Neonatal Hypoglycemia

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Neonatal Hypoglycemia

• Stan Jack, D.O.
• Saint Joseph Hospital Family Practice Residency

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Neonatal Hypoglycemia - Significance

• Persistent or recurrent hypoglycemia can result
  in impaired neurologic development and
  intellectual function
• Other sequela include spasticity, ataxia, and
  seizure disorder

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Neonatal Hypoglycemia - Definition

• Plasma glucose lt40 mg/dL on the first day of life
• Plasma glucose lt40-50 mg/dL after 24 hours of age
• Note whole blood glucose 15 lower than plasma
  glucose measurements

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Neonatal Hypoglycemia - Pathogenesis

• Glucose in utero comes from mother
• After cord cut, glucose in newborn falls during
  first 2 hours, stabilizing by 4-6 hrs (transition
  period)
• Dependent on glycogen storage depletion and
  carbohydrate intake

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Neonatal Hypoglycemia - Causes

• Diminished glucose production (premature, IUGR)
• Increased glucose utilization secondary to
  hyperinsulinism (infants of diabetic mothers,
  Beckwith-Weidmann, erythroblastosis, perinatal
  asphyxia)
• Maternal tx with beta blockers
• Sepsis

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Neonatal Hypoglycemia - Causes (continued)

• Polycythemia
• Metabolic disorders (inborn errors of
  carbohydrate / amino acid metabolism)
• Endocrine disorders (low levels of cortisol,
  growth hormone, epinephrine, or glucagon)
• Heart failure

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Neonatal Hypoglycemia - Clinical Manifestations

• Frequently asymptomatic
• Jittery, tremulous
• Decreased tone
• Irritable or lethargic seizures
• Apnea, bradycardia, cyanosis, tachypnea
• Poor feeding

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Neonatal Hypoglycemia - Screening

• Not routinely monitored unless at risk for
  hypoglycemia (next slide)
• If screening done, obtain sample before feedings

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Neonatal Hypoglycemia - Risk Factors

• Prematurity
• Small or large for gestational age
• Infants of diabetic mothers
• ICU infants (i.e. sepsis)
• Infants of mothers treated with beta blockers

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Neonatal Hypoglycemia - Management

• If lower than 40 mg/dL, surveillance until
  feedings well established and glucose normal
• If asymptomatic and term, obtain blood sample and
  immediately offer breast or formula feeding
  (consider gavage) recheck 20-30 minutes after
  feeding

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Neonatal Hypoglycemia - Management (continued)

• If symptomatic OR not tolerating enteral feeds OR
  plasma glucose lt20-25 OR if persistently lt40 even
  after feeds, start parenteral glucose
• Bolus 200 mg/kg (2 ml/kg 10 dextrose in H2O)
  over 1 minute followed by glucose infusion of 8
  mg/kg per minute
• If requirements high (gt12.5) may need central
  venous catheter

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Neonatal Hypoglycemia - Summary

• Prolonged hypoglycemia may result in long-term
  morbidity
• May be asymptomatic
• Screening is based on risk factors

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Neonatal Hypoglycemia - Summary (continued)

• If asymptomatic and glucose is moderately low,
  begin with feeding and surveillance
• Symtomatic infants with very low glucose levels
  will need parenteral replacement
• Do not hesitate to run things by your upper
  level, attending, or the neonatologist