Combining the patients from the two trials found no difference in neurosensory impairment RR 0. Reasons for the high rate of neurosensory impairment overall are unclear.
Whether such outcomes were caused by conditions that often underlie hypoglycemia or by detrimental effects of hypoglycemia itself is not yet known.
Supporting the former theory is research showing that both late preterm and IUGR infants have independent risk for neurosensory impairment, even with normoglycemia [ 75 ]. While this result was not strong enough to have statistical significance, it raises the question of whether overcorrecting low blood glucose may cause harm.
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. 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. While transient blood glucose levels as low as 1. A higher threshold for investigation of 2. Checking blood glucose in newborn babies. Supplementary Figure 1. The authors wish to acknowledge and thank Drs. The authors also wish to thank these members of the Canadian Pediatric Endocrine Group for their review: Drs. Narvey MD, Seth D. Marks MD. Disclaimer: The recommendations in this position statement do not indicate an exclusive course of treatment or procedure to be followed.
Variations, taking into account individual circumstances, may be appropriate. Internet addresses are current at time of publication.
Skip to Content. Posted: Nov 20, Principal author s Michael R. Abstract Hypoglycemia in the first hours to days after birth remains one of the most common conditions facing practitioners across Canada who care for newborns. Keywords: Dextrose gel; Hypoglycemia; Newborn; Point-of-care.
Related information Fetus and Newborn Committee. Information for parents Checking blood glucose in newborn babies. Table 1. Infants at risk for hypoglycemia. Table 2. Adapted with permission from reference [ 29 ]. Table 3. Thresholds for investigation and treatment of hypoglycaemia. It may be drawn earlier than the time frame suggested if an endocrine or metabolic condition is suspected.
Table 4. Effect of fluid adjustments and dextrose concentration on glucose infusion rates. Light grey boxes — Typical infusion starts for newborns. Previous Article Next Article. Article Navigation.
NeoReviews July 01 Neonatal Hypoglycemia Jane E. McGowan Jane E. This Site. Google Scholar. Pediatr Rev 20 7 : e6—e Cite Icon Cite. After completing this article, readers should be able to:. Describe the most common cause of prolonged neonatal hypoglycemia.
List the signs of hypoglycemia. Doctors take measurements of the mother's abdomen and use ultrasonography to take measurements of the fetus to help estimate the fetus's weight. Gestational age refers to how far along the fetus is.
The gestational age is the number of weeks between the first day of the mother's last menstrual period and the day of delivery. This time frame is often adjusted according to other information doctors receive, including the results of early ultrasound scans, which give additional information regarding the gestational age.
A baby is estimated to be due the due date at 40 weeks of gestation. At a gestational age of 40 weeks, boys who weigh more than about 9 pounds 4 ounces 4. Girls who weigh more than about 9 pounds 1 ounce 4. Doctors use published growth charts or computer apps to evaluate babies at other gestational ages.
Macrosomia large body is a related term used to describe infants who weigh more than 9 pounds 15 ounces 4. Large newborns may be normal babies who simply are large because the parents are large. However, certain problems in the mother sometimes cause babies to be large for gestational age. Diabetes in the mother Diabetes During Pregnancy For women who have diabetes before they become pregnant, the risks of complications during pregnancy depend on how long diabetes has been present and whether complications of diabetes, such Maternal obesity Obesity Obesity is excess body weight.
Obesity is influenced by a combination of factors, which usually results in consuming more calories than the body needs. These factors may include physical inactivity Excessive weight gain during pregnancy the fetus gets more calories as the mother gains more weight. The reason for excessive growth of the fetus varies but primarily results from an abundance of nutrients combined with hormones in the fetus that stimulate growth.
The increased amount of insulin results in accelerated growth of the fetus, including almost all organs except the brain, which grows normally. Symptoms of large-for-gestational-age newborns are mainly related to any complications that occur. Birth injuries Birth Injuries in Newborns Birth injury is damage that occurs as a result of physical pressure during the birthing process, usually during transit through the birth canal. Many newborns have minor injuries during birth Difficult delivery: Vaginal delivery Labor Labor is a series of rhythmic, progressive contractions of the uterus that gradually move the fetus through the lower part of the uterus cervix and birth canal vagina to the outside world The overall incidence of hypoglycemia was The risk factor associated with hypoglycemia was maternal hypertension hypertension vs.
Protective factors for hypoglycemia, meaning a significantly greater proportion of infants were euglycemic than hypoglycemia, included being in labor at time of delivery no vs. LGA yes vs. Significance of SGA infants was unable to be completed due to the small number of infants in this group.
Results from both univariate and final models are presented in Table 2. There is limited evidence regarding the specific incidence and risk factors associated with hypoglycemia in this population.
Due to the design of this study, we have determined risk factors associated with neonatal hypoglycemia, but are not able to ascertain causality.
Harris et al. A recent study reported that the nadir of plasma glucose concentration in preterm infants and extremely preterm infants is after Our glucose samples were taken at a mean postnatal age of Maternal hypertension was identified a risk factor for hypoglycemia, which increased the odds of hypoglycemia by 3.
Maternal hypertension is a known risk factor for neonatal hypoglycemia and may reflect an environment of perinatal stress, placental insufficiency, risk factor for SGA, and risk factor for prematurity 9 , 16 , In addition, maternal beta blocker exposure is a known risk factor for neonatal hypoglycemia MgSO 4 administration was a protective factor for neonatal hypoglycemia in univariate analysis, but became non-significant in multivariate analysis.
Antenatal MgSO 4 reduces incidence of cerebral palsy and hemorrhage in infants born preterm, regardless of total dose 19 — MgSO 4 has been shown to decrease blood brain barrier permeability and increase plasma glucose concentration in a rat model of hypoglycemia In addition, MgSO 4 levels have been associated with lipoprotein metabolism and signal transduction in the insulin pathway 23 — We hypothesized that MgSO 4 decreased the utilization of glucose in the brain through a reduction in cerebral stress and blood brain barrier permeability.
Combined with the impact of MgSO 4 on appropriate insulin regulation and lipoprotein metabolism, we hypothesize that the protective mechanism of MgSO 4 for maintenance of euglycemia is likely multifactorial. Our results indicate that maternal labor may be protective against hypoglycemia in premature infants. Campbell et al.
This gluconeogenic environment of the fetus may be protective to neonates. Antenatal steroid administration was neither a significant risk factor nor protective in our study population. Initial trials of steroid administration found no significant differences 27 , and many studies do not include hypoglycemia data However, studies report that antenatal steroid administration was associated with increased risk of neonatal hypoglycemia in late preterm infants born at 34—36 weeks of gestation Administration of betamethasone for lung maturity in premature infants has been shown to suppress maternal adrenocorticotropic hormone and cortisol levels for up to 24 h, which could explain why antenatal steroid administration was not protective 30 , LGA infants were not at increased risk for hypoglycemia in our population, and SGA infants were unable to be analyzed due to sample size; however, previously studies have demonstrated that these infants are at risk for hypoglycemia 8 , 32 — Infants born SGA have decreased glycogen and fat stores, inappropriate release of insulin, and impaired counter regulatory hormones, leading to increased risk of neonatal hypoglycemia 8 , 34 , Infants born LGA have increased hyperinsulinism, leading to their excessive growth and inappropriate response to hypoglycemia antenatally 36 , Infants of diabetic mothers are more likely to be LGA and they have been previously reported to be associated with neonatal hypoglycemia, although this population was predominantly term infants 32 , Therefore, while LGA infants did not demonstrate significant increase in risk of hypoglycemia in our population, and significance of SGA infants was unable to be completed due to sample size.
Further studies with a larger number of infants might yield different results. Maternal diabetes was not a risk factor for hypoglycemia in our neonatal population. Insulin requirements typically increase into the third trimester due to increasing hormonal levels leading to insulin resistance as well as pancreatic beta cell dysfunction 38 , Our population may not have yet been exposed to a high insulin and hormonally-induced insulin resistant environment, explaining why this was not a significant risk factor.
A limitation of our study was the retrospective analysis from prospectively collected data, therefore some important variables may have not been collected, including symptoms that occurred when infants were hypoglycemic. A second limitation was the smaller sample size which affected the statistical analysis of smaller populations and groups, most notably SGA infants.
While two separate RCTs were combined for this study, they both occurred within an overlapping month time period within the same hospital and with identical treatment protocols aside from the respiratory treatment intervention; therefore, no significant difference in treatment is likely to have affected hypoglycemia 10 , In addition, this study examined the transition phase immediately after birth.
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