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B - Paediatrics MANAGEMENT > Neonatal Hypoglycaemia > Flashcards

Neonatal Hypoglycaemia Flashcards

1
Q

What is hypoglycaemia defined as in neonates?

A

Plasma glucose of less than 2.6mmol/L

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2
Q

Is hypoglycaemia common in babies?

A

It is a common problem in neonates during the first few days of life, but thereafter is uncommon without diabetes

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3
Q

Why are infants at a higher risk of hypoglycaemia?

A
  • High energy requirements

- Relatively poor reserves of glucose from gluconeogenesis and glycogenolysis

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4
Q

What is the result of infants being at high risk of hypoglycaemia with fasting?

A

Infants should never be starved for more than 4 hours, e.g. pre-operatively

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5
Q

What are the causes of neonatal hypoglycaemia?

A
  • Hyperinsulinism
  • Limited glycogen stores
  • Increased glucose use
  • Decreased gluconeogenesis
  • Depleted glycogen stores
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6
Q

What is the most common cause of neonatal hypoglycaemia?

A

Hyperinsulinism

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7
Q

What is neonatal hypoglycaemia caused by hyperinsulinism also known as?

A

Persistent hyperinsulinaemia hypoglycaemia of infancy

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8
Q

When is hyperinsulinism very commonly seen?

A

In infants born to mothers with diabetes

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9
Q

When does neonatal hypoglycaemia caused by limited glycogen stores occur?

A
  • Premature newborns

- Newborns that have IUGR

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10
Q

What can cause increased glucose use in a neonate?

A
  • Hyperthermia
  • Polycythaemia
  • Sepsis
  • Growth hormone deficiency
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11
Q

What can cause decreased gluconeogenesis in a neonate?

A
  • Inborn errors of metabolism

- Adrenal insufficiency

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12
Q

What can cause depleted glycogen stores in a neonate?

A
  • Starvation

- Asphyxia-perinatal stress

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13
Q

What are the categories of risk factors for neonatal hypoglycaemia?

A
  • Maternal

- Neonatal

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14
Q

What are the maternal risk factors for neonatal hypoglycaemia?

A
  • Gestational diabetes
  • Eclampsia
  • Drug use
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15
Q

What are the neonatal risk factors for neonatal hypoglycaemia?

A
  • Small for gestational age
  • Inadequate feeding
  • Respiratory distress
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16
Q

How serious is neonatal hypoglycaemia?

A

It can show no symptoms, or can be life threatening

17
Q

What are some potential signs and symptoms of neonatal hypoglycaemia?

A
  • Tremors
  • Weak or high pitched cry
  • Lethargy
  • Hunger or refusal to feed
  • Sweating
  • Pallor
  • Central nervous system signs
18
Q

What CNS signs may be present in neonatal hypoglycaemia?

A
  • Irritability
  • Headache
  • Seizures
  • Coma
19
Q

How is neonatal hypoglycaemia initially identified?

A

Screening for hypoglycaemia is done on every neonate on admission via the heel prick test

20
Q

What needs to be done if the heel-prick test is positive for hypoglycaemia?

A

Need to confirm diagnosis

21
Q

What further samples need to be collected when the cause of neonatal hypoglycaemia is unknown?

A
  • Blood at time of hypoglycaemia

- First available urine sample

22
Q

What tests are done on blood for neonatal hypoglycaemia when the cause is unknown?

A
  • GH
  • IGF-1
  • Cortisol
  • Insulin
  • C-peptide
  • Fatty acids
  • Ketones
  • Glycerol
  • Branched-chain amino acids
  • Lactate
  • Pyruvate
23
Q

What tests are done on urine in neonatal hypoglycaemia when the cause is known?

A

Check for organic acids

24
Q

What are the differential diagnoses of neonatal hypoglycaemia?

A

The way neonatal hypoglycaemia presents is vague, and may be confused with;

  • Hypocalcaemia
  • Sepsis
  • CNS disorders
  • Cardiorespiratory problems
25
Q

How is neonatal hypoglycaemia at birth treated?

A

Glucose IV infusion 10%

26
Q

How can neonatal hypoglycaemia be treated when it is less severe, borderline, or asymptomatic?

A

Early introduction of breast milk

27
Q

Why might early introduction of breast milk not be an option in the management of mild neonatal hypoglycaemia?

A

If the newborn is having difficulty latching, or breastfeeding is not an option

28
Q

What can be done if early introduction of breast milk is not possible in mild neonatal hypoglycaemia?

A

Oral glucose

29
Q

What should be done in any infant at risk of hypoglycaemia?

A

Their blood sugar should be taken 1 hour after birth

30
Q

What are the complications of neonatal hypoglycaemia?

A

The neurological sequelae may be permanent if hypoglycaemia persists, and include;

  • Neurological damage that results in mental retardation
  • Developmental delay
  • Personality disorders
  • Recurrent seizure activity
  • Impaired cardiovascular function

B - Paediatrics MANAGEMENT (106 decks)

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