Neonatal Hypoglycemia
Neonatal hypoglycemia, defined as a plasma glucose level of less than 30 mg/dL (1.65 mmol/L) in the first 24 hours of life and less than 45 mg/dL (2.5 mmol/L) thereafter, is the most common metabolic problem in newborns. Major long-term sequelae include neurologic damage resulting in mental retardation, recurrent seizure activity, developmental delay, and personality disorders.
Glucose is the main fuel source for the body and brain. It can also cause problems, including breathing and feeding issues. The condition is treatable, but if not detected, it could be fatal, especially if an underlying condition is to blame.
Symptoms –
• Bluish-colored skin (cyanosis)or pale skin
• Breathing problems, such as rapid breathing (tachypnea), pauses in breathing (apnea), or a grunting sound
• Irritability or listlessness
• Loose or floppy muscles (hypotonia)
• Vomiting or poor feeding
• Weak or high pitched cry
• Tremors, shakiness, sweating, or seizures
Causes –
Babies get glucose from their mothers through the placenta before they are born. After birth, their sources of glucose are breast milk and formula. Glucose is also produced in the liver. Blood sugar may drop when there is too much insulin (a hormone that pulls glucose from the blood), if the baby is not producing enough or using too much or if the baby is unable to feed.
Risk Factors –
Some medical conditions that can cause NH are listed below –
• Babies who are unusually small or large for gestational age (see our pages on intrauterine growth restriction [IUGR] and macrosomia)
• Preterm babies: may have poor nutrient reserves and immature hormone systems that can increase their risk
• Babies who were born to diabetic mothers
• Babies who have a history of asphyxia (HIE) or stress in the womb
• Babies with low thyroid hormone levels (hypothyroidism)
• Babies who have certain rare genetic disorders
Complications –
Brain needs blood glucose to function. Not enough glucose can harm the brain’s ability to function. Severe or long-lasting hypoglycemia may cause seizures and serious brain injury
Diagnosis –
Newborns at risk for hypoglycemia should have a blood test to measure blood sugar level frequently after birth. This will be done using a heel stick. The health care provider should continue taking blood tests until the baby’s glucose level stays normal for about 12 to 24 hours.
Other possible tests include newborn screening for metabolic disorders, such as blood and urine tests.
Treatment –
Following treatment methods can be adopted for neonatal hypoglycemia
• IV dextrose (for prevention and treatment)
• Enteral feeding
• Sometimes IM glucagon
Most high-risk neonates are treated preventively. For example, infants of diabetic women who have been using insulin are often started at birth on a 10% D/W infusion IV or given oral glucose, as are those who are sick, are extremely premature, or have respiratory distress. Other at-risk neonates who are not sick should be started on early, frequent formula feedings to provide carbohydrates.
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