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Complications Of Neonatal Hyperglycemia

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 >>

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 >>

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 >>

Hypoglycemia In A Newborn Baby

Hypoglycemia In A Newborn Baby

What is hypoglycemia in a newborn baby? Hypoglycemia is when the level of sugar (glucose) in the blood is too low. Glucose is the main source of fuel for the brain and the body. In a newborn baby, low blood sugar can happen for many reasons. It can cause problems such as shakiness, blue tint to the skin, and breathing and feeding problems. What causes hypoglycemia in a newborn baby? Hypoglycemia can be caused by conditions such as: Poor nutrition for the mother during pregnancy Making too much insulin because the mother has poorly controlled diabetes Incompatible blood types of mother and baby (severe hemolytic disease of the newborn) Birth defects Congenital metabolic diseases Not enough oxygen at birth (birth asphyxia) Liver disease Infection Which newborns are at risk for hypoglycemia? Babies are more likely to have hypoglycemia include: Babies born to mothers with diabetes Babies who are small for gestational age or growth-restricted Preterm babies, especially those with low birth weights Babies born under significant stress Babies with mothers treated with certain medicines such as terbutaline Babies who are large for their gestational age What are the symptoms of hypoglycemia in a newborn baby? Signs of low blood sugar may not be obvious in newborn babies. The most common signs include: Shakiness Blue tint to skin and lips (cyanosis) Stopping breathing (apnea) Low body temperature (hypothermia) Floppy muscles (poor muscle tone) Not interested in feeding Lack of movement and energy (lethargy) Seizures The signs of hypoglycemia can be like other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis. How is hypoglycemia in a newborn baby diagnosed? A simple blood test for blood glucose levels can diagnose the problem. How is hypo Continue reading >>

What Neonatal Complications Should The Pediatrician Be Aware Of In Case Of Maternal Gestational Diabetes?

What Neonatal Complications Should The Pediatrician Be Aware Of In Case Of Maternal Gestational Diabetes?

Go to: INTRODUCTION Gestational diabetes mellitus (GDM) is defined as a glucose intolerance of any degree with onset or first recognition during pregnancy. In high income countries, but also in middle and low income countries, because of the spreading of industrialized lifestyle, the incidence of obesity and type 2 diabetes (T2D) has dramatically increased, and subsequently the incidence of GDM[1]. In high-resource countries, progress has been made during the past fifty years regarding preconceptional care, screening and management of GDM. However, in low and middle-income countries, quality of antenatal care to detect and manage GDM, are often poorly available. As a consequence, the prenatal and neonatal burden of GDM may be paradoxically higher in these countries, although this point is not well documented[2]. Much of the currently available knowledge on the consequences of maternal diabetes on the offspring has been provided by studies on type 1 diabetes (T1D), while the risks related to GDM, which is much more frequent, need to be clarified in order to improve and to adapt neonatal management[3]. Moreover, extensive data suggest that the offspring of diabetic mothers is furthermore exposed to an increased risk of developing chronic, non-communicable diseases at adulthood[4]. Neonatologists are facing first-line this new epidemiologic setting. This review addresses the currently available knowledge on short term consequences of GDM in neonates and focuses on situations with increased risks of neonatal adverse outcomes. Continue reading >>

Stress Induced Hyperglycemia In A Term Baby Mimicking Diabetic Ketoacidosis With Stroke

Stress Induced Hyperglycemia In A Term Baby Mimicking Diabetic Ketoacidosis With Stroke

Go to: Abstract Stress/sepsis induced transient hyperglycemia in the newborn may present with extremely high blood sugar values and may mimic neonatal diabetes mellitus. We present a case of neonatal septicemia with stress induced hyperglycemia mimicking neonatal diabetes mellitus. Extremely high blood sugar values upto 1529 mg/dl with metabolic acidosis were noted in a term good weight baby causing a diagnostic dilemma. It can be seen even in term babies, contrary to the belief that it occurs in preterm and small for gestation babies. Considering the prognostic implications it may cause it is important that hyperglycemia is promptly treated by insulin infusion. Keywords: Hyperglycemia, insulin therapy, neonatal diabetes, stress Go to: Stress induced hyperglycemia is a known complication of Neonatal sepsis, but sometimes it may become very difficult to distinguish it from neonatal diabetes mellitus. We present a case of neonatal septicemia with stress induced hyperglycemia mimicking neonatal diabetes mellitus. Extremely high blood sugar values with metabolic acidosis were noted in a term good weight baby caused a diagnostic dilemma. Go to: CASE REPORT The present case report is about a 3 kg term neonate who presented on the 9th day of life with a history of fever for 2 days, lethargy and one episode of seizure. At admission, he was in a state of shock with severe dehydration. Anterior fontanel was bulging. He was given two boluses of normal saline, radiant warmer care and intravenous antibiotics (cefotaxime and vancomycin) were started. Inotropic support with dopamine was given in view of septic shock. The blood sugar was 1529 mg/dL and arterial blood gases revealed mild metabolic acidosis (pH - 7.289 and HCO3-11.5). Urine ketones were however negative. Dehydration was Continue reading >>

Neonatal Hyperglycemia

Neonatal Hyperglycemia

Hyperglycemia is a serum glucose concentration > 150 mg/dL (> 8.3 mmol/L). The most common cause of neonatal hyperglycemia is Iatrogenic causes usually involve too-rapid IV infusions of dextrose during the first few days of life in very low-birth-weight infants (< 1.5 kg). The other important cause is physiologic stress caused by surgery, hypoxia, respiratory distress syndrome, or sepsis; fungal sepsis poses a special risk. In premature infants, partially defective processing of proinsulin to insulin and relative insulin resistance may cause hyperglycemia. In addition, transient neonatal diabetes mellitus is a rare self-limited cause that usually occurs in small-for-gestational-age infants; corticosteroid therapy may also result in transient hyperglycemia. Hyperglycemia is less common than hypoglycemia, but it is important because it increases morbidity and mortality of the underlying causes. Treatment of iatrogenic hyperglycemia is reduction of the IV dextrose concentration (eg, from 10% to 5%) or of the infusion rate; hyperglycemia persisting at low dextrose infusion rates (eg, 4 mg/kg/min) may indicate relative insulin deficiency or insulin resistance. Treatment of other causes is fast-acting insulin. One approach is to add fast-acting insulin to an IV infusion of 10% dextrose at a uniform rate of 0.01 to 0.1 unit/kg/h, then titrate the rate until the glucose level is normalized. Another approach is to add insulin to a separate IV of 10% D/W given simultaneously with the maintenance IV infusion so that the insulin can be adjusted without changing the total infusion rate. Responses to insulin are unpredictable, and it is extremely important to monitor serum glucose levels and to titrate the insulin infusion rate carefully. In transient neonatal diabetes mellitus, gluc 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 >>

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 >>

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 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. 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. 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 severity of hyperglycemia and infection in 1st week and IVH (p = 0.025 & 0.05 respectively). A significant negative correlation was found with GA and birth weight (p = 0.019, 0.002 respectively). There was high incidence of hyperglycemia in VLBW (66.7%). There was statistically significant relation between hyperglycemi 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 >>

Hyperglycemia In Infants

Hyperglycemia In Infants

What are the other Names for this Condition? (Also known as/Synonyms) High Blood Sugar in Infants Hyperglycemia in Newborns Neonatal Hyperglycemia What is Hyperglycemia in Infants? (Definition/Background Information) Hyperglycemia in Infant is a very common abnormality seen in the metabolism of prematurely born and critically ill newborn children Hyperglycemia is defined as the presence of high levels of glucose (sugar) in blood. The condition occurs due to the lack of sufficient levels of insulin in the body Hyperglycemia in Infants can be the result of gestational diabetes mellitus (a form of type II diabetes) that develops in the mother during pregnancy The signs and symptoms of Neonatal Hyperglycemia may not be apparent during the initial period following birth. The indications of the condition may include frequent urination, dehydration, and increased thirst Undiagnosed and/or untreated hyperglycemia can result in complications such as nerve damage, kidney damage, impaired vision, and greater vulnerability to type II diabetes and heart conditions The mainstay of treatment of Hyperglycemia in Infants is using insulin therapy. With early and adequate treatment of the condition, the prognosis is generally good. In most cases, no long-term effects on the child is noted Who gets Hyperglycemia in Infants? (Age and Sex Distribution) Hyperglycemia in Infants is seen in both term and preterm infants. This form of hyperglycemia (or high blood sugar) is seen in infants shortly after birth; from birth to one month of age Both sexes are equally likely to develop Hyperglycemia. The gender of the baby has no effect on the development of this condition All racial and ethnic groups are generally affected In general, North America has the highest prevalence of diabetes (high blood s Continue reading >>

Low Blood Sugar - Newborns

Low Blood Sugar - Newborns

Babies need blood sugar (glucose) for energy. Most of that glucose is used by the brain. The baby gets glucose from the mother through the placenta before birth. After birth, the baby gets glucose from the mother through her milk or from formula, and the baby also produces it in the liver. Glucose level can drop if: There is too much insulin in the blood. Insulin is a hormone that pulls glucose from the blood. The baby is not producing enough glucose. The baby's body is using more glucose than is being produced. The baby is not able to feed enough to keep the glucose level up. Neonatal hypoglycemia occurs when the newborn's glucose level causes symptoms or is below the level considered safe for the baby's age. It occurs in about 1 to 3 out of every 1,000 births. Low blood sugar level is more likely in infants with one or more of these risk factors: Born early, has a serious infection, or needed oxygen right after delivery Mother has diabetes (these infants are often larger than normal) Have slower than usual growth in the womb during pregnancy Continue reading >>

Neonatal Management Of The Infant Of Diabetic Mother

Neonatal Management Of The Infant Of Diabetic Mother

1 Department of Pediatrics, Dana Dwek Children’s Hospital, Sackler School of Medicine Tel Aviv University, Israel 2 Department of Obstetrics and Gynecology, Clalit Sherutey Briut, Tel Aviv, Israel 3 Department of Neonatology, Laniado Hospital, Natanya, Israel, Technion-Israel Institute of Technology, Haifa *Corresponding Author: Department of Pediatrics Dana Dwek Children’s Hospital 10 Weizman street, Tel Aviv, Israel Tel: 972-3-6974271 E-mail: [email protected] Citation: Mimouni FB, Mimouni G, Bental YA (2013) Neonatal Management of the Infant of Diabetic Mother. Pediat Therapeut 4:186. doi:10.4172/2161-0665.1000186 Copyright: © 2013 Mimouni FB, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Visit for more related articles at Pediatrics & Therapeutics Abstract Many controversies exist about the management of neonatal conditions frequent in the infant of diabetic mother such as asymptomatic neonatal hypoglycemia, hypocalcemia, or polycythemia. In this article, we review the pathophysiology and management of major neonatal complications of diabetes in pregnancy, taking into consideration the major current controversies. Keywords Diabetic; Hypoglycemia; Polycythemia Introduction A Medline search performed on August, 2013, using the key word of “infant of diabetic mother” and the limit of “clinical guidelines” failed to find any article in the English language that represents some kind of consensus opinion on the neonatal management of the Infant of Diabetic Mother (IDM). We retrieved only one paper, in German, published 15 years ago, and written on behalf of German Continue reading >>

Interventions For Treatment Of Neonatal Hyperglycemia In Very Low Birth Weight Infants

Interventions For Treatment Of Neonatal Hyperglycemia In Very Low Birth Weight Infants

Higher-than-normal blood sugar levels are frequently seen in babies born very early (before 32 weeks gestation) or with very low birth weight (< 1500 grams) and who are fed totally or partially by vein. Several types of adverse outcomes have been associated with high blood sugar levels, including increased risks for death, infections, eye problems, and bleeding into the brain. It is not known if treatment to lower the baby's blood sugar helps to prevent those complications and, if so, which treatment is best. These treatment options include decreasing the amount of sugar delivered by vein to nourish the baby or administration of insulin. This review of trials found no evidence of significant effects of these treatments on the risks of death or major complications. However, the studies reviewed were very small. There is a need for larger trials to answer these questions. Evidence from randomized trials in hyperglycemic VLBW neonates is insufficient to determine the effects of treatment on death or major morbidities. It remains uncertain whether the hyperglycemia per se is a cause of adverse clinical outcomes or how the hyperglycemia should be treated. Much larger randomized trials in hyperglycemic VLBW neonates that are powered on clinical outcomes are needed in order to determine whether, and how, the hyperglycemia should be treated. Continue reading >>

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