Hypoglycemia
In the fetus, glucose is supplied via the placenta. Following birth, maternal glucose is no longer available and the newborn must maintain the blood glucose level by glycogenolysis or lipolysis.
After birth, the blood glucose level declines to a minimum of 35 mg/dl and by four to six hours it stabilizes at approximately 50 to 60 mg/dl. Neonatal hypoglycemia within the first 72 hours is defined as plasma glucose of less than 40 mg/dl. After 72 hours of life, 45 mg/dl is the lower limit of normal. Plasma glucose values are approximately 5 mg/dl higher than the whole blood values (chem-strip; dextrostix).
Infants of diabetic mothers are particularly prone to hypoglycemia because of persistent endogenous hyperinsulinemia in response to maternal hyperglycemia. These infants are often LGA with a birth weight exceeding 4 kg. Conversely, SGA infants have often had intrauterine malnutrition. Such infants are also prone to hypoglycemia because of inadequate nutritional reserves. Hypoglycemia is also common in the smaller of discordant twins. Infants with hypoxic ischemic encephalopathy have an increased energy expenditure and are also susceptible to hypoglycemia.
Symptoms of hypoglycemia include jitteriness, seizures, cyanosis, apnea, hypotonia, and poor feeding. Some infants may be completely asymptomatic.
Rapid bedside determination of whole blood glucose concentration can be performed with a test-strip such as Glucostix(r) or Chemstrip(r). A low value must immediately be confirmed by laboratory determination.
Treatment and prognosis: the best therapy is prevention. In an infant with a falling blood glucose level, early feedings, either enteral or parenteral should be initiated. Intravenous infusion of 10% dextrose in water to provide a glucose delivery rate of 5 to 8 mg/kg/min is generally adequate in an infant who cannot be fed enterally.
Quickcheck: Hypoglycemia
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