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Neonatal Hyperglycemia Ppt

Hypoglycemia And Hyperglycemia Are Associated With Poor Outcome

Hypoglycemia And Hyperglycemia Are Associated With Poor Outcome

Insert Program or Hospital Logo Texas Pediatric Society Electronic Poster Contest in Neonatal Hypoxic-Ischemic Encephalopathy Sudeepta K Basu1, Danielle Guffey, Charles G Minard, Jeffrey R Kaiser and Alistair J Gunn 12nd yr Fellow, Neonatal Perinatal Medicine, Baylor College of Medicine Introduction Hypoxic-ischemic encephalopathy (HIE) is an important cause of mortality and poor neurodevelopmental outcomes in neonates1,2 Neonatal hypoglycemia is associated with poor outcomes2,3,4 Derangement of glucose homeostasis is common in infants with HIE, but the mechanisms are not clearly understood3 Whether early glucose derangement in infants with HIE affects outcomes is not conclusive2,3,4 The CoolCap Study was a multi-center randomized controlled trial conducted in 2002-06 involving 234 infants with HIE Selective head cooling in infants with HIE improved outcomes at 18 months1 Secondary analysis of CoolCap Study data Of the 234 infants randomized in the CoolCap Study, 16 (7%) infants were lost to follow-up and glucose data was unavailable in 4 (2%) of infants Plasma glucose levels noted at 0, 4, 8, 12, 24, 48 and 72 hrs after study randomization in 214 (91%) infants Hypoglycemia (≤40 mg/dL) and hyperglycemia (>150mg/dL) identified as single or recurrent occurrences in first 72 hrs Primary poor outcome - death and/or severe neurodevelopmental disability at 18 months of age Chi-square analysis to test for association of deranged glucose in infants with good vs poor outcome Multivariable logistic regression model used to adjust for birth weight, severity of HIE, randomization to cooling or standard therapy 1) Gluckman et al.: Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial. Lancet 2005; 365: 663–70 2 Continue reading >>

Case Based Pediatrics For Medical Students And Residents

Case Based Pediatrics For Medical Students And Residents

Department of Pediatrics, University of Hawaii John A. Burns School of Medicine Chapter III.8. Neonatal Hypoglycemia Return to Table of Contents This is a newborn infant male delivered to a 25 year old G5P3, A+ mother at 37 weeks gestation by C section (for non-reassuring fetal heart tones). The pregnancy is notable for an antenatal ultrasound diagnosis of cleft lip and palate. Maternal serologies are unremarkable and her prenatal glucose tolerance test is normal. At delivery, blow-by oxygen is given for about 2 minutes for poor color and respiratory effort. Apgar scores are 6 (-2 color, -1 tone, -1 respiratory effort) and 9 (-1 color) at one and five minutes, respectively. Exam: Vital signs are normal. Oxygen saturation is 99% in room air. Weight is 3950 gms, height is 54 cm and head circumference is 37.5 cm (all >95th percentile for gestational age). The infant is active and jittery with an obvious left sided cleft lip and palate. Heart is regular without murmurs. Lungs are clear. Abdomen is soft, without masses or hepatosplenomegaly. The remainder of the initial exam is normal. The infant is transferred to the term nursery for transitioning. A bedside glucose is obtained and the blood sugar is read as close to 0 mg/dl. A serum sample is then sent STAT to the lab. An IV is started and 8 ml (2 mg/kg) of 10% dextrose in water (D10W) is given IV. The infant is transferred to the intermediate nursery where a repeat blood sugar 30 minutes after the bolus is still <20 mg/dl. A second IV bolus of D10W is given. The earlier serum glucose sent to the lab, comes back at <2 mg/dl. IV D10 is infusing at 80 ml/kg/day, which is a glucose infusion rate of 5.6 mg/kg/min. A blood sugar obtained 30 minutes after a second bolus is 31 mg/dl. The fluid is changed to 12.5% dextrose (D12.5W Continue reading >>

Implementing A Protocol Using Glucose Gel To Treat Neonatal Hypoglycemia

Implementing A Protocol Using Glucose Gel To Treat Neonatal Hypoglycemia

Historically, determining evidence-based protocols for the treatment of neonatal hypoglycemia has been difficult because of a lack of clinical evidence defining pathologic glucose levels in neonates during the first hours of life (Committee on Fetus and Newborn & Adamkin, 2011). As recently as 2008, an expert panel at the Eunice Kennedy Shriver National Institute of Child Health and Human Development found that no threshold values had been established relating levels of glucose to pathologic neonatal hypoglycemia in infants, which remains true to this day (Cornblath et al., 2000, Hay et al., 2009). This lack of scientific knowledge has led clinicians across the country to use a wide range of disparate interventions. In 2011, in an effort to address this lack of an agreed-on treatment protocol for neonatal hypoglycemia, the American Academy of Pediatrics (AAP) published new management guidelines. These guidelines were necessary because, as the AAP explained, “The generally adopted plasma glucose concentration that defines neonatal hypoglycemia for all infants (< 47 mg/dl) is without rigorous scientific justification” (Committee on Fetus and Newborn & Adamkin, 2011, p. 576). Fetal glucose levels are dependent on maternal glucose supply and placental transfer, with a low-end normal value of 50 mg/dl. A physiologic decrease in glucose levels normally occurs immediately after birth and continues for the first 2 to 3 hours of life. Studies referenced by Hay et al. (2009)) found levels as low as 23 mg/dl in healthy breastfed infants. The Committee on Fetus and Newborn and Adamkin (2011)) found that levels of 30 mg/dl are common in healthy neonates during the initial 1 to 2 hours of life. After this temporary decrease, glucose levels in healthy neonates soon increase to 40 Continue reading >>

Neonatal Diabetes Mellitus: A Disease Linked To Multiple Mechanisms

Neonatal Diabetes Mellitus: A Disease Linked To Multiple Mechanisms

Abstract Transient (TNDM) and Permanent (PNDM) Neonatal Diabetes Mellitus are rare conditions occurring in 1:300,000–400,000 live births. TNDM infants develop diabetes in the first few weeks of life but go into remission in a few months, with possible relapse to a permanent diabetes state usually around adolescence or as adults. The pancreatic dysfunction in this condition may be maintained throughout life, with relapse initiated at times of metabolic stress such as puberty or pregnancy. In PNDM, insulin secretory failure occurs in the late fetal or early post-natal period and does not go into remission. Patients with TNDM are more likely to have intrauterine growth retardation and less likely to develop ketoacidosis than patients with PNDM. In TNDM, patients are younger at the diagnosis of diabetes and have lower initial insulin requirements. Considerable overlap occurs between the two groups, so that TNDM cannot be distinguished from PNDM based on clinical features. Very early onset diabetes mellitus seems to be unrelated to autoimmunity in most instances. A number of conditions are associated with PNDM, some of which have been elucidated at the molecular level. Among these, the very recently elucidated mutations in the KCNJ11 and ABCC8 genes, encoding the Kir6.2 and SUR1 subunit of the pancreatic KATP channel involved in regulation of insulin secretion, account for one third to half of the PNDM cases. Molecular analysis of chromosome 6 anomalies (found in more than 60% in TNDM), and the KCNJ11 and ABCC8 genes encoding Kir6.2 and SUR1, provides a tool to identify TNDM from PNDM in the neonatal period. This analysis also has potentially important therapeutic consequences leading to transfer some patients, those with mutations in KCNJ11 and ABCC8 genes, from insulin t Continue reading >>

Neonatal Hypoglycemia

Neonatal Hypoglycemia

1. HYPOGLYCEMIA IN NEWBORN Dr.David Mendez Miami Childrens Hospital Kidz Medical Services 2. INTRODUCTION • Common metabolic problem • Blood glucose in newborns are generally lower than older children & adult • Fetal glucose level maintained at 2/3 of maternal B.glucose by transplacental route • Glucose level fall in Ist 1-2 hrs,lowest value at age of 3 hrs, increase and stabilise by 4 hrs. • New born – glycogenolysis, gluconeogenesis and exogenous nutrients. 3. DEFINITION Defined as a blood glucose level of <40mg % regardless of gestational age and whether or not symptoms are present Whipple’s triad: • low glucose level documented by accurate lab method • Signs and symptoms of hypoglycemia • Resolution of signs and symptoms on restoration of blood glucose levels. 4. ETIOLOGY • Fetal or Neonatal Hyperinsulinism – ↑utilization of glucose.  Decreased production or store  Increased utilization and/or decreased production 5. Hypoglycemia of the newborn  Fetal or Neonatal Hyperinsulinism – ↑utilization of glucose.  Babies born to Diabetic mothers(15-25 % GDM,2550% DM)  LGA infants-16%  Erythroblastosis  Islet cell hyperplasia  Beckwith-Weidemann(macrosomia,microcephaly,omphalocoele,macroglos sia,visceromegaly). 6. Hypoglycemia of the newborn Insulin producing tumors(islet cell adenoma).  Maternal therapy with tocolytics like terbutaline,ritodrine, OHA and diuretics (chlorothiazide)  Glucose infusion through UAC –high glucose into celiac,SMA—stimulate insulin from pancreas 7. Hypoglycemia of the newborn  Decreased production or store:  Prematurity  IUGR (15% in SGA)  Inadequate calorie intake  Delayed onset of feeding 8. Hypoglycemia of the newborn  Increased utilisation or decreased production: Continue reading >>

Neonatal Hypoglycemia - Neonatology - Lecture Slides, Slides For Neonatology. All India Institute Of Medical Sciences

Neonatal Hypoglycemia - Neonatology - Lecture Slides, Slides For Neonatology. All India Institute Of Medical Sciences

Microsoft PowerPoint - Neonatal Hypoglycemia ppt 1.ppt [Read-Only] [Compatibility Mode] Incidence • 1-5 per 1,000 births • 8% in LGA • 15% SGA ( IUGR) • 30% entire population of high risk infants 2 Docsity.com Glucose Physiology A. Glucose Homeostasis in Utero • Energy as glucose,lactate,FFAs,ketones,surplus amino acids • Facilitated diffusion across the placenta • Fetal blood glucose concentration approx 70% of maternal value 3 Docsity.com Glucose Homeostasis in Utero Insulin appears in the fetal pancreas and plasma at 12 weeks gestation • permissive in accumulation of hepatic glycogen stores • high insulin: glucagon inc glycogen synthesis and suppression of glycogenolysis suppresses lipolysis 4 Docsity.com Glucose Homeostasis in Utero • Marked increase in glycogen synthesis during early and mid gestation associated increase in circulating concentration of both insulin & cortisol • Fetal ,hormonal and metabolic milieu establishes a ready substrate supply that can be used during the metabolic transition from fetus to newborn. 5 Docsity.com Glucose Homeostasis in Newborn AT DELIVERY: rapid glycogenolysis Adaptive response surge in plasma glucagon & decrease in plasma insulin (high glucagon: insulin) mobilizes glucose & fatty acids from glycogen & triglyceride depots high glucagon: insulin induces synthesis of enzymes required for gluconeogenesis Low blood glucose values are usually NOT related to any significant problem but are 20 to normal process of metabolic adaptation to extrauterine life 6 Docsity.com To maintain normal levels of hepatic glucose in newborn: • Adequate stores of glycogen and gluconeogenic precursors (fatty acid,glycerol,amino acids,lactate) • Appropriate concentration of hepatic enzymes required for glucogenolysis and glucon 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 >>

Background Drug Information

Background Drug Information

One Year Post-Exclusivity Adverse Event Review: Insulin Aspart Recombinant Pediatric Advisory Committee Meeting November 16, 2006 Hari Cheryl Sachs, MD, FAAP Medical Officer Pediatric and Maternal Health Staff Office of New Drugs Center for Drug Evaluation and Research Food and Drug Administration Background Drug Information Drug: NovoLog® (insulin aspart recombinant) Therapeutic Category: human insulin analog Sponsor: Novo Nordisk Inc Original Market Approval: June 7, 2000 Mechanism of action: regulation of glucose metabolism Binds to insulin receptors on muscle and fat Facilitates cellular uptake of glucose Inhibits output of glucose from liver Background Drug Information Indication: treatment of patients with diabetes mellitus, for the control of hyperglycemia Normally with regimen of intermediate or long-acting insulin May be infused via external insulin pumps May be used intravenously under medical supervision Dosage: Individualized, immediately prior to a meal Note: more rapid onset and shorter duration of regular insulin, usually used win regimens with intermed or long acting Dosage individualized, immediately before meal (within 5 to 10 min) Total daily requirement: typically 0.5 to 1.0 units/kg/day Meal related: 50 to 70 % total insulin may be provided by NovoLog Drug Use Trends (Outpatient Settings): Insulin Aspart Recombinant Dispensed prescriptions for NovoLog have been increasing (June 2004 to May 2006)1 Total NovoLog® and NovoLog® Mix 70/30 prescriptions increased by estimated 29% (~ 2.4 to 3.4 million)1 Relative increase in pediatric patient count: 22% (~47,000 to 57,000)2 Pediatric patients accounted for ~13% of prescriptions2 Majority of pediatric NovoLog® prescriptions to patients ages 12-16 years1 1Verispan LLC, Vector One National, Jun 20 Continue reading >>

A Case Of Neonatal Diabetes Presentation, Diagnosis And Management

A Case Of Neonatal Diabetes Presentation, Diagnosis And Management

Abstract We present a case of neonatal diabetes with special focus on the diagnostic therapeutic and education problems faced by the pediatric endocrinology team (physicians, nurses and diabetes educators) during the hospital course. Keywords: NDM: Neonatal Diabetes Mellitus Introduction Neonatal diabetes mellitus (NDM) is an extremely rare presentation of diabetes. Affected infants are often found to be hyperglycemic (but rarely ketotic). Once considered a single disease, neonatal DM is now known to be caused by mutation affecting insulin synthesis and release, and by several mutations causing severe insulin resistance. Knowing the cause is important to selection of appropriate therapy. The therapy is also different from the typical pediatric because of size and diet. Training the family to care for the diabetic neonate is challenging for all. This case report will review the presentation, work up needed to reach the diagnosis, and the management plan and goals. Case Report A preterm male infant was born at 37 weeks’ gestation, weighing 1565 grams. His mother is a 25 year old G2P0010. The mother denied any history of diabetes. The baby’s parents were first cousins of Pakistani origin. Her pregnancy was complicated by intrauterine growth retardation (IUGR) and low amniotic fluid index score (AFI). Labor was induced because of severe IUGR. The APGAR scores were 8 at 1 minute and 9 at 5 minutes. Patient was admitted to the neonatal intensive care unit because of the severely wasted appearance. On physical examination at birth, temperature was 96.5°–97.1° F, heart rate 118, respiratory rate 31, and blood pressure 83⁄48. The patient was very pale with light skin; the head was normocephalic without deformities. Cardiovascular and respiratory examinations were norma 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 >>

Factors That Contribute To Have A High-risk Neonate:

Factors That Contribute To Have A High-risk Neonate:

Introduction: Definition of High-risk Neonate: Any baby exposed to any condition that make the survival rate of the neonate at danger. A) High-risk pregnancies: e.g.: Toxemias B) Medical illness of the mother: e.g.: Diabetes Mellitus C) Complications of labor: e.g.: Premature Rupture Of Membrane (PROM), Obstructed labor, or Caesarian Section (C.S). D)  Neonatal factors: e.g.: Neonatal asphyxia Identification of some High-risk Neonates: The previous conditions often will result in Premature birth, Low birth weight infants, or infants suffering from: Hypothermia, Hyperthermia, Hypoglycemia, Infant of Diabetic Mother (IDM), Neonatal Sepsis, Hyperbilirubinemia, and Respiratory Distress Syndrome (RDS). Some Definitions: -  Low Birth Weight Infant: Is any live born baby weighing 2500 gram or less at birth. (VLBW: <1500 gm, ELBW:<1000 gm). - Preterm: When the infant is born before term. i.e.: before 38 weeks of gestation.  -  Premature: When the infant is born before 37weeks of gestation. -  Full term: When the infant is born between 38 – 42 weeks of gestation.  -  Post term: When the infant is born after 42 weeks of gestation. Definition: It is a condition characterized by lowering of body temperature than 36°C. Types of Hypothermia: Could be classified according to: Causes and according to Severity. I)     According to Causes: 1-   Primary Hypothermia: (immediately associated with delivery) In which the normal term infant delivered into a warm environment may drop its rectal temperature by 1 – 2°C shortly after birth and may not achieve a normal stable body temperature until the age of 4 – 8 hours. In low birth weight infants, the decrease of body temperature may be much greater and more rapid unless spec Continue reading >>

Neonatal Hypoglycemia

Neonatal Hypoglycemia

Presentation on theme: "NEONATAL HYPOGLYCEMIA"— Presentation transcript: 1 NEONATAL HYPOGLYCEMIA 3 References 5 Hypoglycemia is one of the most frequent metabolic problems in neonatal medicine 6 Neonatal glucose concentrations decrease after birth to as low as 30 mg/dL during the first 1 to 2 hours after birth 7 هموستاز گلوکز و سازگاری متابولیک طی انتقال از زندگی جنینی به نوزادی 9 Numerical definition of hypoglycemia/ determination of a cut- off value Is it true? 10 Approach based on clinical manifestation 11 Approach based on neurologic and developmental outcomes Data for this functional definition that correlates the glucose concentration with adverse neurodevelopmental outcome is still very limited 12 Approach based on neurologic and developmental outcomes 13 Approach based on neurologic and developmental outcomes This statement remains unchanged by more recently published evidence from a 15-year follow-up cohort of preterm infants (<32 weeks of gestation) with frequent low blood glucose measurements in the first 10 days and their carefully matched controls 14 Of concern is the widespread adoption of a single numerical value based on two published papers (whose results are now generally considered not to justify their conclusions) that a level of less than 2.6mmol/L (<47 mg/dL) should be used to define neonatal hypoglycemia 16 First The numerical ‘cut off’ value of the definition was widely adopted as <2.6 mmol/l (47 mg/dl) from the late 1980s, influenced by an important publication in 1988 by Lucas et al. They reported serious impairment in motor and cognitive development at 18 months in babies with recurrent ‘asymptomatic hypoglycemia’. 17 They stated that: ‘the association between modest hypoglyce Continue reading >>

Prophylactic Oral Dextrose Gel For Newborn Babies At Risk Of Neonatal Hypoglycaemia: A Randomised Controlled Dose-finding Trial (the Pre-hpod Study)

Prophylactic Oral Dextrose Gel For Newborn Babies At Risk Of Neonatal Hypoglycaemia: A Randomised Controlled Dose-finding Trial (the Pre-hpod Study)

Abstract Neonatal hypoglycaemia is common, affecting up to 15% of newborns, and can cause brain damage. Currently, there are no strategies, beyond early feeding, to prevent neonatal hypoglycaemia. Our aim was to determine a dose of 40% oral dextrose gel that will prevent neonatal hypoglycaemia in newborn babies at risk. Methods and Findings We conducted a randomised, double-blind, placebo-controlled dose-finding trial of buccal dextrose gel to prevent neonatal hypoglycaemia at two hospitals in New Zealand. Babies at risk of hypoglycaemia (infant of a mother with diabetes, late preterm delivery, small or large birthweight, or other risk factors) but without indication for admission to a neonatal intensive care unit (NICU) were randomly allocated either to one of four treatment groups: 40% dextrose at one of two doses (0.5 ml/kg = 200 mg/kg, or 1 ml/kg = 400 mg/kg), either once at 1 h of age or followed by three additional doses of dextrose (0.5 ml/kg before feeds in the first 12 h); or to one of four corresponding placebo groups. Treatments were administered by massaging gel into the buccal mucosa. The primary outcome was hypoglycaemia (<2.6 mM) in the first 48 h. Secondary outcomes included admission to a NICU, admission for hypoglycaemia, and breastfeeding at discharge and at 6 wk. Prespecified potential dose limitations were tolerance of gel, time taken to administer, messiness, and acceptability to parents. From August 2013 to November 2014, 416 babies were randomised. Compared to babies randomised to placebo, the risk of hypoglycaemia was lowest in babies randomised to a single dose of 200 mg/kg dextrose gel (relative risk [RR] 0.68; 95% confidence interval [CI] 0.47–0.99, p = 0.04) but was not significantly different between dose groups (p = 0.21). Compared to mu Continue reading >>

Glucose Regulation In Preterm Newborn Infants

Glucose Regulation In Preterm Newborn Infants

Abstract After birth, continuous transplacental transfer of glucose is interrupted. Neonates have to provide brain and vital organs with sufficient glucose. In term newborn infants, this is accomplished through well-coordinated hormonal and metabolic adaptive changes. During the first week of life, preterm infants are at high risk of abnormal glucose homeostasis. They are at risk of hypoglycemia due to limited glycogen and fat stores that should have occurred in the third trimester. Continuous glucose infusion is always required soon after birth to maintain the glucose level. However, under such conditions, many preterm infants develop hyperglycemia. Defective islet β-cell processing of proinsulin is likely related to hyperglycemia. There is also evidence that preterm infants are partially resistant to insulin. By contrast with adults, hepatic glucose production is not suppressed during parenteral glucose infusion. Exogenous insulin infusion partially reduces endogenous glucose production in preterm newborn infants. This treatment is efficient and safe when used with caution. More research is needed to understand the specificity of glucose homeostasis in preterm infants and to evaluate the long-term consequences of metabolic and nutritional support during early life. © 2007 S. Karger AG, Basel Introduction Transition from fetal to neonatal life requires a number of adaptations which are more difficult to accomplish by preterm than term newborn infants. Knowledge of key regulatory mechanisms of glucose homeostasis during fetal life and the early neonatal period is essential to understand the specificities of glucose homeostasis in preterm infants. During early postnatal life, infants born prematurely are at high risk of altered glucose homeostasis. Early continuous glu 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 >>

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