Australia and New Zealand facilitate breast feeding
Midwifery 30(12) pp 1179-1186
bull TAM EW HAEUSSLEIN LA BONIFACIO SL GLASS HC ROGERS EE JEREMY RJ
BARKOVICH AJ and FERRIERO DM 2012 Hypoglycemia is associated with increased risk for
brain injury and adverse neurodevelopmental outcome in neonates at risk for encephalopathy The
Journal of pediatrics 161(1) pp 88-93
bull UNICEF 2013 hypoglycaemia guidance july 2013 UNICEF
Kilder tilfoslashjet 2016
bull AGHDAS K TALAT K and SEPIDEH B 2014 Effect of immediate and continuous mother-infant
skin-to-skin contact on breastfeeding self-efficacy of primiparous women a randomised control trial
Women and birth journal of the Australian College of Midwives 27(1) pp 37-40
bull BEIRANVAND S VALIZADEH F HOSSEINABADI R and POURNIA Y 2014 The Effects of
Skin-to-Skin Contact on Temperature and Breastfeeding Successfulness in Full-Term Newborns
after Cesarean Delivery International journal of pediatrics 2014 pp 846486
bull FENGER-GRON J FENGER-GRON M BLUNCK CH SCHONEMANN-RIGEL H and
WIELANDT HB 2015 Low breastfeeding rates and body mass index in Danish children of women
with gestational diabetes mellitus International breastfeeding journal 10 pp 26-015-0051-8
eCollection 2015
bull JAGIELLO KP and AZULAY CHERTOK IR 2015 Womens Experiences With Early
Breastfeeding After Gestational Diabetes Journal of obstetric gynecologic and neonatal nursing
JOGNN NAACOG 44(4) pp 500-509
bull SAMAYAM P RANGANATHAN PK KOTARI UD and BALASUNDARAM R 2015 Study of
Asymptomatic Hypoglycemia in Full Term Exclusively Breastfed Neonates in First 48 Hours of Life
Journal of clinical and diagnostic research JCDR 9(9) pp SC07-10
bull SOBREVIA L SALSOSO R SAEZ T SANHUEZA C PARDO F and LEIVA A 2015 Insulin
therapy and fetoplacental vascular function in gestational diabetes mellitus Experimental physiology
100(3) pp 231-238
bull STEWART CE SAGE EL and REYNOLDS P 2015 Supporting Baby Friendly a quality
improvement initiative for the management of transitional neonatal hypoglycaemia Archives of
disease in childhoodFetal and neonatal edition
bull
Kilder tilfoslashjet 2016
bull AGHDAS K TALAT K and SEPIDEH B 2014 Effect of immediate and continuous mother-infant
skin-to-skin contact on breastfeeding self-efficacy of primiparous women a randomised control trial
Women and birth journal of the Australian College of Midwives 27(1) pp 37-40
bull BEIRANVAND S VALIZADEH F HOSSEINABADI R and POURNIA Y 2014 The Effects of
Skin-to-Skin Contact on Temperature and Breastfeeding Successfulness in Full-Term Newborns
after Cesarean Delivery International journal of pediatrics 2014 pp 846486
bull FENGER-GRON J FENGER-GRON M BLUNCK CH SCHONEMANN-RIGEL H and
WIELANDT HB 2015 Low breastfeeding rates and body mass index in Danish children of women
with gestational diabetes mellitus International breastfeeding journal 10 pp 26-015-0051-8
eCollection 2015
bull JAGIELLO KP and AZULAY CHERTOK IR 2015 Womens Experiences With Early
Breastfeeding After Gestational Diabetes Journal of obstetric gynecologic and neonatal nursing
JOGNN NAACOG 44(4) pp 500-509
bull SAMAYAM P RANGANATHAN PK KOTARI UD and BALASUNDARAM R 2015 Study of
Asymptomatic Hypoglycemia in Full Term Exclusively Breastfed Neonates in First 48 Hours of Life
Journal of clinical and diagnostic research JCDR 9(9) pp SC07-10
bull SOBREVIA L SALSOSO R SAEZ T SANHUEZA C PARDO F and LEIVA A 2015 Insulin
therapy and fetoplacental vascular function in gestational diabetes mellitus Experimental physiology
100(3) pp 231-238
bull STEWART CE SAGE EL and REYNOLDS P 2015 Supporting Baby Friendly a quality
improvement initiative for the management of transitional neonatal hypoglycaemia Archives of
disease in childhoodFetal and neonatal edition
bull
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