Hypoglycemia

 Hypoglycemia

Metabolic problem in Neonates.

Normal fasting glucose; 70-140mg/dl

In children blood glucose level <40mg/dl represent; Hypoglycemia

In Newborn; plasma glucose level; <30mg/dl in first 24 hours of life and less than 45mg/dl thereafter.

Causes of Hypoglycemia

1. Persistant hyperinsulinemia

2. Limited glycogen stores (in premature and intrauterine growth retardation babies)

3. Increased glucose use (hyperthermia, polycythemia, sepsis or growth hormone deficiency)

4. Decreased glycogenolysis, Gluconeogenesis or use of alternate nutrients for energy.

5. Depleted glycogen stores (asphyxia, perinatal stress, starvation)

In premature baby; limited glycogen stores, hypothermia, sepsis

Risk factors

1. Sepsis (blood infection)

2. Low thyroid hormone production; endocrine disorders

3. Inborn errors of metabolism 

4. IUGR (intrauterine growth retardation)

5. Babies of mothers with diabetes

6. Birth asphyxia

7. Premature babies

Neonatal Hypoglycemia

Fetal life with constant supply of glucose from mother.

Extrauterine life of intermittent supply with feeding.

Clinical features

1. Cyanosis (Bluish discoloration of skin)

2. Breathing problem/dysnea

3. Hypotonia; weak muscle tone

4. Grunting

5. Poor feed

6. Hypotension

7. Decreased reflexes

8. Twitching and tremors

9. Seizures/altered sensorium

10. Irritability or lethargy

Management

1. Hypothermia causes hypoglycemia

Hypthermia prevented by initiating breastfeeding as soon as possible after birth (within 30 minutes).

When baby get cold, uses up more glycogen to keep warm, utilize glucose store to keep warm, blood sugar level drops.

2. Pharmacological management

1. Symptomatic infants need a bolus of 2-4ml of 10% dextrose and then infusion of 5-10mg/kg/minute till blood glucose level rises above 40mg/dl.

If hypoglycemia continues, baby need medication;

Diazoxide (to increase blood sugar)

Ocreotide (to reduce insulin production)

Complications of Hypoglycemia

1. Developmental delay; failure to thrive 

2. Seizures

3. Heart failure

4. Prolonged hypoglycemia lead to brain damage

5. Altered brain activity