hypoglycemia in neonates

8/7/2019 Hypoglycemia in Neonates

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Neonatal Hypoglycemia



Definition

� Blood Sugar level less than 2.6 mmol/L



Glucose levels can drop if:

� There is too much insulin in the blood

(hyperinsulinism). Insulin is a hormone that pulls

glucose from the blood into the cells to be used

for energy.

� There is not enough glycogen, the form in which

glucose is stored in the body.

� The baby is not producing enough glucose.� The baby¶s body is using more glucose than is

being produced.



Hypoglycemia In Neonates

� Transient Hypoglycemia

� Decreased glycogen stores

� Recurrent and persistant hypoglycemia



Transient Hypoglycemia

� Sepsis

� Asphyxia

� Hypothermia� Polycythemia

� Infant of diabetic mother

� Insufficient glucose administration

� Shock



� Maternal drug usage- exp: terbutaline,

labetolol..

� Exchange transfusion� Large for gestational age infants



Decreased Glycogen Stores

� Intrauterine growth restriction / small for

gestational age

� Premature / Postmature infants� Caloric intake is insufficient



Recurrent and Persistant

Hypoglycemia� Hormone excess hyperinsulinism

� Hormone deficiencies

� Hereditary defects in carbohydratemetabolism

� Hereditary defects in amino acid

metabolism



Causes not to be missed

� Expired dextrostrix

� Patient kept NBM but no IVD/ IVD not up

to requirement� IV line not functioning well



Hypoglycemic babies may appear with

symptoms or without symptoms



Common symptoms of

Hypoglycemia� Jitterness

� Cyanosis

� Apnea

� Irregular respirations� Poor sucking or feeding

� Tremors

� Irritability

� Hypotonia� Exaggerated moro reflex

� Temperature instability



Rarely,

� Bradycardia / tachycardia

� Abnormal cry (high pitched cry)

� Tachypnea� Vomitting



How causes and symptoms of

hypoglycemia related



� Infusion rate of glucose is 4-6mg/kg/min and canbe increased up to 12-20mg/kg/min

� Breast feeding should be encourage wherepossible

� Milk Formula provides more energy/ml thanD10%



� Milk feed must not be discontinued or

reduced when on IVD unless NEC is

suspected

� In premature babies/ babies that required

fluid restriction, may increase

concentration of glucose before volume

increment.



Investigations

� DXT

� FBC- to evaluate sepsis and to rule out

polycythemia



Follow-up studies for persistant

Hypoglycemia

Blood

� Random Glucose

� Lactate/ Pyruvate

� Ketone Bodies

� FFA

� Aminoacids

� Insulin/ C-peptide� Cortisol/growth

� Hormone



Urine

� Ketones

� Reducing substance� Organic acids



Diagnostic Criteria For

Hyperinsulinism

� Glucose requirement >6-8mg/kg/min to maintainBS above 3mmol/L

� Random BS<2.6mmol/L

� Detectable insulin with raised C-peptide whenhypoglycaemia

� Low blood FFA and ketone body whenhypoglycemia

� Glycemis response after administration of glucagons when hypoglycaemia

� Absence of ketouria.



Complications of Hypoglycemia

� Cardiac failure

� Mental retardation

� Cerebral Oedema� Renal failure

hypoglycemia in neonates

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