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Neonatal hypoglycaemia (Clinical presentation (Asymptomatic, Jittery,…
Neonatal hypoglycaemia
Definition
Neonatal blood
glucose <2.6mmol/L
Pathophysiology
Reduced neonatal stores of glucose
e.g. IUGR/LBW, inborn errors of metabolism
Increased glucose consumption e.g.
sepsis, hypothermia, hypoxia, polycythemia,
haemolytic disease, seizures
High insulin levels e.g. maternal DM,
pancreatic cell hyperplasia
Aetiology
Developmental
IUGR
LBW
Preterm
Genetic
Inborn errors of metabolism
Infection
Sepsis
Metabolic
Hypothermia
Hypoxia
Maternal DM
Pancreatic cell hyperplasia
Haematological
Haemolytic disease
Drugs
Maternal B-blockers
Foetal alcohol syndrome
Endocrine
Pituitary/adrenal insufficency
Idiopathic
Seizures
Clinical
presentation
Asymptomatic
Jittery
Apnoea
Poor feeding
Drowsiness
Irritable
Hypotonia
Seizures
Coma
Diagnosis
Examination
Investigations
Bedside
Observations
BM (glucose levels)
Bloods
FBC, U+E, LFTs
glucose, FFAs, amino acids, lactate, ammonia, C-peptide
Hormones (insulin, GH, cortisol, B-hydroxybbutyrate)
Urine
Dipstick (glucose, ketones, infection)
History
Management
Medical
IV glucose
Indication: symptomatic/severe hypo (<1mmol/L)
E.g. glucose 10% IV per weight/hr
MOA: replenishes serum glucose
SEs: electrolyte disturbances (monitor U+Es)
Enteral feeding
Indication: asymptomatic infants (2.0-2.6mmol/L)
E.g. enteral milk, NG feed (not tolerating milk)
Glucagon
Indication: emergency, resistant hypo
E.g. glucagon 0.5mg IM
Surgical
Subtotal pancreatectomy
Indication: resistant hypoglycaemia
due to pancreatic disease
MOA: remove part of pancreas, reduced B-cell bulk,
thus reduced insulin production
Conservative
BM monitoring in high risk infants