NEONATAL

HYPOGLYCEMIA
NEONATAL HYPOGLYCEMIA

AAP: blood glucose of <47 mg/dL [2.61 mmol/L]

PES: blood glucose value of less than 50 mg/dL (2.77 mmol/L) in
the first 48 hours after birth threshold for neonatal
hypoglycemia
threshold of 60 mg/dL (3.33 mmol/L) in the first 48 hours if
there is concern for a congenital hypoglycemia disorder
Background

Blood glucose concentrations as low as 30 mg/dL common in

healthy neonates by 1-2 hours after birth
Neonates compensate for physiologic hypoglycemia by
producing alternative fuels including ketone bodies, released from
fat
Epidemiology

1-3 in 1,000 live births

may occur in up to 10% of healthy term newborns, especially in
the first 24-48 hours after birth
Risk factors
Physiologic mechanisms leading to hypoglycemia:
Low hepatic glycogen stores
Inadequate muscles stores as a source of AA for
gluconeogenesis
Inadequate lipid stores as a source of fatty acids
Infants at HIGHEST RISK for clinically significant NH:
SGA
LGA
Born to mothers who have diabetes
Late preterm
Clinical Manifestations
Not specific
jitteriness, cyanosis, seizures,
apneic episodes, tachypnea, weak
or high-pitched cry, floppiness or
lethargy, poor feeding, and eye-
rolling
Coma and seizure with prolonged
NH (plasma or blood glucose
concentration lower than 10 mg/dL
range) and repetitive hypoglycemia
When to screen

Normal of neonatal glucose after birth (1-2) hrs.): as low as 30

mg/dL
12 hrs. after birth: increase above 45 mg/dL
 Management

Adamkin (2011). Clinical Report Postnatal Glucose Homeostasis in Late-Preterm and Term Infants.
American Academy of Pediatrics, Vol. 127, No. 3, pp. 575-579.
Prognosis

Principal concern: avoidance and treatment of cerebral energy

deficiency
Prognosis is good in asymptomatic neonates with hypoglycemia of
short duration
Hypoglycemia recurs in 10-15% of infants after adequate
treatment
Recurrence more common if IVF are extravasated or discontinued
too rapidly before oral feedings are well tolerated
THANK YOU!