Pathophysiology Of Neonatal Hypoglycemia
Glucose is the primary metabolic fuel for the fetus. The fetus receives glucose from its mother through carrier-mediated diffusion down a concentration gradient across the placenta . Fetal glucose concentrations are ~80% of maternal concentrations and fluctuate with changes in maternal glucose concentrations . The function of insulin in the fetus is as a growth hormone rather than to regulate glucose concentrations, and secretion of insulin occurs at a lower glucose concentration in the fetus than in postnatal life .
Maternal and therefore fetal glucose concentrations increase during labor and delivery in response to secretion of maternal stress hormones such as catecholamines and glucocorticoids . Once the umbilical cord is clamped, glucose supply is interrupted and neonatal glucose concentrations decrease, reaching a low point ~12 h after birth. In turn, insulin secretion decreases while secretion of counter-regulatory hormones such as glucagon and catecholamines increases, stimulating gluconeogenesis and glycogenolysis, and resulting in a gradual increase in glucose concentrations . However, these do not reach adult concentrations until after 72 h of age . Delay or interruption of this postnatal metabolic adaptation results in neonatal hypoglycemia.
Clinical Aspects Of Neonatal Hypoglycemia: A Mini Review
- Liggins Institute, University of Auckland, Auckland, New Zealand
Introduction: Neonatal hypoglycemia is common and a preventable cause of brain damage. The goal of management is to prevent or minimize brain injury. The purpose of this mini review is to summarize recent advances and current thinking around clinical aspects of transient neonatal hypoglycemia.
Results: The groups of babies at highest risk of hypoglycemia are well defined. However, the optimal frequency and duration of screening for hypoglycemia, as well as the threshold at which treatment would prevent brain injury, remains uncertain. Continuous interstitial glucose monitoring in a research setting provides useful information about glycemic control, including the duration, frequency, and severity of hypoglycemia. However, it remains unknown whether continuous monitoring is associated with clinical benefits or harms. Oral dextrose gel is increasingly being recommended as a first-line treatment for neonatal hypoglycemia. There is some evidence that even transient and clinically undetected episodes of neonatal hypoglycemia are associated with adverse sequelae, suggesting that prophylaxis should also be considered. Mild transient hypoglycemia is not associated with neurodevelopmental impairment at preschool ages, but is associated with low visual motor and executive function, and with neurodevelopmental impairment and poor literacy and mathematics achievement in later childhood.
These Babies 2 To 3 Times More Apt To Struggle With Planning Memory Attention At Age 4 Study Finds
TUESDAY, Aug. 8, 2017 Low blood sugar affects about one in six newborns, and new research suggests it could lead to brain difficulties in childhood.
Babies who experience low blood sugar at or near birth are at least two to three times more likely to face problems with planning, memory, attention, problem-solving and visual-motor coordination by the age of 4.5, New Zealand researchers said.
The low blood sugar did not affect general thinking function or IQ, but it did affect problem-solving and other skills known as executive functioning, and also eye-hand coordination, the findings showed. These are crucial for many tasks, said study leader Chris McKinlay. He is a neonatologist at the Liggins Institute at the University of Auckland.
We dont know fully what this means for learning, McKinlay said. We think this may have an effect on educational achievement.
Low blood sugar in newborns, known as neonatal hypoglycemia, is the most common preventable cause of brain damage in infancy. Those at risk of low blood sugar include babies born prematurely, those small or large for their gestational age, and those born to mothers with diabetes.
For these high-risk infants, it is common to do a blood glucose test, using a heel prick. If the level is too low, the child can be treated with a form of sugar to return it to normal levels.
The study was published online Aug. 7 in JAMA Pediatrics.
More information
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Treatment For High Blood Sugar Levels
For those with high blood sugar levels, it is vital to keep track of your blood sugars at home on a daily basis. This can be done with a glucose meter. These test monitors are often provided to diabetic patients so that they can manage their blood sugar levels at home everyday. They are available to purchase online if you are non-diabetic but wish to check on your levels regularly for safety.
Diabetic patients can be prescribed medications to help with insulin levels when their blood sugar is high. Those with type 1 diabetes will be prescribed medication which needs to be taken several times daily. This type of diabetes has no cure but can be managed with the right medication.
Those with type 2 diabetes or gestational diabetes can treat their high blood sugar with a change in diet or exercise. A healthier balanced diet is usually advised and sometimes, insulin medication is also prescribed if the blood sugar level becomes abnormally higher than the high reading for diabetic patients.
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Risk Factors For Hypoglycemia
Many different factors can cause hypoglycemia in infants. Some babies are more likely to have a low supply of glucose. In Canada, medical professionals should perform routine glucose checks on the following at-risk infants:
- Full-term babies that have congenital conditions, as in conditions present at birth, such as metabolic diseases, asphyxia at birth, liver disease, and infection.
- Preterm babies, born more than three weeks before the due date, and underweight infants are at significant risk for low blood sugar and often struggle to regulate glucose levels.
- Babies born to a mother with diabetes, or gestational diabetes, are at a higher risk for neonatal hypoglycemia.
- Babies who are much larger for their gestational age.
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Incidence And Risk Factors
The incidence of neonatal hypoglycemia varies between studies depending on the diagnostic threshold, the glucose screening protocol and measurement method used, and the population studied . However, the incidence of transient neonatal hypoglycemia is estimated to be 515% of newborns , and in at-risk babies, it approximates 50% . Babies with multiple risk factors do not have a higher incidence but may experience more severe hypoglycemia.
Table 1. Risk factors for neonatal hypoglycemia.
What Are The Symptoms Of Hypoglycemia In The Newborn
Symptoms of hypoglycemia may not be obvious in newborn babies and each baby may experience symptoms differently. The following are the most common symptoms of hypoglycemia:
Since the symptoms of hypoglycemia may resemble other conditions or medical problems, it is advisable to consult your baby’s physician for a diagnosis.
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Erythroblastosis Fetalis And Beta
Although maternal diabetes is themost common cause ofhyperinsulinism in the newborn, postnatal insulinsecretion may be abnormal due toseveral other disorders. Infants whohave erythroblastosis fetalis haveincreased levels of insulin and anincrease in the number of pancreaticbeta cells. The mechanism for thisdevelopment is unclear, but onepossibility is that glutathione releasedfrom hemolyzed red cells inactivatesinsulin in the circulation, whichtriggers more insulin secretion andupregulates the beta cells. Exchangetransfusions may exacerbate theproblem because transfused bloodusually is preserved with acombination of dextrose and other agents.During the exchange, the infantreceives a significant glucose load,with subsequent exaggerated insulinresponse from the hyperplasticpancreas. At the end of the exchange,the rate of dextrose administrationreturns to baseline, but insulin levelsremain elevated, leading to furtherhypoglycemia.
Use of beta-agonist tocolyticagents such as terbutaline also isassociated with hyperinsulinemia inthe newborn, especially if the agentwas used for more than 2 weeks andwas discontinued less than 1 weekprior to delivery. Affected infantsalso appear to have reducedglycogen stores, which further aggravatesthe hyperinsulinemia and its effectson decreasing glucoseconcentrations.
Investigating Causes Of Persistent Hypoglycemia
As noted above, infants experiencing hypoglycemia in the first 72 hours post-birth generally do not require investigation unless there is a clinical suspicion of an underlying condition with risk for persistent, recurrent, or severe hypoglycemia. Infants with hypoglycemia that persists beyond 72 hours should be evaluated further. When a blood glucose reading < 2.8 mmol/L is obtained beyond the transitional period, a critical sample should be drawn as soon as possible. The workup should include a confirmatory plasma glucose, beta-hydroxybutyrate, bicarbonate, lactate, free fatty acids, insulin, growth hormone, cortisol, carnitine, and acylcarnitine profiling. Further workup should be conducted in collaboration with specialists in endocrinology and inborn errors of metabolism.
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How Can I Prevent Low Blood Glucose In My Baby
The most natural way to feed your baby and to keep a normal blood glucose level is early and frequent breastfeeding. Talk to your health care provider before you start using breast milk substitutes .
Its also important to know if your baby is at risk for low blood glucose .
Do not smoke during pregnancy. Babies who are exposed to tobacco dont grow well.
What Are The Symptoms Of Hypoglycemia In A Newborn Baby
Signs of low blood sugar may not be obvious in newborn babies. The most common signs include:
- Blue tint to skin and lips
- Stopping breathing
- Not interested in feeding
- Lack of movement and energy
The signs of hypoglycemia can be like other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis.
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Medication For Type 1 Diabetes Mellitus
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Treatment To Manage Blood Sugar Levels In Pregnant Women
Summary
One of the most effective preventive measures for neonatal hypoglycemia is that pregnant women should control their blood sugar levels during pregnancy. It helps them to reduce the risk of hypoglycemia in the newborn and developing other related complications. Routine monitoring of gestational diabetes, lifestyle changes, and medications are the measures to control diabetes for pregnant women.
Some ways help in managing the blood sugar levels in women planning their pregnancy or already pregnant. It reduces the risk of hypoglycemia in newborn babies. Here are some of those measures:
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How Is Blood Glucose Checked
Blood glucose is checked with just a few drops of blood, usually taken from your babys heel.
If your baby is at-risk but doing well, blood glucose will be checked around 2 hours of age and then again before your baby feeds. In total, it will be checked about 3 to 5 times during the first and second days of life.
In The First 72 Hours Post
Symptomatic hypoglycemia
Because symptomatic hypoglycemia causes neuronal injury , urgent intervention to maintain glucose levels 2.6 mmol/L in unwell at-risk infants is recommended.
Asymptomatic hypoglycemia
Williams supports the cut-off of < 2.6 mmol/ L in at-risk infants at 4 to 6 hours of age. Cornblath et al. proposed the concept of operational thresholds, the range of blood glucose concentrations at which clinicians should consider intervention. They distinguished between the threshold glucose value that requires action and the target glucose level that interventions aim for . Recently, the 4.5-year follow-up study of a large cohort indicated increased risk in some measures of neurological impairment, such as executive functioning and visual motor function, with recurrent or severe hypoglycemia.
In at-risk infants, blood glucose levels < 2.6 mmol/L, particularly when persistent, are associated with adverse outcomes. More randomized clinical trials to compare interventions, intervention thresholds, and long-term outcomes are needed.
Recommendations for the management of hypoglycemia are outlined in Supplementary Figure 1.
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Drug Treatment For Hypoglycemia In Newborns
The early treatment of low blood sugar levels in newborns prevents the complications of neurologic damage. Feeding the newborn with breast milk or formula is encouraged to avoid hypoglycemia. The doctors use a nasogastric tube in newborns who are unable to drink breast milk or formula. Many newborns cannot protect their airways or are unable to drink milk. Drugs like dextrose, diazoxide, glucagon, and octreotide are administered to them with the help of IV, nasogastric tube, intramuscular, or intraosseous routes.
Treatment Options For Hypoglycemia In Newborns
Treatment for neonatal hypoglycemia is designed to correct low blood glucose levels. This can be as simple as extra feedings of breastmilk or formula, oral sugar gel, or an intravenous sugar solution and a stay in the NICU. Typically, interventions continue until your baby can maintain safe blood sugar levels, which can last for hours or days after birth. Medications are also available for use in rare cases.
Learning that your baby has a medical issue can understandably be scary, but neonatal hypoglycemia typically isn’t something to worry too much about. Once diagnosed, this condition can be treated fairly easily, meaning you can rest assured that your child will grow up strong, healthy, and capable of leading a perfectly normal and even exceptional! life.
BabyCenter’s editorial team is committed to providing the most helpful and trustworthy pregnancy and parenting information in the world. When creating and updating content, we rely on credible sources: respected health organizations, professional groups of doctors and other experts, and published studies in peer-reviewed journals. We believe you should always know the source of the information you’re seeing. Learn more about our editorial and medical review policies.
UpToDate. Management and Outcome of Neonatal Hypoglycemia
National Institutes of Health. Low blood sugar newborns.
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How We Care For Hypoglycemia
At Boston Childrens Hospital, we treat hypoglycemia in our General Endocrinology Program, a multi-disciplinary program dedicated to the treatment of a wide range of endocrinological disorders. Caring for more than 7,000 patients each year, our division is one of the largest pediatric endocrinology practices in the country. We provide state-of-the-art diagnosis, treatment, and clinical management for children with hypoglycemia and related disorders.
What Is Neonatal Hypoglycemia
Neonatal hypoglycemia occurs in between 1 and 3 of every 1000 births, making it the most common metabolic issue among newborns. The condition refers to a newborn baby with low blood sugar levels following birth. Among healthy newborns, its actually quite normal for blood sugar to dip right after a baby enters the world. However, when glucose concentrations drop in the first 24 hours of life, your infant may be diagnosed with neonatal hypoglycemia.
Without treatment, chronic low blood sugar could be associated with neurological damage and result in developmental issues. However, medical professionals are trained to closely monitor for symptoms of neonatal hypoglycemia and intervene quickly, which can drastically reduce the risk of complications.
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Low Blood Sugars In Babies
We have recommended your baby be closely monitored because he or she is at risk of, or has had a low blood sugar level. Babies with a low blood sugar level may need to be admitted to the Newborn Intensive Care Unit for treatment until their blood sugar level reaches and is maintained within a normal range. However, many babies at risk of low blood sugars are able to be with their mother on the ward. A baby who has had a low blood sugar level with no complications does not need special checks after leaving hospital.
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Foods That Increase Insulin
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