HYPOGLYCEMIA

in
newborn
 Definition of
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.
• Neonatal hypoglycemia is the most common metabolic
problem in newborns.
 Neonates at risk of
hypoglycemia
Babies weighing less than 2.0 kg birth weight, preterm babies

LGA (large for gestational age) babies especially those weighing more
than 3.5 kg,

infants of diabetic mothers,

those with delayed cry at birth, any sick neonate who is not sucking or
accepting feeds are all at risk of developing hypoglycemia.

The other risk factors for hypoglycemia are RDS, polycythemia, shock,
and hypothermia
Factors which increase the risk of hypoglycemia

• Various factors which increase the risk of

hypoglycemia are hypothermia & cold Stress, cold
environment, wet baby and inadequate feeding.
 Etiolog
y

• Persistent hyperinsulinemic hypoglycemia of infancy (PHHI)

• Limited glycogen stores (eg, prematurity, intrauterine growth

retardation)
• Increased glucose use (eg, hyperthermia, polycythemia, sepsis,
growth hormone deficiency)
• Decreased glycogenolysis, gluconeogenesis, or use of alternate
fuels (eg, inborn errors of metabolism, adrenal insufficiency)
• Depleted glycogen stores (eg, asphyxia-perinatal stress,
starvation)
Symptoms of
hypoglycemia
The symptoms of hypoglycemia are very nonspecific and can mimic
any illness.

• The common symptoms are:

• Not looking well
• Lethargic,
• Weak cry,
• Poor feeding,
• Temperature instability like hypothermia,
• Poor respiratory effort: shallow breathing, apnea or cyanosis
• CNS symptoms like: excessive jitteriness, convulsions or hypotonia.
 Treatmen
t
• To raise the blood sugar value to normal range, give 200 mg/kg of
dextrose i.e. 2 ml /kg of 10% dextrose as bolus slowly over 3-5
minutes and start maintenance fluids with a dextrose infusion rate
(DIR) of 6 – 8 mg/kg/min.

• The maximum strength of dextrose that can be given through a

peripheral vein is 12.5%.

• Repeat Dextrostix after 15-30 minutes, if still low, repeat bolus and
increase (DIR) by 1 – 2 mg/kg/min or the maintenance fluids by 10 –
20 ml/kg/day.
How to monitor blood glucose in hypoglycemia
• In asymptomatic babies measure blood glucose within 2 hrs of
birth, preferably before feeds.
• Frequency & duration depends on clinical features and glucose value,
initial frequency may be 2 hrly, and later 4 hrly and finally 8 - 12
hrly.

• Monitoring is usually done for 72 hrs after birth in at risk newborns

or till glucose levels remain normal for 48 – 72 hrs.

• Symptomatic babies: may require more frequent monitoring.

• Maintain the same DIR till the blood glucose is stable for at least 6 –
8hrs and then decrease the DIR by not greater than 1 – 2 mg/kg/min
every 2 hours with adequate monitoring.