Hypoglycemia in the Newborn Laura Plachta, M'D'

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Hypoglycemia in the NewbornLaura Plachta, M.D.
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Definition Hypoglycemia

• Two plasma glucose levels lt 35 mg/dl in the first
  72 hours of life
• Or, if symptomatic, plasma glucose levels lt 40
  mg/dl, with symptoms resolving upon
  administration of glucose
• After 72 hours, defined as 2 measurements lt 45
  mg/dl

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Infants at Greatest Risk

• SGA (Small for Gestational Age)
• LGA (Large for Gestational Age)
• IDM (Infants of Diabetic Mothers)

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Causes of hypoglycemia

• Hyperinsulinemia
• IDM
• Decreased production or stores
• prematurity
• IUGR

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Causes of hypoglycemia, cont

• Perinatal stress
• asphyxia
• sepsis, shock
• hypothermia
• Inborn errors of metabolism
• galactosemia
• fructose intolerance
• Polycythemia

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Clinical signs commonly associated with neonatal
hypoglycemia

• tremors or jitteriness
• irritability
• apneic spells, cyanotic spells
• seizures
• limpness/lethargy

• hypothermia
• weak cry
• poor feeding
• cardiac failure or arrest

May be caused by other disease processes
(infection, heart failure) or may be a
contributing factor to a primary disease.
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Treatment

• Identification of infants at risk (SGA, LGA, IDM,
  etc.)
• Prompt administration of glucose for any
  measurement lt 30 mg/dl
• enteral feedings ASAP
• emergency 2 cc/kg of D10W IV
• systematic monitoring of infant for further
  episodes (e.g. accucheck Q 1 hour x 3 and QAC for
  infants at risk)