neonatal problem 2

8/3/2019 Neonatal Problem 2

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HYPOGLYCAEMIA

Blood glucose level is < 2.6 mmol/l in a term or

preterm infant



Hypoglycemia is the most commonmetabolic problem in newborns. It occursin approximately 1 - 3 out of every1,000 births.



Babies need glucose for energy. Most of thatglucose is used by the brain.

The foetus gets glucose from the mother throughthe placenta. After birth, the baby gets glucose byproducing it in the liver and from food.

Glucose levels can drop if:

There is too much insulin in the blood(hyperinsulinism).

There is not enough glycogen The baby is not producing enough glucose.

The baby¶s body is using more glucose than isbeing produced.



ETIOLOGY: conditions associated with an increased risk for

neonatal hypoglycemia include:

1. Decreased

substrate

availability:

Intra-uterine growthretardation

Glycogen storagedisease

Inborn errors (e.g.,

fructose intolerance)

Prematurity

2. Hyperinsulinemia:

Infant of diabeticmother

Islet cell hyperplasia

Erythroblastosisfetalis

Exchange transfusion



3. Other endocrine abnormalities:

Hypothyroidism

Adrenal insufficiency

4. Increased glucose utilization: Cold stress

Increased work of breathing

Sepsis

Perinatal asphyxia

5. Miscellaneous conditions:

Polycythemia

Congenital heart disease

CNS abnormalities



Symptoms

Jitteriness and irritability

Apnoea

Cyanosis

Hypotonia

Poor feeding

Convulsion

Tremor Sweating

Hunger, nausea, and vomiting



Management : Prevention and Early

detection

Identify babies at risk

For well babies who are at risk :

-immediate feeding:first feed can be given at labour

room-supplement feeding until breastfeeding established

For unwell babies

-set up dextrose 10% drip

Regular glucometer monitoring-on admission and at 1,2,4 hours later

-3 to 6 hourly pre feeding samples once glucose stablefor 24-48 hours.



Treatment

Repeat the glucometer test and send Random Blood Sugar

stat

Examine and document any symptoms

Note when the last feeding was given If on iv drip , check the iv infusion of glucose is adequate and

running well

If blood sugar level (BSL) < 1.5 mmol/l or if the baby

symptomatic-intravenous bolus dextrose 10% at 2-3ml/kg

-followed by dextrose 10% drip at 60-90 ml/kg/day ( for

1st day of life) to maintain normal blood glucose



if baby sugar level 1.5-2.5mmol/l

-give supplementary feed as

soon as possible-If BSL remains < 2.6mmol/l and

baby refused to feed ,set updextrose 10% drip.

-if baby is on dextrose 10% drip ,consider stepwise incrementusing glucose infusion rate by

2mg/kg/min until blood sugar is



Glucose monitoring

-if capillary blood sugar is < 2.6 mmol/l,check theglucometer half hourly

If capillary blood sugar >2.6 mmol/l for 2

readings : Monitor hourly x 2,then 2 hourly x 2,then 4-6 hourly

if blood sugar remains normal.

Start feeding when capillary blood sugar remains

stable and increase as tolerated. Reduce the iv infusion rate one hour after feeding

increment.



Complications

Severe or long-term hypoglycemia may lead to :

Brain damage Developmental delay

Heart failure

Seizures



Prognosis

The outlook is good for newborns who do not

have symptoms, or who have hypoglycemia

that gets better with treatment. However,

hypoglycemia can return in a small percentageof babies after treatment.

The condition is more likely to return when

babies are taken off intravenous feedingsbefore they are fully ready to eat by mouth.

Babies with symptoms are more likely to

develop problems with learning. This is

especially true for babies with lower-than-



2. INFANT OF DIABETIC MOTHER



An infant of a diabetic mother is a baby born to a

mother who has diabetes. The phrase specifically

refers to a baby who is born to a mother who had

persistently high blood glucose levels duringpregnancy.



Causes, incidence, and risk factors

High blood sugar levels in pregnant women

often have specific effects on their infants.

Infants born to mothers who have diabetes are

generally larger than other babies. They mayhave large organs, particularly the liver, adrenal

glands, and heart.

These infants may have episodes hypoglycemia

shortly after birth because of increased

insulin.The infant will need close monitoring of

blood sugar levels.



Symptoms

The infant is usually large for gestational age. Othersymptoms may include:

Blue or patchy (mottled) skin color, rapid heartrate, rapid breathing (signs of immature lungs or heart failure)

Newborn jaundice

Poor feeding, lethargy, weak cry (signs of severe

low blood sugar) Puffy face

Reddish appearance

Tremors or shaking shortly after birth



Signs and tests

An ultrasound performed on the mother in the lastfew months of pregnancy shows that the baby islarge for gestational age.

Lung maturity testing may be performed on theamniotic fluid if delivery is being considered morethan a week before the due date.

After birth, tests may show that the infant has low

blood sugar and low blood calcium. Anechocardiogram may show an abnormally largeheart, which can lead to heart failure.



Complications

Macrosomia

Congenital heart defects

Heart failure

Small left colon syndrome - causes symptoms of intestinalblockage

Hyperbilirubinemia -- may cause permanent brain damage

Immature lungs ² lack of surfactant

Neonatal polycythemia -- this may cause a blockage in the

blood vessels Severe hypoglycemia- may cause permanent brain damage

Stillbirth



Treatment

All infants who are born to mothers with diabetes

should be tested for low blood sugar

(hypoglycemia), even if they have no symptoms.

If an infant had one episode of low blood sugar,

tests to check blood sugar levels will be done over

several days. This will continue until the infant's

blood sugar remains stable with normal feedings.

Early feeding may prevent low blood sugar in mild

cases. Persistent low blood sugar is treated with

glucose given through a vein.



Prognosis

Better control of diabetes and early recognition of

gestational diabetes has decreased the number and

severity of problems in infants born to mothers with

diabetes. Usually, an infant's symptoms go awaywithin a few weeks. However, an enlarged heart

may take several months to get better.

neonatal problem 2

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