Metabolic Disturbances

Of
Newborn

ASSIST. PROF. Dr. MOHAMMED A.

DARWEESH
Hypoglycemia

Hypocalcemia

Hypomagnesemia

Hyperthermia

Neonatal cold injury

 Hypoglycemia
• Blood glucose level is < 40 – 45 mg/dl.
Causes:
1. IDM.
2. Preterm baby, small for gestational age and IUGR.
3. Severs illnesses that interfere with feeding e.g.
sepsis, meningitis, pneumonia, heart failure and
severe RDS.
4. Metabolic disorders.
 Clinical manifestations
and
Management of hypoglycemia

• As discussed in the previous lecture

 Hypocalcemia

• is a total serum calcium concentration:

< 8 mg/dL (< 2 mmol/L) in term infants or
< 7 mg/dL (< 1.75 mmol/L) in preterm infants.
• It is also defined as an ionized calcium level
< 3.0 mg/dL

Normal serum calcium (9-11 mg./dl)

• Early onset (in the first 2 days of life).
Causes:
( preterm, SGA, IDM, Perinatal asphyxia and congenital
hypoparathyroidism).

• Late onset (> 3 days), which is rare

The cause is usually ingestion of cow’s milk or formula
with a too-high phosphate load; elevated serum
phosphate leads to hypocalcemia.
 Hypocalcemia
• Found In 22% of IDM
• The nadir 24-72 hrs
• Symptomatic hypocalcemia occurs
when the S.Ca++ below 7 mg/dl
• Signs and symptoms include: hypotonia, tachypnea,
apnea, poor feeding, jitteriness, tetany, and seizures
• In well babies (asymptomatic)
resolves without treatment
• Treatment may be necessary : unable to feed ,
symptomatic , has a coexisting illness.
 Treatment :
Emergency treatment of neonatal tetany consists of IV
injections of 2 ml/kg of a 10% solution of calcium gluconate
(200 mg non elemental/kg = 18.6 mg elemental /kg) at the rate
of 0.5-1 mL/min while the heart rate is monitored.

Additionally, 1,25-cholecalciferol (calcitriol) should be given.

initial dosage is 0.25 µg/24 hr;
maintenance dosage 0.01-0.10 µg/kg/24 hr (max.1-2 µg/24 hr.)
Calcitriol has a short half-life and should be given in 2 equal
divided doses.
 Hypomagnesemia
Causes:
• Idiopathic in newborn infants,
• Association with hypocalcemia.
• Decreased intestinal absorption,
• Neonatal hypoparathyroidism,
• Hyperphosphatemia,
• Renal loss (primary or secondary to drugs,e.g.,amphotericin B)
• Iatrogenic deficiency caused by loss during exchange transfusion
or insufficient replacement during total intravenous alimentation.

Infants of diabetic mothers may have lower than normal

serum magnesium levels.
 clinical manifestations
• are indistinguishable from those of hypocalcemia and
tetany may contribute to the accompanying hypocalcemia
• Hypomagnesemia occurs when serum magnesium levels fall
below 1.5 mg/dL (0.62 mmol/L), although clinical signs do
not usually develop until serum magnesium levels fall
below 1.2 mg/dL.
• Because the hypocalcemia accompanying hypomagnesemia
is inadequately corrected by administration of calcium
alone, hypomagnesemia should also be suspected in any
patient with tetany not responding to calcium therapy
Treatment
 IMinjection of magnesium sulfate.
25-50 mg/kg/dose every 8 hr for 3-4 doses
usually suffices.
The accompanying hypocalcemia usually corrects itself as the
hypomagnesemia resolves.

• The same daily dose can be given for oral maintenance

therapy.
• In most cases, the metabolic defect is transient, and treatment
can be discontinued after 1-2 wk.
• A few patients appear to have a permanent form of the
disease that requires continuous oral supplementation with
magnesium to prevent recurrence of hypomagnesemia.
 Hyperthermia In The Newborn
• Elevation in temperature (38–39°C) is occasionally
noted on the 2nd–3rd day of life. This disturbance is
likely to occur in breast-fed infants whose intake of
fluid is low or in infants who are overdressed or are
exposed to high environmental temperatures.

• The skin is hot and dry, and initially the infant usually
appears flushed and apathetic. Tachypnea and
irritability may be noted. This stage may be followed
by stupor, grayish pallor, coma, and convulsions.
 Management:
• The condition is prevented by suitable dressing of infants
according to the environmental temperature.

• Administering oral or parenteral fluids or lowering the

environmental temperature leads to reduction of the fever and
alleviation of symptoms. Oral hydration should be with
additional nursing or formula and not with pure water, due to
the risk of hyponatremia.

• Older infants may require cooling for a longer time by repeated

immersion or by the use of a water-cooled mattress or other
apparatus for induction of hypothermia.
 Neonatal Cold Injury
• usually occurs in infants in inadequately heated homes
during cold spells.
• The initial features are apathy, refusal of food, oliguria,
and coldness to touch.
• The extremities are red, immobile, and edematous.
• Local hardening over areas of edema may lead to
confusion with scleredema.
• Bradycardia and apnea may occur.
• Rhinitis is common, as are hypoglycemia and acidosis.
• Hemorrhagic manifestations are frequent; massive
pulmonary hemorrhage is a common finding at autopsy
Management:
• Treatment consists of warming and
recognizing and correcting hypotension and
metabolic imbalances, particularly
hypoglycemia.
• Prevention consists of providing adequate
environmental heat.
• The mortality rate is about 10%; about 10%
of survivors have evidence of brain damage.
Thank you