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Hypoglycemia In Newborn Treatment

Guidelines For The Detection And Management Of Hypoglycemia, Hyperglycemia, And Normoglycemia In Preterm And Term Neonates

Guidelines For The Detection And Management Of Hypoglycemia, Hyperglycemia, And Normoglycemia In Preterm And Term Neonates

John A. Widness, MD Peer Review Status: Internally Peer Reviewed Hypoglycemia Definition: Plasma glucose < 40 mg/dL in both term or preterm infants. Incidence: The definition of neonatal hypoglycemia has been based on statistical criteria.2 The incidence of this condition in term AGA infants is approximately 2%. Infants at Risk immediately following birth: IDMs, IGDMs (especially those whose mothers received oral hypoglycemic agents), LGA (>90%ile), SGA (IUGR <10%ile), post-asphyxiated, APGAR < 5 at five minutes, polycythemic, immune hemolytic disease, suspected sepsis, hypothermia (rectal temperature <35¾C), congenital anomalies, Beckwith-Wiedman syndrome, infants ≤ 36 wks gestation, infants ≥42 wks gestation, & those whose mothers received large amounts of i.v. glucose prior to delivery. Signs: Non-specific, including tremulousness, twitching, jitteriness, irritability, exaggerated Moro reflex, high pitched cry, seizures, apnea, limpness, poor feeding, cyanosis, temperature instability, and coma. Screening of Infants at Risk (see table at end of this section): Screen by plasma glucose measurements at 1, 2, 4, 8 and 24 hours of age if not receiving glucose containing i.v. fluids, or when symptomatic. Diagnosis: By plasma glucose measurements only. For diagnostic purposes it is imperative that plasma glucose be measured in the NICU or Hospital laboratory by quantative chemical analysis and NOT by a semi-quantitative reagent strip method (e.g., Chemstrip bG®). Although use of reagent strips is widespread, their use, even for glucose screening purposes, is controversial1. This is because of their inaccuracy and imprecision relative to accepted laboratory determined glucose values. Treatment decisions in infants without signs ("asymptomatic") of hypoglycemia should n Continue reading >>

Management Strategies For Neonatal Hypoglycemia

Management Strategies For Neonatal Hypoglycemia

Go to: POSTNATAL GLUCOSE ADAPTATION During fetal life, glucose passively diffuses across the placenta, using a concentration gradient. This process results in a fetal plasma glucose concentration approximately 70% to 80% of that of the maternal venous plasma glucose concentration.8 Insulin does not cross the placenta; therefore, the fetus must secrete insulin independently. With the clamping of the umbilical cord, the neonate’s supply of glucose ceases while insulin secretion continues. The residual fetal insulin leads to a rapid decline in plasma glucose within the first hours of life.10 To overcome decreasing glucose concentrations, the release of counterregulatory hormones such as glucagon and cortisol in combination with the production of endogenous glucose through gluconeogenesis and glycogenolysis occurs. In healthy neonates, feeding is also initiated within approximately 12 hours of birth, further aiding in the increase of serum glucose concentrations. If feeding cannot be initiated, other metabolic substrates such as ketones will likely increase to offset the effects of lower glucose concentrations. Transient hypoglycemia can occur during the first hours of life because of a slow or immature fasting adaptation process. Continue reading >>

Neonatal Hypoglycemia

Neonatal Hypoglycemia

Hypoglycemia is a serum glucose concentration < 40 mg/dL (< 2.2 mmol/L) in term neonates or < 30 mg/dL (< 1.7 mmol/L) in preterm neonates. Risk factors include prematurity, being small for gestational age, maternal diabetes, and perinatal asphyxia. The most common causes are deficient glycogen stores, delayed feeding, and hyperinsulinemia. Signs include tachycardia, cyanosis, seizures, and apnea. Diagnosis is suspected empirically and is confirmed by glucose testing. Prognosis depends on the underlying condition. Treatment is enteral feeding or IV dextrose. Neonatal hypoglycemia may be transient or persistent. Causes of transient hypoglycemia are Deficiency of glycogen stores at birth is common in very low-birth-weight preterm infants, infants who are small for gestational age because of placental insufficiency, and infants who have perinatal asphyxia. Anaerobic glycolysis consumes glycogen stores in these infants, and hypoglycemia may develop at any time in the first few hours or days, especially if there is a prolonged interval between feedings or if nutritional intake is poor. A sustained input of exogenous glucose is therefore important to prevent hypoglycemia. Causes of persistent hypoglycemia include Hyperinsulinism most often occurs in infants of diabetic mothers and is inversely related to the degree of maternal diabetic control. When a mother has diabetes, her fetus is exposed to increased levels of glucose because of the elevated maternal blood glucose levels. The infant responds by producing increased levels of insulin. When the umbilical cord is cut, the infusion of glucose to the neonate ceases, and it may take hours or even days for the neonate to decrease its insulin production. Hyperinsulinism also commonly occurs in physiologically stressed infants who Continue reading >>

Babies With Hypoglycemia

Babies With Hypoglycemia

If you’ve been told that your newborn baby has hypoglycemia (low blood sugar) or is at risk of developing this condition, you should also know that there are ways that breastfeeding can help the situation. Low blood sugar occurs when the body’s demand for glucose (a simple sugar) is greater than its supply. Infants get glucose from the lactose (milk sugar) that is in milk and colostrum. Some infants have greater difficulty maintaining an adequate blood sugar than others. While an occasional dip in blood sugar is harmless, prolonged periods of low blood sugar can damage the central nervous system. Babies at risk for developing hypoglycemia include: preterm or post-term babies, infants of diabetic mothers, babies of mothers who were given a large dose of glucose solution intravenously during labor, infants who are either small or large for gestational age, and infants who experience respiratory distress, breathing difficulties, or who are the product of a complicated delivery. Babies at risk for hypoglycemia need to breastfeed frequently. Here’s how breastfeeding can help: Focus your energy on encouraging your baby to nurse well and often. Small, frequent, high protein, high calorie meals of colostrum are much better for your baby than the bottles of sugar water offered by hospital staff. See “Latch-on basics” and “Waking the sleepy baby” for tips on getting newborns to breastfeed effectively. Keeping baby from wasting energy will help keep blood sugar at appropriate levels. Frequent breastfeeding has an energy-sparing effect. Babies use less energy at the breast than they do crying or taking milk from a bottle. Offer the breast often, for comfort as well as food. If supplements are medically indicated in your baby’s first days of life, use infant formula Continue reading >>

Hypoglycaemia (low Blood Sugar) In Newborns

Hypoglycaemia (low Blood Sugar) In Newborns

What is hypoglycaemia? Hypoglycaemia means low blood sugar. Your baby's sugar levels are regulated by his hormones, the key hormone being insulin. Insulin helps his body to store sugar (blood glucose) and release it when he needs it. When everything is working well, your baby's hormones keep his blood sugar levels balanced. When the balance is out, hypoglycaemia can happen. If your baby's blood sugar is low and it is not treated, it could be harmful to his health. Low blood sugar that isn't picked up can even lead to a baby's brain being damaged. That's why your midwife or doctor will closely monitor your baby to make sure he stays well. Rest assured that if your baby is not premature, and is otherwise healthy, he is unlikely to have low blood sugar. What causes hypoglycaemia in newborns? Your baby's blood sugar levels go down in the first few hours after birth, which is completely normal. Your baby gets his glucose from milk. When your baby has just had a feed, his sugar levels will go up. As the next feed draws closer, his sugar levels will start to dip. Keeping the right level of sugar in the blood is a delicate balancing act. Most healthy babies can cope easily with these normal ups and downs in blood sugar level. If you feed your baby whenever he wants, he will take the milk he needs to ensure his sugar levels remain balanced. However, some babies can be at risk, including babies born to mums who have diabetes. These babies may produce too much insulin when they are born, making them prone to lower blood sugar levels. Babies are also susceptible to hypoglycaemia if they: were born prematurely or very small had breathing difficulties at birth have suffered excessive coldness, or hypothermia have an infection Low blood sugar in newborns can usually be reversed quickl Continue reading >>

Glucagon In The Treatment Of Hypoglycemia In Newborn Infants Of Diabetic Mothers

Glucagon In The Treatment Of Hypoglycemia In Newborn Infants Of Diabetic Mothers

Thesis Infants of diabetic mothers are at high risk to develop hypoglycemia after birth. After birth, glucose and ketone bodies are the main substrates of brain energy. Under normal condition, the adrenergic response seen immediately after birth suppresses insulin release and stimulates glucagon secretion which enhances gluconeogenesis and ketogenesis. An inversion of the insulin/glucagon ratio is seen soon after birth as a normal, physiologic phenomenon. Consequently, a post delivery glucose nadir is reached between 30 to 90 minutes after birth, followed by a spontaneous recovery before 3-4 hours of age. In infants of diabetic mothers, this inversion of the ratio is postponed and a more profound and sustained hypoglycemia is seen. Early feeding is of great importance to diminish the severity and incidence of hypoglycemia. But, if despite an appropriate calorie intake, low levels of sugar are seen, an intravenous infusion of glucose should be commenced. In case that IV glucose is not effective or can't be supplied immediately, intramuscular glucagon is a therapeutic alternative. We hypothesize that a single intramuscular injection of glucagon together with the appropriate oral intake of nutrients is a safe and an effective alternative to the IV infusion of glucose alone in the treatment of hypoglycemia in term infants of diabetic mothers. Methods Appropriately grown or large for date, term infants of insulin treated diabetic mothers, with no other known medical problems, are potential candidates for our study. Hypoglycemia will be defined as serum glucose level lower than 45 mg%. Infants of diabetic mothers will arrive to the nursery and immediately receive early feeding before 30 minutes of life. At that time, glucose will be checked. If glucose level is lower than 45 Continue reading >>

A Novel Algorithm In The Management Of Hypoglycemia In Newborns

A Novel Algorithm In The Management Of Hypoglycemia In Newborns

International Journal of Pediatrics Volume 2014 (2014), Article ID 935726, 5 pages Department of Neonatology, Fernandez Hospital, Hyderguda, Hyderabad, Telangana 500029, India Academic Editor: Naveed Hussain Copyright © 2014 Swapna Naveen et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Study Objective. To evaluate the safety of a new protocol in comparison to the standard protocol for managing hypoglycemia in neonates. Methods. Open label RCT-pilot study. Neonates admitted to NICU with hypoglycemia and requiring intravenous fluids were included. Fifty-seven eligible neonates were randomly allocated to either intervention group (starting fluids with 10% dextrose and increments of 1.5%) or standard protocol group (GIR of 6 mg/kg/min with increments of 2 mg/kg/min) till control of hypoglycemia. Primary outcome of the study was to know proportion of infants with subsequent hypoglycemia and hyperglycemia after enrolment. Results. The initial GIR (6 ± 0 mg/kg/min versus 4.8 ± 1.4 mg/kg/min, P < 0.001), the mean maximum GIR (6.7 ± 1.6 mg/kg/min versus 5.6 ± 2 mg/kg/min, P = 0.03), the maximum concentration of glucose infused (13.8 ± 2.9% versus 10.9 ± 1.9%, P < 0.001), and the total amount of glucose infused were significantly lower in the intervention group. The mean maximum blood sugar was significantly higher (129 ± 57 mg/dL versus 87 ± 30 mg/dL, P = 0.001) and there was a trend towards high proportion of infants with Hyperglycemia in the standard protocol group (n = 10, 39% versus n = 5, 16%, P = 0.07). The median difference between the highest and the lowest recorded sugar for any Continue reading >>

Low Blood Sugar - Newborns

Low Blood Sugar - Newborns

Definition A low blood sugar level in newborn babies is also called neonatal hypoglycemia. It refers to low blood sugar (glucose) in the first few days after birth. Alternative Names Neonatal hypoglycemia Causes 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 Are smaller in size than normal for their gestational age Symptoms Infants with low blood sugar may not have symptoms. If your baby has one of the risk factors for low blood sugar, nurses in the hospital will check your baby's blood sugar level, even if there are no symptoms. Also, blood sugar level is very often checked for babies with these symptoms: Breathing problems, such as pauses in breathing (apnea), rapid breathing, or a grunting sound Irritability or listlessness Poor feeding or vomiting Problems keeping the body Continue reading >>

Hypoglycemia In The Newborn

Hypoglycemia In The Newborn

Home> Medical care> Endocrine Program> Conditions> Hypoglycemia in the newborn What is hypoglycemia in the newborn? Hypoglycemia is a condition that results from decrease in the blood glucose (sugar) level. It is often self-limited and commonly seen during the first 2-3 hours in healthy infants after birth. Who is affected by hypoglycemia in the newborn? Approximately two out of 1,000 newborn babies have hypoglycemia. Babies who are more likely to develop hypoglycemia include: Babies born to diabetic mothers are at a risk for developing hypoglycemia after delivery because the source of glucose (the mother's blood) is gone and the baby's high insulin level tends to metabolize the existing glucose faster. Small for gestational age, prematurity, low brith weight or growth-restricted babies may have limited glycogen stores in the liver or have immature liver function that results in hypoglycemia. What causes hypoglycemia in the newborn? Hypoglycemia may be caused by conditions that: Lower the amount of glucose in the bloodstream Result in lower storage of glycogen (sugar stored in liver) Cause increase use of glycogen stores (sugar stored in the liver) Prevent the use of glucose by the body Glucose-a vital fuel: Glucose is an important source of immediate energy for the body that is found in food. Glucose can also be stored as glycogen both in the liver and muscles for later use and if in excess it gets converted to fat. Glucose is the main source of fuel for the brain, and is especially important for babies and young children. Complex hormonal and neurologic mechanisms regulate the amount of glucose between meals. During pregnancy, the fetus gets glucose through the placenta from the mother. Some of the glucose gets stored as glycogen in the placenta and later in the fetal 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 Hypoglycemia Treatment & Management

Neonatal Hypoglycemia Treatment & Management

Approach Considerations Start a 5% or 10% dextrose drip when hypoglycemia is recurrent. In terms of prehospital care, stabilize acute, life-threatening conditions and initiate supportive therapy in patients with hypoglycemia. If a patient is alert and has intact airway protective reflexes, oral liquids containing sugar (eg, orange juice) can be administered. [10] A study by Joshi et al suggested that in women with pregestational type 1 or type 2 diabetes, neonatal hypoglycemia can be avoided by aiming at an intrapartum blood glucose level of 4-7 mmol/L. [11] Emergency department care Supportive therapy includes oxygen, establishing an intravenous (IV) line, and monitoring. Seizures unresponsive to correction of hypoglycemia should be managed with appropriate anticonvulsants. Marked acidosis (pH < 7.1) suggests shock or serious underlying disease and should be treated appropriately. The treatment goal is to maintain a blood glucose level of at least 45 mg/dL (2.5 mmol/L). For the infant or child who does not drink but has intact airway protective reflexes, orogastric or nasogastric administration of oral liquids containing sugar may be performed. Inpatient care Any child with documented hypoglycemia not secondary to insulin therapy should be hospitalized for careful monitoring and diagnostic testing. Surgery If hypoglycemia is diagnosed in an infant younger than 3 months, surgical intervention may be necessary. Surgical exploration usually is undertaken in severely affected neonates who are unresponsive to glucose and somatostatin therapy. Near-total resection of 85-90% of the pancreas is recommended for presumed congenital hyperinsulinism, which is most commonly associated with an abnormality of beta-cell regulation throughout the pancreas. Risks include the development Continue reading >>

Neonatal Hypoglycemia

Neonatal Hypoglycemia

OBJECTIVES After completing this article, readers should be able to: Describe the most common cause of prolonged neonatal hypoglycemia. List the signs of hypoglycemia. Describe the condition that has been implicated as a mechanism of hypoglycemic brain injury. Case Study A term male infant was born after an uneventful pregnancy to a 28-year-old gravida I woman who had no evidence of hyperglycemia and no chronic diseases. The infant had Apgar scores of 7 and 9 at 1 and 5 minutes, respectively. His growth parameters were in the normal range, with weight at the 60th percentile, head circumference at the 50th percentile, and length at the 50th percentile. The baby was taken to the well baby nursery, examined and bathed, and then taken to the mother for nursing at about 2 hours of age. He appeared slightly jittery at that time and was not very interested in nursing or very aware. A blood glucose concentration of 1.39 mmol/L (25 mg/dL) was obtained using a One Touch® instrument. The baby was fed 25 mL of 5% dextrose in water. The blood glucose concentration obtained 1 hour later was 2.22 mmol/L (40 mg/dL), and the baby nursed for about 5 minutes at each breast with apparent satisfaction. Jitteriness and“ lack of interest” were improved. Normal nursery routine was followed, with no comment in the chart by the nursing staff about the infant’s feeding or behavior until the second day of life when he again appeared jittery and fussy. Glucose concentration at that time was 1.11 mmol/L (20 mg/dL). The infant was fed by breast or bottle (routine 20 kcal/oz house formula) alternating every 2 hours, and clinical signs improved. One Touch® glucose concentrations obtained over the next 24 hours were variable, but overall the concentration increased, with a predischarge, preprand Continue reading >>

Oral Glucose Gel May Be Effective Treatment For Neonatal Hypoglycemia

Oral Glucose Gel May Be Effective Treatment For Neonatal Hypoglycemia

Neonatal hypoglycemia (low blood sugar in a new baby) is a common problem in hospital nurseries. Some infants can have low blood sugar and show no symptoms, others become jittery and may feed poorly, and in severe cases, the infant may suffer brain damage or have developmental delay. Hospitals routinely screen babies that are at risk for hypoglycemia by testing for glucose levels in blood obtained from a heel stick. While a symptomatic baby with low glucose clearly needs treatment, there is some debate about what glucose level needs intervention if the baby appears well. 1In other words, how low does it have to go before we treat the baby based on just the number. Current therapy involves high-sugar formula feeds (which have been shown to produce cow’s milk allergies in babies prone to allergic reactions)2, IV dextrose infusions, and occasionally requires admission to a NICU. Since all of these things disrupt mother-child bonding and the establishment of breastfeeding, most cases require significant clinical experience to properly weigh the risks and benefits. In children and adults, treatment of hypoglycemia is much less complicated. Anyone who finds their blood sugar running low can just have a snack. People prone to hypoglycemia often carry a small packet of glucose gel with them that they can eat in an emergency. If the gel is such an easy solution, why is it not used in babies? Several studies showed mixed results using a gel to raise babies’ blood sugar and suggested that giving external foods caused the babies to suckle less at the breast.3-5 However, a more recent study by Harris, et al, nicknamed the “Sugar Babies Study,” reexamined this question from the perspective of the babies’ hospital course rather than just the blood glucose numbers. They found Continue reading >>

New Approaches To Management Of Neonatal Hypoglycemia

New Approaches To Management Of Neonatal Hypoglycemia

Abstract Despite being a very common problem after birth, consensus on how to manage low glucose concentrations in the first 48 h of life has been difficult to establish and remains a debated issue. One of the reasons for this is that few studies have provided the type of data needed to establish a definitive approach agreed upon by all. However, some recent publications have provided much needed primary data to inform this debate. These publications have focused on aspects of managing low blood glucose concentrations in the patients most at-risk for asymptomatic hypoglycemia—those born late-preterm, large for gestational age, small for gestational age, or growth restricted, and those born following a pregnancy complicated by diabetes mellitus. The goal of this review is to discuss specific aspects of this new research. First, we focus on promising new data testing the role of buccal dextrose gel in the management of asymptomatic neonatal hypoglycemia. Second, we highlight some of the clinical implications of a large, prospective study documenting the association of specific glycemic patterns with neurodevelopmental outcomes at two years of age. Keywords Neonatal hypoglycemiaDextrose gelContinuous glucose monitoringInfant of a diabetic motherLate pretermSmall for gestational ageLarge for gestational ageIntrauterine growth restriction Background Hypoglycemia is one of the most frequently encountered problems in the first 48 h of life, and low glucose concentrations are perhaps the most common biochemical abnormality seen by providers caring for newborns. Unfortunately, the optimal strategy for managing this problem remains elusive and is a matter of differing interpretations of the available literature [1–8]. New data to inform the optimal management of these newborn Continue reading >>

F A C T S H E E T F O R P A T I E N T S A N D F A M I L I E S

F A C T S H E E T F O R P A T I E N T S A N D F A M I L I E S

What is it? Hypoglycemia [hahy-poh-glahy-SEE-mee-uh] means a low level of glucose in the blood (low blood sugar). Glucose is a type of sugar that is the brain’s main source of energy. About 15 out of every 100 newborn babies have low blood glucose levels in the first few days of life. Why is it a concern? Hypoglycemia may cause your baby’s brain to not work well. If a newborn baby’s blood glucose level is very low or stays low for a long time, the baby can have seizures or a brain injury. Most of the time, a newborn’s blood glucose level can quickly go back to normal with treatment. Early treatment can help prevent possible problems like seizures and brain injury. How is it diagnosed? Hypoglycemia is diagnosed by testing your baby’s blood. This test requires taking a small amount of blood from your baby’s heel, then testing it at your baby’s bedside. If the blood glucose level is too low for your baby’s age, the doctor will diagnose hypoglycemia and start treatment. At Intermountain hospitals, healthcare providers regularly check the blood glucose levels of babies who have symptoms or risk factors for hypoglycemia. Risk factors are things that increase a baby’s chance of getting hypoglycemia. (Possible risk factors in a newborn are listed on page 2 of this fact sheet.) Hypoglycemia in a Newborn What are the symptoms? Some newborns with hypoglycemia have no symptoms at all. Others have one or more of these: • Bluish or very pale skin • Breathing problems such as fast breathing or pauses in breathing • Fussiness or low energy • Low muscle tone — slack muscles or “floppiness†• Vomiting or poor feeding • Low body temperature • Shakes, tremors, or se Continue reading >>

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