1 / 13

Neonatal Hypoglycemia

Neonatal Hypoglycemia. Stan Jack, D.O. Saint Joseph Hospital Family Practice Residency. Neonatal Hypoglycemia - Significance. Persistent or recurrent hypoglycemia can result in impaired neurologic development and intellectual function

susan
Télécharger la présentation

Neonatal Hypoglycemia

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Neonatal Hypoglycemia Stan Jack, D.O. Saint Joseph Hospital Family Practice Residency

  2. Neonatal Hypoglycemia - Significance • Persistent or recurrent hypoglycemia can result in impaired neurologic development and intellectual function • Other sequela include spasticity, ataxia, and seizure disorder

  3. Neonatal Hypoglycemia - Definition • Plasma glucose <40 mg/dL on the first day of life • Plasma glucose <40-50 mg/dL after 24 hours of age • Note: whole blood glucose ~15% lower than plasma glucose measurements

  4. Neonatal Hypoglycemia - Pathogenesis • Glucose in utero comes from mother • After cord cut, glucose in newborn falls during first 2 hours, stabilizing by 4-6 hrs (transition period) • Dependent on glycogen storage depletion and carbohydrate intake

  5. Neonatal Hypoglycemia - Causes • Diminished glucose production (premature, IUGR) • Increased glucose utilization secondary to hyperinsulinism (infants of diabetic mothers, Beckwith-Weidmann, erythroblastosis, perinatal asphyxia) • Maternal tx with beta blockers • Sepsis

  6. Neonatal Hypoglycemia - Causes (continued) • Polycythemia • Metabolic disorders (inborn errors of carbohydrate / amino acid metabolism) • Endocrine disorders (low levels of cortisol, growth hormone, epinephrine, or glucagon) • Heart failure

  7. Neonatal Hypoglycemia - Clinical Manifestations • Frequently asymptomatic • Jittery, tremulous • Decreased tone • Irritable or lethargic; seizures • Apnea, bradycardia, cyanosis, tachypnea • Poor feeding

  8. Neonatal Hypoglycemia - Screening • Not routinely monitored unless at risk for hypoglycemia (next slide) • If screening done, obtain sample before feedings

  9. Neonatal Hypoglycemia - Risk Factors • Prematurity • Small or large for gestational age • Infants of diabetic mothers • ICU infants (i.e. sepsis) • Infants of mothers treated with beta blockers

  10. Neonatal Hypoglycemia - Management • If lower than 40 mg/dL, surveillance until feedings well established and glucose normal • If asymptomatic and term, obtain blood sample and immediately offer breast or formula feeding (consider gavage); recheck 20-30 minutes after feeding

  11. Neonatal Hypoglycemia - Management (continued) • If symptomatic OR not tolerating enteral feeds OR plasma glucose <20-25 OR if persistently <40 even after feeds, start parenteral glucose • Bolus 200 mg/kg (2 ml/kg 10% dextrose in H2O) over 1 minute followed by glucose infusion of 8 mg/kg per minute • If requirements high (>12.5%) may need central venous catheter

  12. Neonatal Hypoglycemia - Summary • Prolonged hypoglycemia may result in long-term morbidity • May be asymptomatic • Screening is based on risk factors

  13. Neonatal Hypoglycemia - Summary (continued) • If asymptomatic and glucose is moderately low, begin with feeding and surveillance • Symtomatic infants with very low glucose levels will need parenteral replacement • Do not hesitate to run things by your upper level, attending, or the neonatologist

More Related