COMMON NEONATAL

DISORDERS
AND ITS MANAGEMENT
Prepared By
L. DIVA CHANU
Asso. Prof. AIN
 Hypoglycaemia:

Hyppoglycaemia is the most common metabolic

problem in neonates. In children, a blood glucose
value of lees than 40mg/dl represent
hypoglycaemia. A plasma glucose level of less than
30mg/dl in the first 24 hours of life and less than
45mg/dl thereafter constitute hypoglycaemia in
newborn.
 CAUSES/ ETHIOLOGY
 Persistent hyperinsulinemia

 Limited glycogen stores

 Increased glucose use

 Decreased glycogenolysis,
gluconeogenesis or use of alternate
nutrients for energy.
 Depleted glycogen stores.
 RISK FACTORS
 Blood infection( sepsis)
 Endocrine disorders such as low thyroid
hormone production.
 Inborn errors of metabolism
 Intra uterine growth retardation
 Birth asphyxia
 Diabetes mother’s baby
 Premature babies
 GLUCOSE METABOLISM
HYPOGLYCEMIA

Glucagon Growth Cortisol

Insulin Epinephrine
hormone

Hepatic Fat Insulin Protein

Glucose Break Sensitivity Break
Output down Down

Glucose
Ketones Gluconeogenesis
Utilization

Glucose
NORMAL HYPOGLYCEMIA COUNTER REGULATION
 Management:
 Hypoglycaemia can be prevented by initiating
breast feeding within 2 hours of birth.
 Symptomatic infants need a bolus of 2-4ml of
10% dextrose and then infusion of
5-10mg/kg/minute till blood glucose rises
above 40mg/dl.
 If hypoglycaemia continues, the baby may
need medication like Diaz oxide( to increase
blood sugar) or Octreotide ( to reduce insulin
production)
 HYPOCALCAEMIA
• Definition:
Hypocalcaemia is defined as the
total serum concentration of calcium
is less than 8.5mg/dl in children,
8mg/dl in term neonates & 7mg/dl in
preterm neonates.
Maintenance of normal serum calcium level

Normal S. Calcium level

In plasma calcium In plasma calcium

Secretion of PTH Secretion of PTH

Calcium absorption Calcium absorption

from GIT from GIT

Bone reabsorption Bone reabsorption

Calcium excretion in Calcium excretion in

urine urine
Restored normal calcium
level
 ETIOLOGY
• Hypocalcaemia may occur due to
the following reasons:
i. Vitamin D deficiency
ii. Metabolic disorder
iii. Increase calcium loss from the
body
iv. Other causes
 ETIOLOGY Contd……
I Vitamin D deficiency
 malabsorption

 malnutrition

 congenital rickets

II Metabolic causes
 hypoparathyroidism

 hypomagnesaemia

 hyperphosphatemia
 ETIOLOGY Contd……
III Increased calcium loss from the body
 Hypercalciuria
 prolong corticosteroid therapy
 prolong furosemide therapy
 Renal tubular necrosis
IV Other causes
 Hypoproteinemia
 Infants of diabetic mother
 Infants fed with milk having high
content of phosphate like cow’s milk
 Phototherapy
 CLINICAL FEATURES
a. Early Neonatal Hypocalcemia:
Occurs within 48-72 hrs. of birth and
Manifestations are:
 High pitch cry
 Intermittent cyanosis
 Edema
 Vomiting
 Abdominal distension
 Period of apnea
CLINICAL FEATURES Contd……..
b. Late Neonatal Hypocalemia:
Occurs 3-7 days after birth or even as
late as 6 wks. of age. Manifestations are
 Irritability & jitteriness
 Muscular twitching
 Tremors
 Focal or generalized convulsion
 Carpopedal spasm(Spasm of muscles of
hand & feet)
 Laryngospasm
DIAGNOSTIC EVALUATION
 History of mother
 Estimation of gestational age of
neonate
 Blood investigation include estimation
of:
- Serum calcium
- Serum phosphate
- Serum alkaline phosphate
 Hormone assay
 MANAGEMENT
 10% calcium gluconate is administered in dose
of 2ml/kg IV to control seizures.
 5ml/kg/day of 10% calcium gluconate is
administered, later on.
 Oral therapy is continued as folloe up.
 Magnesium administration is necessary to
correct any hypomagnesemia because
hypocalcemia does not response until low
magnesium level is corrected.
 PREVENTION
 High calcium & low phosphate diet is
required.
 Infants drinking regular cow’s milk or
evaporated milk must be given
humanized infant formula.
 infant who are susceptible to
hypocalcemia should get calcium
gluconate in dose of 1ml/kg IV 4 hrs.
 Later on a suitable calcium & phosphate
oral preparation at the ratio of 2:1
should be given to the neonate.
 HYPOTHERMIA
• INTRODUCTION:
Neonatal hypothermia often
due to lack of attention by health care
providers, continues to be a very
important cause of neonatal death.
A newborn is more prone to develop
hypothermia because of large surface
area per unit of body weight.
 DEFINITION

• Normal axillary temperature is 36.5-

37.5°C. In hypothermia the temperature
is below 36.5°C. According
to severity, hypothermia is classified
as-
• -Clod stress- : 36.0 °C to 36.4 °C
• -Moderate hypothermia-: 32.0 °C to
35.9°C
• -Severe hypothermia-: <32°C
 CLINICAL FEATURES
• Peripheral vasoconstriction
- Acrocyanosis
- Cool extremities
- Decrease peripheral perfusion
• CNS depression
- Lethargy
- Bradycardia
- Apnea
- Poor feeding
 CLINICAL FEATURES
• Increase Metabolism
- Hypoglycemia
- Hypoxia
- Metabolic acidosis
• Increase pulmonary artery pressure
- Distress
- Tachypnea
• Chronic Signs
- Weight loss
- Poor weight gain
MANAGEMENT OF HYPOTHERMIA
 Hypothermic baby has to be rewarmed as quickly as

possible.

• The methods used to manage cold stress include –

• Skin-to-skin contact

• A warm room or Bed

• A 200 watt bulb

• A radiant warmer or an incubator

• Monitor axillary temp. every half hour till it reaches

36.5⁰C, Then hourly for next 4 hours,

 CONTD……..
 Moderate Hypothermia(> 32 to < 36⁰C )
• Skin-to-skin contact in warm room or warm bed.
• Monitor every 15-30 minutes.
 Sever Hypothermia (< 32⁰C )
• Use air heated incubator (air temp 35-36⁰C)
• In addition: Measures must be taken to reduce heat
loss
• 10% dextrose must be started intravenously at the
rate of 60-80ml/kg/day
• Administer vitamin k 1mg to term &0.5mg to
preterm
• Provide oxygen
 Prevention of
hypothermia:

• Warm delivery room

• Warm resuscitation
• Immediate drying
• Skin-to-skin contact between baby and
mother
• Breastfeeding
• Bathing and weighing postponed
• Appropriate clothing and bedding
• Mother and baby together
• Warm transportation
•
 Prevention of
Hypothermia
• In Delivery Room:
 Conduct delivery in Warm room
 Immediately Dry the newborn
 Ensure that baby head is well
covered
 Keep the baby by the mother’s side
• Skin- to- skin contact( Kangaroo
Method):
 Assist in maintaining the
temperature
 Facilitates breastfeeding
 Improve mother-infant bonding
THANK YOU