NEONATAL HYPOGLYCEMIA AND HYPOCALCEMIA

In hypoglycemia and hypocalcemia, separation of the placental suddenly interrupts the

constant infusion of glucose. The high level of circulating glucose at the time the umbilical cord
is severed falls rapidly in the presence of fetal hyperinsulinism. Asymptomatic or symptomatic
hypoglycemia occurs within the first 1 to 3 hours after birth.

Hypocalcaemia occurs in 30% of IDMs. In addition, hypocalcaemia is associated with preterm

birth, birth trauma, and Perinatal asphyxia. symptoms of hypocalcaemia, a prevalent finding in
IDMs and IGDMs, are similar to those of hypoglycemia but they occur between 24 and 36 hours
of age. However, hypocalcemia must be considered if therapy for hypoglycemia is ineffective.

NEONATAL HYPOGLYCEMIA

Neonatal hypoglycemia is a common metabolic disorder which can cause unexplained death and
high mortality incidence and severity of the condition can be reduced by initiating appropriate
feeding regimen and timely administration of supplements. Prompt intervention and therapy
have dramatic response in the improvement of the neonatal condition.

DEFINITION: Hypoglycemia in the newborn baby is termed when the glucose level is less
than 40mg/dl, irrespective of period of gestational age.

It may be asymptomatic or symptomatic.

CAUSES: neonatal hypoglycemia is found soon after birth in low birth weight infants of
diabetic mothers. It may seen as secondary problem to Perinatal stresses like asphyxia,
hypothermia, infection , polycythemia, respiratory distress and neurological disturbances. It may
also be found in IUGR, smaller twins, babies born to mother with PIH, Rh incompatibility and
maternal tocolytic therapy like isoxsuprine, salbutamol etc.

Intractable hypoglycemia may occur due to number of metabolic and developmental disorders
like glycogen storage disease, galactosemia, adrenal insufficiency etc.

CLINICAL MANIFESTASTIONS:

The clinical features are associated with release of epinephrine and activation of automatic
nervous systems which may altered due to anoxia and intracranial injury.

The neonates may present with refusal of feeds, sweating, tachycardia, tremors, pallor,
hypothermia, lethargy or irritability, restlessness, convulsions and coma.

Apnea with cyanosis, tachypnea with irregular breathing may also occur in preterm babies.
PROGNOSIS: the prognosis of hypoglycemia is generally poor. Untreated symptomatic
neonates usually have fatal outcome. Among survivors of symptomatic cases, about 50 percent
neonates may have mental retardation or cerebral palsy with convulsions. In asymptomatic
hypoglycemic babies of diabetic mothers the prognosis usually excellent.

MANAGEMENT: hypoglycemia should be prevented by early initiation of breastfeeding

within first hour of birth. The baby should be nursed in warm or themoneutral environment with
careful observation of at risk situations and prevention of hypoxia and hypothermia.

In symptomatic infant with convulsions, 25 percent dextrose 2ml/kg IV bolus is given. If there
is no convulsions, 10 percent dextrose 2 ml /kg IV is given followed by continuous infusion of
10 percent dextrose at a rate of 6-8 mg/kg/minute. Blood glucose level to be checked every ½
hourly.

Infusion rate to be reduced only if last two glucose estimation is more than 60 mg/dl. Oral feeds
are introduced gradually and glucose infusion is tapered off.

NURSING DIAGNOSIS:

High risk for injury related to metabolic effects of maternal condition