Hypoglycemia and Hyperbilirubinemia Flashcards
When is the lowest glucose level after birth?
2 hours old
Neurogenic symptoms of hypoglycemia
- Adrenergic (jitteriness/tremors, irritability, tachypnea, pallor)
- Cholinergic (sweating, huger, parenthesis)
Neuroglycopenic symptoms of hypoglycemia
Poor suck Poor feeding Weak or high pitched cry Change in level of consciousness (sleepy, lethargy, coma) Seizures Hypotonia
4 non specific findings of hypoglycemia
Apnea
Bradycardia
Cyanosis
Hypothermia
When do we screen glucose levels in infants?
Asymptomatic at risk infants may be measured at 2h and 6 hours
Symptomatic infants should be treated for glucose < 2.6
Routine screening of AGA, at term, health and able to stay with their mother is not recommended
How do you replace glucose when blood sugar is between 1.8-2.5?
Enteral supplementation may be used
Less than 1.8 needs IV
Long term consequences of neonatal hypoglycemia
Learning disabilities
CP seizures disorders
Visual impairment
Neurodevelopmental delay
4 critical samples for hypoglycemia
Glucose
Insulin
Cortisol
GH
Management options for hypoglycemia
Feeding (breastfeeding/measured) Dextrose gel IV dextrose Glucagon Dizoxide Glucose polymers
Which form of bilirubin is neurotoxic?
Unconjugated bilirubin
Risk factors for neonatal jaundice
Visible jaundice < 24 hours or before discharge at any age < 38 weeks Previous sibling with severe hyperbilirubinemia Visible bruising Cephalohematoma Male sex Maternal age > 25 Asian or European Dehydration Exclusive or partial breastfeeding
Physiological hyperbilirubinemia
Occurs 2-3 days of life
Pathophys: decreased RBC lifespan, increased RBC mass and breakdown, immaturity of liver conjugation enzymes
Pathological hyperbilirubinemia
< 24 hours of life
> 2 weeks of life
Conjugated hyperbilirubinemia
Excessive rate of rise > 5 mg/dL/24hrs
Main cause of conjugated hyperbilirubinemia to not miss
Biliary atresia
Kernicterus
Deposition of unconjugated bilirubin in brain cells
Early signs: lethargy, poor feeding, loss of moro reflex
Late signs: opisthotonus, bulging fontanelle, twitching and high pitched cry
Prognosis: death, rigidity, movement disorders, low IQ, hearing loss
