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A CASE
DISCUSSION OF
NEONATAL
HYPOGLYCEMIA

BY: KHAIRAH BINTI MOHD KHALID

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CASE STUDY
B/O Su
DOB 19/08/2018 at 1815 H
Born Term at 37 weeks via EMLSCS
(Indication : Breech & abn CTG)

AS : 9195
BW 3.6 kg
G6PD : Normal
Mother ABO : AB Positive
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MOTHER ANTENATAL &
SHORT FAMILY HISTORY
Mother antenatally :
1. GDM on insulin total 68 u
2. Maternal obesity (BMI 30)
3. PIH on T Methyldopa 50mg TDS
4. No risk of sepsis
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Referred by O & G team to standby at OTA for suspicious CTG
& breech in labour

Baby born vigorous, good tone, good cry with AS 9195

Indirect suction : Clear

Admitted SCN for infant of Mother GDM on Insulin

Total 68u
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EXAMINATION
Alert, moving 4 limb, active on handling, AFNT, not tachypnic,
CRT < 2sec, no jitteriness, pink, warm peripheries , no high
pitch cry, not dysmorphic

Vital signs

Birth weight : 3.6 kg

HR : 154 bpm
Length :
T : 35.8’c
SPO2: 100% under RA Head circumference :

Pain score :
+ HEAD AFNT
No swelling
EYE & EARS Normal
Red reflex present
MOUTH No cleft lips or palate

CHEST Symmetrical chest movement

Equal air entry
S1, S2
HEART No murmur
Bilateral femoral pulses palpable
Apex beat not displaced
Soft. Not distended
ABDOMEN No hepatosplenomegaly
Umbilicus : 2A 1V
GENITALIA & ANUS Normal female genitalia
Anus patent
HIPS & LIMB Hip stable
No CTEV / DDH
REFLEXES Moro : Complete
Suckling : Good
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Progression in Nursery
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GM TREND
19/8/2018
7pm 1.6 Bolus 7.5cc
8pm 7.1
9pm 1.8 Bolus 7.5cc + NBM
10pm-7am 3.7-4.2 NBM + IVD D12.5%
20/8/2018
8am 3.9
10am 2.4 Bolus 11cc STAT &
Increased dextrosity to D15%
12-5pm 3.7-5.0
6pm 2.7 Start IV Glucagon + IVD 1/5NS D15%
8pm -12am 4.3-7.6
21/8/2018

22/8/2018
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IMPRESSION

1. INFANT OF MOTHER GDM ON INSULIN

(TOTAL 68 U)

2. RECURRENT HYPOGLYCEMIA SECONDARY TO

HYPERINSULINISM
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LABORATORY INVESTIGATION
FBC
HB 15.5
TWDC 15.5
Platelet 312
HCT 49.2
Renal Profile
CRP <0.12
Urea 3.1
Sodium 134 RBS 0.4
Potassium 4.7
Chloride 105
Creatinine 47
Liver Function Test

Total bilirubin 166

Direct bilirubin 13
Indirect bilirubin 153.4
TP/ALP 49/203
Alb/Glob 33/16
ALT 16
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CRITICAL SAMPLING (20/8/2018)
Serum Cortisol 619.4
Insulin Pending
Growth hormone Pending
Ketone Pending
Organic Acid Pending

BLOOD C+S (20/8/2018) Negative

URINE BIOCHEMISTRY
pH 5
SG 1.006
Leucocytes, Nitrite, Protein Negative
Glucose, Ketone, Urobilinogen Negative
Bilirubin, RBC Mnegative
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UPON DISCHARGE
GM stable
No more hypoglycemic episode
Tolerating full feeding (TF165cc/kg/day)
No vomiting
No fever
Hemodynamically stable

O/E: Alert, active on handling, AFNT, not tachypnic, CRT <2 sec, no jitteriness

Lung: Equal air entry

CVS : No murmur heard
Abd : Soft, not distended
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PLAN UPON DISCHARGE
(25/8/2018)

1. Allow discharge today

2. TCA Paeds Clinic in 2/12 – To review pending

investigations & follow up for growth & development