HYPOGLYCEMIA/ HYPERGLYCEMIA

IN THE NEONATE

What is the definition of a neonate?

The first 30 days of an infants life or

A premature infant that has not been discharged since being born

Hypoglycemia:

•What is it?•Blood sugar <40-50 mg/dl

•Depends on reference•Bedside testing

•Fairly accurate•F/U with serum glucose

•Higher than bedside test•Not accurate if not run quickly

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HYPOGLYCEMIA

Who is at risk? And why?

oInfant of diabetic motheroHyperinsulinemia

oPremature infantoDecreased glycogen stores

oSGA/LGA infantoHyperinsulinemia

oStressed or Sick infantoUsing their glucose quickly

Signs & Symptoms:

Jitteriness, Irritability, Hypotonia, Lethargy, Hypothermia, Respiratory distress, Seizures.. Or there may be NONE.

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Management of Low Blood Sugar

For the term baby in no sign of distress:

Early feeding – usually with formula or breastfeeding

Follow-up blood sugar 30 min to 1 hour after feeding

Continue to monitor blood sugar according to hospital policy

For a term baby in distress:

Management will be with IV fluids or gavage feeding depending on symptoms

For a preterm baby:

IVF – D10W (initial fluids)

IV Bolus of 2 ml/kg of D10W

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Hyperglycemia:

Blood sugar < 200 mg/dl

Causes: Stress

Will usually resolve with time

PrematurityMay need lower sugar concentration in IVFMay need insulin

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Things to remember:

HYPOGLYCEMIA:

• Blood sugar < 45 mg/dl

•At risk: IDM, SGA, LGA, Prematurity,

Stress

•TX: early feedings, IVF, monitor closely

HYPERGLYCEMIA:

• Blood sugar > 200 mg/dl

•Causes: stress, severe prematurity

•TX: usually self resolves; except in

severe preemie

DIABETES in the NEONATE is RARE

EDUCATION/ PREVENTION:

•Identify at risk patients – type I, type II, and gestational diabetic moms

•Educate mom about potential risks to fetus/ newborn

•Educate mom on importance of maintaining good glucose control during pregnancy

•Early recognition of at risk infants

•Early feedings for at risk infants

•Ongoing communication with the family regarding infants status

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One last important note: PAIN MANAGEMENT•Heel stick = HURTS

•IV insertion = HURTS

•Babies feel pain!

•Babies remember pain!

•Baby a patient advocate and provide appropriate pain management!

Swaddling, decreased light, sucrose pacifier, holding – to name a few.

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PAIN MANAGEMENT:

Sucrose Pacifier

Dim the lights

Swaddle the baby