Fifth stage
PediatricLec6
د.رياض
14/12/2016
Neonatal hypoglycemiaDefinition:
When Serum glucose <40mg/dl(<2.2mmol/l)in term newborn, and <30mg/dl(<1.7mmol/l)in preterm babies.it is usually transient and rarely permanent hypoglycemia.common risk factors to suspect it to occur are ;
Premature babies.
Small for gestational age SGA
Neonatal Sepsis
Infant of diabetic mother IDM.
Perinatal asphyxia
Erythroblastosis fetalis.
Aetiology of neonatal hypoglycemia
Deficient glycogen store; In premature, SGA, feeding delay due to sick newborn.Hyperinsulinism ; infant of diabetic mother IDM,
Beckwith-Wiedman S.(hyperplasia of islet cells, macroglossia, umbilical hernia), erythroblastosis fetalis (Rh-isoimunisation.).
Inborn error of metabolism like in defective fatty acids metabolism, glycogen storage diseases and galactosemia
Hormonal deficiency; low growth hormone, congenital hypothyroidism, cortisol hormone deficiency like in congenital adrenal hyperplasia CAH.
Symptoms and signs:
Many newborns with hypoglycemia are asymptomatic. Features includes; poor feeding, lethargy, apnea , seizures, jitterness, cyanotic spells, tremors, hypothermia. all these features are nonspecific and subtle, it simulate sepsis, hypothermia, hypocalcemia, so when a risk factor is present and clinical features are suggestive then do rapid bedside capillary needle stick blood sugar test. Treatment of symptomatic and asymptomatic cases is crucial, because recurrent attacks or persistent hypoglycemia may damage the brain and may lead to mental retardation and CP in future.
Treatment:
For symptomatic newborn; Rapid IV 2-4ml/kg D10% (DEXTROSE) given, followed by infusion of 4-8mg glucose/kg/min fluid for many hrs, followed by early oral feedings when the condition allows. In resistant difficult cases; glucagon injection or hydrocortisone can be used if glycogen store present.
For asymptomatic and mild cases; early encouragement of repetitive oral feedings together with BS testings : is enough to correct hypoglycemia.