NEONATAL HYPOGLYCAEMIA

Introductory question
Define Hypoglycemia in newborns
Serum glucose < 40 mg/dl (2.2 mmol/L) in symptomatic term neonates
In the first 24 to 48 hours of life
Or < 30mg/dl (1.7 mmol/L) in preterm neonates in the first 48 hours of life

Focused question
Etiology of hypoglycemia

1-Transient neonatal hypoglycemia

Causes of transient hypoglycemia are

 Inadequate substrate (eg, glycogen)

 Immature enzyme function leading to deficient glycogen stores
 Transient hyperinsulinism

2-Persistent neonatal hypoglycemia

 Hyperinsulinism
 Defective counter-regulatory hormone release (growth hormone,
corticosteroids, glucagon, catecholamines)
 Inherited disorders of metabolism (eg, glycogen storage
diseases, disorders of gluconeogenesis, fatty acid oxidation disorders)
Competence question
Treatment of Neonatal hypoglycaemia
Most high-risk neonates are treated preventively. For example, infants of diabetic
women who have been using insulin are often started at birth on a 10% D/W
infusion IV or given oral glucose,
Any neonate whose glucose falls to ≤ 50 mg/dL (≤ 2.75 mmol/L) should begin
prompt treatment with enteral feeding or with an IV infusion of up to 12.5%
D/W, 2 mL/kg over 10 minutes; higher concentrations of dextrose can be infused
if necessary through a central catheter. The infusion should then continue at a rate
that provides 4 to 8 mg/kg/minute of glucose (ie, 10% D/W at about 2.5 to 5
mL/kg/hour). Serum glucose levels must be monitored to guide adjustments in
the infusion rate. Once the neonate’s condition has improved, enteral feedings
can gradually replace the IV infusion while the glucose concentration continues
to be monitored. IV dextrose infusion should always be tapered, because sudden
discontinuation can cause hypoglycemia.
If starting an IV infusion promptly in a hypoglycemic neonate is
difficult, glucagon 100 to 300 mcg/kg IM (maximum, 1 mg) usually raises the
serum glucose rapidly, an effect that lasts 2 to 3 hours, except in neonates with
depleted glycogen stores

Hypoglycemia refractory to high rates of glucose infusion may be treated

with hydrocortisone 12.5 mg/m2 every 6 hours

If hypoglycemia is refractory to treatment, other causes (eg, sepsis) and possibly

an endocrine evaluation for persistent hyperinsulinism and disorders of defective
gluconeogenesis or glycogenolysis should be considered
Escape question

Do you think you have to treat asymptomatic hypoglycemia in newborn?