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Complications Of Hyperglycemia In Neonates

Neonatal Hyperglycemia After Acetazolamide Therapy For Hydrocephalus In Extremely Low Birth Weight Infants

Neonatal Hyperglycemia After Acetazolamide Therapy For Hydrocephalus In Extremely Low Birth Weight Infants

Affiliations: Department of Pediatrics, Pediatric Neurology UNIT, Mansoura University, Mansoura, Egypt | Department of Endocrinology, Elazhar University, Cairo, Egypt Note: [] Correspondence: Dr. Riad Elsayed, Department of Pediatric, Pediatric Neurology UNIT, Mansoura University, Mansoura, Egypt, P.O. Box 282, Dammam 31411, Saudia Arbia. Tel.: +966 535731101; Fax: +966 3 8203436; E-mail: [email protected] Abstract: Hyperglycemia is a common complication of extremely low birth weight infants (ELBW) which may have an impact upon their morbidity and mortality. Hyperglycemia in ELBW can occurred as result of many factors. We report a rare case of hyperglycemia in an ELBW infant after administration of a carbonic anhydrase inhibitor (acetazolamide), used for temporary management of posthemorrhagic hydrocephalus, our case was seen in one of the private hospital at Dammam city, Saudi Arabia. Keywords: Neonatal hyperglycemia, acetazolamide, hydrocephalus, ELBW Continue reading >>

Neonatal Hypoglycemia And Hyperglycemia

Neonatal Hypoglycemia And Hyperglycemia

Introduction Brief introduction of neonatal hypoglycemia and hyperglycemia Neonatal hypoglycemia and hyperglycemia: impaired glucose metabolism in the neonatal period is very common. Because of the difference between the blood samples and the glucose method in the blood, the definition of neonatal hypoglycemia is more chaotic. Most of the scholars' hypothesis is hypoglycemia: full blood glucose <1.67mmol / L (30mg / (20mg / dl) within 3 days after birth, <2.2mmol / L (40mg / dl) after I weeks; current trend Whole blood glucose <2.2mmol> 7.0mmol / L (125mg / dl), or plasma sugar> 8.12 ~ 8.40mmol / L (145 ~ 150mg / dl). basic knowledge Medicare disease: No Prevalence ratio: 0.00652% Susceptible people: newborns Infection: no infectious Complications: coma pediatric cerebral palsy mental retardation Treatment of common sense Departments: Newborn Pediatric Science Treatment: drug treatment supportive treatment Treatment cycle: 1-2 weeks Cure rate: 85% Commonly used drugs: insulin injection Tips Hypoglycemia neurological damage to the prognosis of brain injury is not good, low blood sugar damage to the brain tissue depends on the severity and duration of hypoglycemia, most authors believe that the prognosis of symptomatic hypoglycemia is poor, but asymptomatic hypoglycemia duration Long, can also lead to central nervous system injury. Etiology Neonatal hypoglycemia and hyperglycemia etiology Sugar and fat storage (30%): Fetal liver glycogen storage occurs mainly in the last 4 to 8 weeks of gestational age, fetal brown fat from the gestational age of 26 to 30 weeks, has been extended to 2 to 3 weeks after birth. On the one hand, low birth weight children, including premature infants and less than gestational age (SGA) children with low glycogen and fat storage, on the other h Continue reading >>

Neonatal Diabetes

Neonatal Diabetes

Tweet Neonatal diabetes is a rare form of diabetes that is usually diagnosed in children under 6 months of age. This early occurring type of diabetes is caused by one of a number of genetic mutations and is therefore described as a monogenic form of diabetes. Neonatal diabetes is treatable and may or may not require insulin so a diagnosis by genetic testing is recommended. Types of neonatal diabetes There are two main types of neonatal diabetes: Transient Neonatal Diabetes Mellitus Permanent Neonatal Diabetes Mellitus Transient neonatal diabetes is so called because it usually disappears within a year of birth but can come back again typically during adolescence. Permanent neonatal diabetes, once diagnosed, stays for the rest of life. How common is neonatal diabetes? Neonatal diabetes is very rare, occurring in around 1 in 300,000 to 1 in 400,000 births. Out of the two types of neonatal diabetes, the transient type is slightly more common affecting 50-60% of cases of neonatal diabetes. [105] Symptoms and diagnosis The symptoms of neonatal diabetes include persistent thirst, frequent urination and dehydration. [103] Tweet Type 2 diabetes mellitus is a metabolic disorder that results in hyperglycemia (high blood glucose levels) due to the body: Being ineffective at using the insulin it has produced; also known as insulin resistance and/or Being unable to produce enough insulin Type 2 diabetes is characterised by the body being unable to metabolise glucose (a simple sugar). This leads to high levels of blood glucose which over time may damage the organs of the body. From this, it can be understood that for someone with diabetes something that is food for ordinary people can become a sort of metabolic poison. This is why people with diabetes are advised to avoid sources of Continue reading >>

Newborn Services Clinical Guideline

Newborn Services Clinical Guideline

Note: The electronic version of this guideline is the version currently in use. The general disclaimer regarding use of Newborn Services Guidelines and Protocols applies to this guideline. Immaturity of pancreatic function Insulin resistance Large dextrose load Stress e.g. infection Side-effect of medication e.g. glucocorticoid therapy Associated with periventricular haemorrhage, retinopathy of prematurity and death Undernutrition leading to faltering growth Osmotic diuresis leading to dehydration Exacerbation of hypoxic ischaemic brain injury Reduce dextrose intake For babies in the first 72 hours of life, or who are receiving a large volume of intravenous fluids, consider changing 10% dextrose to 5% dextrose Insulin Criteria for insulin use: Persistent blood glucose concentration ≥ 10 mmol/L (If there is significant glycosuria ≥ 2+, check a blood glucose concentration) Criteria for insulin use Persistent blood glucose concentration ≥ 10 mmol/L (If there is significant glycosuria ≥ 2+, check a blood glucose concentration) Exceptions to Insulin Use First 72 hours of life Acute transient stress e.g. post surgery, acute sepsis etc. Administer in same line as intravenous fluids, so if there are any interruptions, both are interrupted together Starting dose usually 0.05 units/kg/hr, then adjusted according to requirements Do not include insulin in the total daily fluid intake - it should be titrated on top of the prescribed fluid intake Monitor the blood glucose concentration, initially 2 hourly, and once stable at least 8 hourly Aim for a blood glucose concentration between 6 and 10 mmol/L Once the blood glucose concentration is stable within the target range, wean insulin dose at least daily, more often if tolerated 1 Alsweiler JM, Harding JE, Bloomfield FH. Tight Continue reading >>

Fetal Complications Of Gdm

Fetal Complications Of Gdm

Untreated, moderate or severe gestational diabetes mellitus (GDM) increases the risk of fetal and neonatal complications, and the risk of congenital malformations is slightly increased in infants of mothers with GDM compared to the general population. Maternal obesity increases the risk of gestational diabetes and is an independent risk factor for perinatal complications. There is a positive correlation between maternal blood glucose levels and increased birth weight, and the risk of macrosomia can be reduced by treating glucose levels during pregnancy. Introduction Gestational diabetes is associated with an increased risk of macrosomia, perinatal complications, and a small increase in the risk of congenital malformations. Maternal obesity is often associated with GDM and is in itself an independent risk factor for perinatal complications, and macrosomia is the main factor linked to perinatal complications in GDM. Untreated moderate or severe GDM increases the risk of fetal and neonatal complications. Congenital malformations The risk of congenital malformations is slightly increased in infants of mothers with GDM compared to the general population. GDM comprises two type of diabetes: (1) diabetes strictly related to pregnancy with no increased risk of congenital malformations, and (2) diabetes diagnosed during pregnancy but preexisting before pregnancy with similar risk of congenital malformations to that of preexisting diabetes (3-7%). Thus, increased risk is of congenital malformations is associated with the presence of undiagnosed type 2 diabetes among women with GDM [1]. A relationship exists between the risk of congenital malformations, maternal blood glucose levels, gestational age at diagnosis of diabetes and maternal obesity, all of which are found in type 2 di Continue reading >>

Neonatal Hypoglycemia

Neonatal Hypoglycemia

Neonatal hypoglycemia is a transient or temporary condition of decreased blood sugar or hypoglycemia in a neonate.[1][2] Mechanism and pathophysiology[edit] Temporary hypoglycemia in the first three hours after birth is a normal finding. Most of the time it resolves without medical intervention. The lowest blood sugars occur one to two hours after birth. After this time, lactose begins to be available through the breast milk. In addition, gluconeogenesis occurs when the kidneys and liver convert fats into glucose..[3] Risk[edit] Those infants that have an increased risk of developing hypoglycemia shortly after birth are: preterm asphyxia cold stress congestive heart failure sepsis Rh disease discordant twin erythroblastosis fetalis polycythemia microphallus or midline defect respiratory disease maternal glucose IV maternal epidural postmaturity hyperinssulinnemia endocrine disorders inborn errors of metabolism diabetic mother maternal toxemia intrapartum fever[4] Treatment[edit] Some infants are treated with 40% dextrose (a form of sugar) gel applied directly to the infant's mouth.[5] See also[edit] Congenital hyperinsulinism Hyperinsulinemic hypoglycemia [edit] Bibliography[edit] Walker, Marsha (2011). Breastfeeding management for the clinician : using the evidence. Sudbury, Mass: Jones and Bartlett Publishers. ISBN 9780763766511. External links[edit] Hypoglycemia in the Newborn, Lucile Packard Children’s Hospital Continue reading >>

Review Of Newborn Implications

Review Of Newborn Implications

Jamie Haushalter, CPNP-PC Newborn Nursery Emily Freeman, CPNP-PC Newborn Nursery Purpose and Objectives Review pathophysiology of diabetes in pregnancy and implications for the newborn Apply “Up to Date†Information to practice. The learner will be able to Identify at least 3 neonatal complications associated with being an infant of a diabetic mother. Explain the pathophysiology of increased incidence of respiratory distress in the IDM infant. Types of Diabetes Preconception Diabetes Type 1 or Type II Diabetes 1.8 percent prevalence Usually diagnosed if fasting glucose ≥92 or random glucose ≥200. Hgb A1C ≥6.5% Gestational Diabetes Diabetes first diagnosed during pregnancy. 2-25% prevalence Glucose tolerance test btw 24-28wks 1hr (50g): ≥130 with 99% sensitivity and 77% specificity 1hr (50g): ≥140 with 85% sensitivity and 86% specificity Gestational Diabetes: Classifications The White Classification system is used to differentiate between gestational diabetes and diabetes that existed prior to pregnancy. Gestational diabetes is class A with the following subclassifications: A1GDM: diet controlled A2GDM: medication controlled with insulin versus oral anti-hyperglycemic agents Insulin is recommended therapy, as oral anti-hyperglycemics are not approved for treatment of GDM, however they are often used. Oral anti-hyperglycemic agents that are sometimes used: Glyburide: studies have not shown an increased risk of excessive neonatal hypoglycemia with this medication. Metformin: Often provides less control of maternal blood sugars than insulin or glyburide. Maternal Diabetes Results in Fetal Complications….WHY? In first trimester, hyperglycemia can lead to SAB or birth defects, more commonly in pregestational diabetes. In the 2nd a Continue reading >>

Fluid And Electrolyte Management In The Very Low Birth Weight Neonate

Fluid And Electrolyte Management In The Very Low Birth Weight Neonate

Fluid and electrolyte management in the very low birth weight infant is critical to survival. The amount of fluid present in the plasma, interstitial fluid, and cellular fluid changes throughout the fetal and neonatal period, presenting a challenging situation. One of the many factors influencing fluid requirements is the insensible water loss by mechanisms such as evaporation. Low birth weight infants are especially susceptible to this due to their large body surface area and immature skin, often resulting in hypernatremia and the complications associated with it. However, some infants may experience hyperkalemia, hyperglycemia, and/or hyponatremia, resulting in various other complications. Careful monitoring is essential in deciding how to manage these infants. This article aims to discuss the management of fluid and electrolytes in very low birth weight infants and address ways to decrease the morbidity and mortality associated with the imbalances in fluid and electrolytes seen in this population. Fluid and electrolyte management of critically ill infants continues to be a challenge in intensive care. The problem is further compounded in the very low birth weight infant, where appropriate fluid management is critical in preventing morbidity and mortality, but requirements become difficult to ascertain. Fluid in the fetus and neonate is distributed among three main compartments: plasma, interstitial fluid, and cellular fluid. The amount of fluid in each of these compartments based on body weight, changes from the fetal to neonatal period, and continues to change throughout the neonatal period. In the early fetal period, approximately 95% of the fetus is water, with the proportion gradually decreasing during gestation to about 80% at 8 months of gestation, and 75% at t Continue reading >>

Hyperglycemia - Infants

Hyperglycemia - Infants

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Hypoglycemia In The Newborn

Hypoglycemia In The Newborn

What is hypoglycemia in the newborn? Hypoglycemia is a condition in which the amount of blood glucose (sugar) in the blood is lower than normal (under 50 mg/dL). Who is affected by hypoglycemia in the newborn? Babies who are more likely to develop hypoglycemia include: Babies born to diabetic mothers may develop hypoglycemia after delivery when the source of glucose (via the umbilical cord) is gone and the baby's insulin production metabolizes the existing glucose. Small for gestational age or growth-restricted babies may have too few glycogen stores. Premature babies, especially those with low birthweights, who often have limited glycogen stores (sugar stored in the liver) or an immature liver function. Babies born under significant stress. Babies who experience temperature instability (for instance, get cold) or when mothers were treated with certain drugs (for instance, terbutaline) Infants of diabetic mothers Babies who are large for their gestational age. This is associated with gestational diabetes, but also with forms of congenital hyperinsulinism What causes hypoglycemia in the newborn? Hypoglycemia may be caused by conditions that: Lower the amount of glucose in the bloodstream. Prevent or lessen storage of glucose. Use up glycogen stores (sugar stored in the liver). Inhibit the use of glucose by the body. Many different conditions may be associated with hypoglycemia in the newborn, including the following: Inadequate maternal nutrition in pregnancy Excess insulin produced in a baby of a diabetic mother Severe hemolytic disease of the newborn (incompatibility of blood types of mother and baby) Birth defects and congenital metabolic diseases Birth asphyxia Cold stress (conditions that are too cold) Liver disease Infection Why is hypoglycemia in the newborn a con Continue reading >>

Glucose And Heart Surgery: Neonates Are Not Just Small Adults

Glucose And Heart Surgery: Neonates Are Not Just Small Adults

DESPITE the many advances in cardiac surgery, neurologic complications continue to be recognized postoperatively. Cognitive deficits appear in about one-half of adults after coronary artery bypass grafting and in as many as one-third of children after neonatal heart surgery. 1,2 Preoperative, intraoperative, and postoperative episodes of hypoxia-ischemia all seem to contribute to these complications. Hyperglycemia has been shown to worsen neurologic injury in adult ischemia models. 3 Given the risk of ischemic neurologic injury in neonatal heart surgery and the role of hyperglycemia in ischemic brain injury in adults, de Ferranti et al. 's examination of the relationship of blood glucose to neurologic outcome after neonatal heart surgery, published in this issue of the Journal, addresses an important and timely question. 4 To appreciate the distinction between neonates and adults, it is useful to briefly review their differences in whole body and brain glucose metabolism. During development, brain metabolism changes markedly. Glucose crosses the blood-brain barrier through transporter proteins (GLUT1), and then enters the cell through a second glucose transporter system (GLUT3). Glycolysis then begins with the phosphorylation of glucose by hexokinase I. GLUT3 and hexokinase I increase fivefold from neonate to adult as cerebral metabolic rate increases. 5 The developmental increase in cerebral glucose metabolic rate corresponds with an increase in synaptic activity, synaptogenesis, and myelination of specific brain regions. Cerebral glucose metabolism yields adenosine triphosphate, which provides energy to maintain ion gradients, support synaptic activity, and preserve cellular homeostasis. Unlike the adult brain, the neonatal brain is able to metabolize ketone bodies (a Continue reading >>

Prediction Of Hyperglycemia In Preterm Newborn Infants

Prediction Of Hyperglycemia In Preterm Newborn Infants

ORIGINAL ARTICLES Mário Cícero Falcão and José Lauro Araújo Ramos RHCFAP/2952 SUMMARY: Many conditions are associated with hyperglycemia in preterm neonates because they are very susceptible to changes in carbohydrate homeostasis. The purpose of this study was to evaluate the occurrence of hyperglycemia in preterm infants undergoing glucose infusion during the first week of life, and to enumerate the main variables predictive of hyperglycemia. This prospective study (during 1994) included 40 preterm neonates (gestational age <37 weeks); 511 determinations of glycemic status were made in these infants (average 12.8/infant), classified by gestational age, birth weight, glucose infusion rate and clinical status at the time of determination (based on clinical and laboratory parameters). The clinical status was classified as stable or unstable, as an indication of the stability or instability of the mechanisms governing glucose homeostasis at the time of determination of blood glucose; 59 episodes of hyperglycemia (11.5%) were identified. A case-control study was used (case = hyperglycemia; control = normoglycemia) to derive a model for predicting glycemia. The risk factors considered were gestational age (£31 vs. >31 weeks), birth weight (£1500 vs. >1500 g), glucose infusion rate (£6 vs. >6 mg/kg/min) and clinical status (stable vs. unstable). Multivariate analysis by logistic regression gave the following mathematical model for predicting the probability of hyperglycemia: 1/exp{-3.1437 + 0.5819(GA) + 0.9234(GIR) + 1.0978(Clinical status)} The main predictive variables in our study, in increasing order of importance, were gestational age, glucose infusion rate and, the clinical status (stable or unstable) of the preterm newborn infant. The probability of hyperglycem Continue reading >>

Incidence, Risk Factors And Complications Of Hyperglycemia In Very Low Birth Weight Infants

Incidence, Risk Factors And Complications Of Hyperglycemia In Very Low Birth Weight Infants

Abstract Background: Prevalence of hyperglycemia in preterm infants varies widely between 20% and 88%. Hyperglycaemia in very low birth weight infants (VLBW) is associated with increased morbidity (necrotizing enterocolitis, late onset sepsis, intraventricular hemorrhage,) and mortality. Objective: To study the incidence of hyperglycemia in VLBW infants and the correlation between hyperglycemia and different neonatal parameters, antenatal as well as postnatal risk factors, complications and outcome. The study also aimed at studying the relation between the onset and degree of hyperglycemia and different study parameters. Methodology: This cross-sectional comparative study included 60 VLBW neonates admitted since birth in Abulrich new Children Hospital NICU, Egypt. Random blood glucose (BG) was measured during 1st week of life (checked every 3 h in the 1st 48 h, then every 6 h for the next 5 days) using glucometer strips. Thorough maternal history taking, neonatal assessment and recording of medications, nutrition and IV fluid intake during 1st week of life as well as development of complications. Results: Forty VLBW neonates (66.7%) developed hyperglycemia during 1st week of life. Among hyperglycemic cases 20 neonates (50%) developed severe hyperglycemia while 16 (40%) developed moderate hyperglycemia and only 4 (10%) had mild hyperglycemia. There was statistically significant relation between hyperglycemia and gestational age, birth weight, placental insufficiency during pregnancy, receiving inotropes and milk intake after birth (p = 0.05, 0.042, 0.044, 0.001 and 0.007 respectively). There was statistically significant relation between hyperglycemia and LOS, IVH, death (p = 0.001, 0.003 & 0.022 respectively). There was statistically significant relation between severit Continue reading >>

Disproportionate Body Composition And Neonatal Outcome In Offspring Of Mothers With And Without Gestational Diabetes Mellitus

Disproportionate Body Composition And Neonatal Outcome In Offspring Of Mothers With And Without Gestational Diabetes Mellitus

OBJECTIVE High birth weight is a risk factor for neonatal complications. It is not known if the risk differs with body proportionality. The primary aim of this study was to determine the risk of adverse pregnancy outcome in relation to body proportionality in large-for-gestational-age (LGA) infants stratified by maternal gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS Population-based study of all LGA (birth weight [BW] >90th percentile) infants born to women with GDM (n = 1,547) in 1998–2007. The reference group comprised LGA infants (n = 83,493) born to mothers without diabetes. Data were obtained from the Swedish Birth Registry. Infants were categorized as proportionate (P-LGA) if ponderal index (PI) (BW in grams/length in cm3) was ≤90th percentile and as disproportionate (D-LGA) if PI >90th percentile. The primary outcome was a composite morbidity: Apgar score 0–3 at 5 min, birth trauma, respiratory disorders, hypoglycemia, or hyperbilirubinemia. Logistic regression analysis was used to obtain odds ratios (ORs) for adverse outcomes. RESULTS The risk of composite neonatal morbidity was increased in GDM pregnancies versus control subjects but comparable between P- and D-LGA in both groups. D-LGA infants born to mothers without diabetes had significantly increased risk of birth trauma (OR 1.19 [95% CI 1.09–1.30]) and hypoglycemia (1.23 [1.11–1.37]). D-LGA infants in both groups had significantly increased odds of Cesarean section. CONCLUSIONS The risk of composite neonatal morbidity is significantly increased in GDM offspring. In pregnancies both with and without GDM, the risk of composite neonatal morbidity is comparable between P- and D-LGA. RESEARCH DESIGN AND METHODS This prospective population-based cohort study was performed using data Continue reading >>

Infant Of Diabetic Mother

Infant Of Diabetic Mother

Infants of diabetic mothers (IDMs) have experienced a nearly 30-fold decrease in morbidity and mortality rates since the development of specialized maternal, fetal, and neonatal care for women with diabetes and their offspring. Before then, fetal and neonatal mortality rates were as high as 65%. Today, 3-10% of pregnancies are affected by abnormal glucose regulation and control. Of these cases, 80-88% are related to abnormal glucose control of pregnancy or gestational diabetes mellitus. Of mothers with preexisting diabetes, 35% have been found to have type 1 diabetes mellitus, and 65% have been found to have type 2 diabetes mellitus. Infants born to mothers with glucose intolerance are at an increased risk of morbidity and mortality related to the following: These infants are likely to be born by cesarean delivery for many reasons, among which are such complications as shoulder dystocia with potential brachial plexus injury related to the infant's large size. These mothers must be closely monitored throughout pregnancy. If optimal care is provided, the perinatal mortality rate, excluding congenital malformations, is nearly equivalent to that observed in normal pregnancies. Continue reading >>

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