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Neonatal Hypoglycemia
Aka: Neonatal Hypoglycemia, Hypoglycemia in Infants
- Causes
- Decreased Glucose stores
- Prematurity
- Intrauterine Growth Retardation (IUGR)
- Hypoxia or asphyxia
- Sepsis
- Hypothermia
- Congenital Heart Disease
- Glycogen Storage Disease
- Glucagon deficiency
- Adrenal Insufficiency
- Galactosemia
- Fructose intollerance
- Hyperinsulinism
- Mother with Diabetes Mellitus
- Erythroblastosis Fetalis
- Exchange Transfusion in Newborns
- Beckwith-Wiedemann Syndrome
- Nesidioblastosis
- Islet Cell adenoma
- Leucine sensitivity
- Maternal Medications
- Salicylates
- Beta-Sympathomimetics
- Chlorpropamide
- Benzothiadiazide
- Associated Conditions in children of diabetic mothers
- Perinatal asphyxia
- Birth Trauma (Shoulder dystochia)
- Congenital anomalies
- Hypocalcemia
- Hyperbilirubinemia
- Respiratory distress syndrome
- Polycythemia
- Feeding problems
- Renal vein thrombosis
- Symptoms
- Jittery or Tremors
- Lethargic
- Hypotonia
- Apnea
- Hypothermia
- Cyanosis
- Seizures
- Weak or high pitched cry
- Poor feeding
- Labs
- Blood Glucose Monitoring
- Hours of life: 1, 2, 3, 6, 12, 24, and 48 hours
- Increase frequency of checks for symptoms
- Serum Calcium
- Check if lethargic or jittery despite normal Glucose
- Hematocrit
- For signs of Polycythemia
- Neonatal Bilirubin (as indicated)
- Arterial Blood Gas
- Indicated for signs of respiratory distress
- Radiology
- Chest XRay indicated for respiratory distress
- Management: General Approach
- Monitor Blood Sugar closely at above intervals
- Glucose 35 to 45 mg/dl
- Oral Glucose replacement (see below)
- Parenteral Glucose replacement if symptomatic
- Glucose 25-34 mg/dl
- Attempt oral Glucose replacement (see below)
- Parenteral Glucose replacement usually indicated
- Glucose <25 mg/dl
- Parenteral Glucose Replacement (initially with bolus)
- Strongly consider NICU Admission
- Glucagon if Intravenous Access delayed
- Dose: 0.1 mg/kg/dose to 1 mg max IM or SQ q30 min
- Not effective in SGA infants
- Oral Glucose Replacement
- Gavage or oral feedings hourly until Glucose normal
- Use 5% Dextrose in Water (D5W) or Infant Formula
-
Parenteral Glucose Replacement
- Preparation of Glucose Solutions
- D10W = 1:4 Dilution of D50W in sterile water
- Do NOT use >12.5% Glucose solutions in newborns
- Intravenous Glucose Maintenance
- Load: 2 ml/kg D10W at 2 ml/min
- Maintenance: 80 ml/kg/day D10W
- Emergent Glucose replacement
- Dose: 0.5-1.0 g/kg (5-10 ml/kg D10W) IV over 20 min