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Neonatal Hypoglycemia
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Definition
� Blood Sugar level less than 2.6 mmol/L
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Glucose levels can drop if:
� There is too much insulin in the blood
(hyperinsulinism). Insulin is a hormone that pulls
glucose from the blood into the cells to be used
for energy.
� There is not enough glycogen, the form in which
glucose is stored in the body.
� The baby is not producing enough glucose.� The baby¶s body is using more glucose than is
being produced.
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Hypoglycemia In Neonates
� Transient Hypoglycemia
� Decreased glycogen stores
� Recurrent and persistant hypoglycemia
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Transient Hypoglycemia
� Sepsis
� Asphyxia
� Hypothermia� Polycythemia
� Infant of diabetic mother
� Insufficient glucose administration
� Shock
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� Maternal drug usage- exp: terbutaline,
labetolol..
� Exchange transfusion� Large for gestational age infants
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Decreased Glycogen Stores
� Intrauterine growth restriction / small for
gestational age
� Premature / Postmature infants� Caloric intake is insufficient
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Recurrent and Persistant
Hypoglycemia� Hormone excess hyperinsulinism
� Hormone deficiencies
� Hereditary defects in carbohydratemetabolism
� Hereditary defects in amino acid
metabolism
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Causes not to be missed
� Expired dextrostrix
� Patient kept NBM but no IVD/ IVD not up
to requirement� IV line not functioning well
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Hypoglycemic babies may appear with
symptoms or without symptoms
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Common symptoms of
Hypoglycemia� Jitterness
� Cyanosis
� Apnea
� Irregular respirations� Poor sucking or feeding
� Tremors
� Irritability
� Hypotonia� Exaggerated moro reflex
� Temperature instability
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Rarely,
� Bradycardia / tachycardia
� Abnormal cry (high pitched cry)
� Tachypnea� Vomitting
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How causes and symptoms of
hypoglycemia related
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� Infusion rate of glucose is 4-6mg/kg/min and canbe increased up to 12-20mg/kg/min
� Breast feeding should be encourage wherepossible
� Milk Formula provides more energy/ml thanD10%
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� Milk feed must not be discontinued or
reduced when on IVD unless NEC is
suspected
� In premature babies/ babies that required
fluid restriction, may increase
concentration of glucose before volume
increment.
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Investigations
� DXT
� FBC- to evaluate sepsis and to rule out
polycythemia
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Follow-up studies for persistant
Hypoglycemia
Blood
� Random Glucose
� Lactate/ Pyruvate
� Ketone Bodies
� FFA
� Aminoacids
� Insulin/ C-peptide� Cortisol/growth
� Hormone
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Urine
� Ketones
� Reducing substance� Organic acids
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Diagnostic Criteria For
Hyperinsulinism
� Glucose requirement >6-8mg/kg/min to maintainBS above 3mmol/L
� Random BS<2.6mmol/L
� Detectable insulin with raised C-peptide whenhypoglycaemia
� Low blood FFA and ketone body whenhypoglycemia
� Glycemis response after administration of glucagons when hypoglycaemia
� Absence of ketouria.