Neonatal hypoglycemia

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Neonatal Hypoglycemia
CausesHyperinsulinism, limited glycogen stores, increases glucose use, decreased gluconeogenesis, depleted glycogen stores
Risk factorsMaternal-Gestational diabetes, eclampsia, drug use. Neonate- small for gestational age, inadequate feeding, respiratory distress
Diagnostic methodBlood sample
Treatment40% dextrose gel, 10% dextrose influsion, early breastfeeding

Neonatal hypoglycemia occurs when the neonate's blood glucose level is less than the newborn's body requirements for factors such as cellular energy and metabolism.[1] Neonatal hypoglycemia is when the blood glucose level is below 30 mg/dl within the first 24 hours of life and below 45 mg/dl thereafter.[2] The neonates gestational age, birth weight, metabolic needs, and wellness state of the newborn has a substantial impact on the neonates blood glucose level.[1] There are known risk factors that can be both maternal and neonatal.[1] This is a treatable condition.[1] Its treatment depends on the cause of the hypoglycemia. Though it is treatable, it can be fatal if gone undetected.[1] Hypoglycemia is the most common metabolic problem in newborns.[2]

Long term complications of neonatal hypoglycemia include:

  • Neurologic damage that results in mental retardation[2]
  • Developmental delay[2]
  • Personality disorders[2]
  • Recurrent seizure activity[2]
  • Impaired cardiovascular function[2]

Neonatal hypoglycemia occurs in between 1 in 3 births out of every 1,000 births.[3]

Mechanism and pathophysiology[edit]

There are two types of hypoglycemia: transient and reoccurring.[1] Each is associated with different risk factors.[1] They are both based on other conditions that cause decrease hepatic glucose production.[1] Neonatal hypoglycemia occurs because an infants brain is dependent on a healthy supply of glucose.[1] During the last trimester of pregnancy, glucose is stored in the liver, heart, and skeletal muscles.[1] Newborns do have the ability to use an alternative form of energy.[1] However, some newborns are only able to compensate this glucose deficiency up to a certain limit. Infants who have hyperinsulinism may increase the risk to develop hypoglycemia.[1] There are other conditions that can increase the risk of an infant becoming hypoglycemic (See Risks).[1]

Etiology[edit]

Causes of neonatal hypoglycemia[edit]

Congenital hyperinsulinism
InsulinHexamer.jpg
Insulin (which this condition creates in excess)
CausesMaternal diabetes, isolated islet adenoma
Risk factorsMaternal diabetes
Diagnostic methodBlood sample
TreatmentOctreotide, and nifedipine, Diazoxide

Hyperinslunism[edit]

The most common cause on neonatal hypoglycemia is hyperinsulinism.[2] Hyperinsulinism is also called persistent hyperinsulemic hypoglycemia of infancy (PHHI).[2] This is seen very frequently to the neonates born from mothers with diabetes.[2] Congenital hyperinsulinism is correlated with the abnormality of beta-cell regulation within the pancreas.[2] Isolated islet adenoma, which is a focal disease, is often the cause of congenital hyperinsulism.[2] Drug-induced hyperinsulisim is correlated with the administration insulin or use of hypoglycemic medication.[2] In critical cases, a drug called Diazoxide is availed to stop any secretion of insulin.[2]

Limited glycogen stores[edit]

Limited glycogen storage occurs in premature newborns or newborns that had intrauterine growth retardation.[2]

Increased glucose use[edit]

Major causes of increased glucose use in a newborn include hyperthermia, polycythemia, sepsis, and growth hormone deficiency.[2]

Decreased gluconeogeneis[edit]

Two major issues that cause decreased gluconogeneis are inborn errors of metabolism and adrenal insufficiency.[2]

Depeleted glycogen stores[edit]

Most common causes of depleted glycogen stores are starvation and asphyxia-perinatal stress.[2]

Risks[edit]

Maternal risks[edit]

The maternal facets that cause the neonate to have an increased risk of developing hypoglycemia shortly after birth are:

Neonatal risks[edit]

Those infants that have an increased risk of developing hypoglycemia shortly after birth are:

Clinical manifestations[edit]

The way in which neonatal hypoglycemia symptoms may be presented is vague or hard to tell apart from other conditions. The symptoms can be confused with:

  • hypocalcemia[1]
  • septicemia[1]
  • CNS disorders[1]
  • Cardiorespiratory problems[1]

Neonatal hypoglycemia can also show no symptoms in some newborns or may be life threatening.[2]

Some observed symptoms are (these symptoms may be transient but reoccurring):

  • Jitteriness[2]
  • hypothermia [4]
  • irritability [4]
  • pallor [4]
  • tremors[1]
  • twitching[1]
  • weak or high pitched cry
  • lethargy[2]
  • hypotonia[1]
  • seizures[2]
  • coma[2]
  • cyanosis[2]
  • apnea[2]
  • rapid and irregular respirations[1]
  • diaphoresis[2]
  • eye rolling[1]
  • refusal to feed[1]
  • hunger [2]

Diagnostic evaluation[edit]

Screening for hypoglycemia is done on every neonate on admission.[1] One way of screening includes a heal stick to test the blood glucose level at the bedside.[1] Diagnosing hypoglycemia in neonates requires two consecutive blood glucose readings of less than 40 mg/dl to properly diagnose hypoglycemia.[1] Bedside glucose monitoring is only effective if the equipment is accurate, rapid, and reliable.[1] This form of testing is often faster and more cost effective.[1] Laboratory serum glucose testing is the most accurate way of testing blood glucose levels.[1] These specimens are either taken from the heel, arterial, or venous punctures and must be store immediately on ice in order to prevent glycolysis, further altering the results.[1] The hypoglycemic neonate should have a glucose test every 2–4 hours for the first 24 hours of life.[1]

Therapeutic management[edit]

Some infants are treated with 40% dextrose (a form of sugar) gel applied directly to the infant's mouth.[5] There are two main ways that neonatal hypoglycemia is treated.[1] The first way includes intravenous infusion of glucose.[1] For less severe, borderline, asymptomatic hypoglycemic neonates early introduction of breast milk can be effective for raising glucose levels to a healthy level.[1] Any infant at risk of hypoglycemia should have their blood sugar taken again one hour after birth.[1] Oral glucose is another option to restore normal glucose levels if the newborn is having difficulty latching to the breast or breastfeeding is not an option, however, breast milk is proven to be a better source as it includes glucose and carbohydrates.[1] It is recommended by The American Academy of Pediatrics that infants feed within the first hour of life with the glucose reading being 30 minutes after this feeding for an accurate result.[1] If the initial feeding does not raise the newborn's blood glucose above 40 mg/dl then the newborn must receive an IV infusion of 10% dextrose in water as a mini bolus as 2 ml/kg over 1 minute.[1] Following the mini bolus a continuous infusion of 10% dextrose in water at 80-100 ml/kg/day in order to maintain a healthy serum glucose level between 40–50 mg/dl.[1] Maintaining newborn thermoregulation is a large part in preventing further hypoglycemia as well.[1]

Nursing care management[edit]

The biggest nursing concern for a neonate experiencing hypoglycemia is the physical assessment to potentially find the cause.[1] It is also essential to prevent environmental factors such as cold stress that may predispose the newborn for further decreasing blood sugar.[1] Within the physical assessment, comorbidities of hypoglycemia should also be assessed such as intolerance of feeding, or respiratory distress.[1] Another important nursing intervention is assisting the mother in successful breastfeeding as this can prevent and treat hypoglycemia.[1]

If an IV infusion of 10% dextrose in water is initiated then the nurse must monitor for:

•Circulatory overload[1]

•Hyperglycemia[1]

•Glycosuria[1]

•Intracellular dehydration[1]

Research[edit]

2013 Prospective study[edit]

Risk factors and clinical manifestations[edit]

Neonatal hypoglycemia is becoming more prevelant due to the increasing preterm births and the increase in mothers having diabetes and being obese.[6] Neonatal hypoglycemia affects 5% to 15% of healthy babies and is associated with brain injury and poor neuron developmental outcome.[6] A 6 month prospective study done at Liaquat University Hospital studied 100 neonates with hypoglycemia.[6] Upon admission, the neonates blood was drawn into a dry fluoride oxalate containing specimen bottle and was tested in the laboratory for the plasma glucose level.[6] Out of the 100 neonates, 49% of the babies with hypoglycemia were under 37 weeks gestation and just over half of the neonates that had hypoglycemia were male.[6] The two most common characteristics that were found prior to admission were delayed feeding and low birth weight.[6] Furthermore, the 3 most common clinical manifestations of the neonates with hypoglycemia were jittieriness 38%, lethargy 35%, and temperature instability 32%.[6] The most common maternal risk factors for neonatal hypoglycemia were eclampsia 22%,maternal drug use 15% (beta blockers, oral hypoglycemic agents, and valproate), and maternal diabetic mellitus 13%.[6] The findings for the most common neonatal risk factors are small for gestational age 49%, inadequate feeding 35%. and respiratory distress 32%.[6] To reduce the number of neonates developing hypoglycemia, mothers should deliver in tertiary care hospitals and the neonates need the correct care antenatal.[6] Proper and crucial assessments can help avoid the neonate become hypoglycemic.

See also[edit]

References[edit]

  1. ^ a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac ad ae af ag ah ai aj ak al am an ao ap aq ar as at au av aw ax ay az ba bb bc bd be bf bg bh bi bj bk bl bm bn bo bp Wong's nursing care of infants and children. Hockenberry, Marilyn J.,, Wilson, David, 1950 August 25-2015 (10th ed.). St. Louis, Missouri. ISBN 9780323222419. OCLC 844724099.
  2. ^ a b c d e f g h i j k l m n o p q r s t u v w x y z aa Cranmer, Hilliarie. "Neonatal Hypoglycemia". Medscape.
  3. ^ "Low blood sugar - newborns: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 2018-11-07.
  4. ^ a b c Workbook in practical neonatology. Polin, Richard A. (Richard Alan), 1945-, Yoder, Mervin C., (Fifth ed.). Philadelphia, PA. ISBN 9781455774845. OCLC 877024368.
  5. ^ Weston, PJ; Harris, DL; Battin, M; Brown, J; Hegarty, JE; Harding, JE (4 May 2016). "Oral dextrose gel for the treatment of hypoglycaemia in newborn infants". The Cochrane Database of Systematic Reviews. 5 (5): CD011027. doi:10.1002/14651858.CD011027.pub2. PMID 27142842.
  6. ^ a b c d e f g h i j Bhand SA, Sheikh F, Siyal AR, Nizamani MA, Saeed M. Neonatal Hypoglycemia; Presenting pattern and risk factors of neonatal hypoglycemia. ProfessionalMedJ2014;21(4):745-749

Bibliography[edit]

  • Walker, Marsha (2011). Breastfeeding management for the clinician : using the evidence. Sudbury, Mass: Jones and Bartlett Publishers. ISBN 9780763766511.

External links[edit]


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