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The Neonate
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Laura De Angelis, Luca Ramenghi
Neonatal hypoglycemia is a common condition, often associated with prenatal and perinatal risk factors (e.g. maternal diabetes, large for gestational age [LGA], small for gestational age [SGA], fetal growth restriction [FGR], prematurity), while rarely it may be caused by congenital abnormalities of glucose metabolism. The exact threshold to define hypoglycemia still remains unclear, but according to the 2011 report by the Committee of Fetus and Newborn of the American Academy of Pediatrics (AAP), hypoglycemia is defined as a blood glucose <40 mg/dL in the first 4 hours of life and <45 mg/dL from 4 to 24 hours of life in high-risk neonates [4].
Glycogenosis type I – von Gierke disease
Published in William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop, Atlas of Inherited Metabolic Diseases, 2020
William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop
In classic type Ia glycogen storage disease, symptoms usually occur in the first months of life, and the disease may be recognized at birth. There may be neonatal hypoglycemia. Hepatomegaly is often present at birth [13] and progresses to huge enlargement of the liver without splenomegaly (Figures 59.2–59.7). The kidneys are also enlarged and may be visualized on roentgenography or may even be palpable. It is common in this condition for the liver to be palpable at the iliac crest in infancy and early childhood. The abdomen is protuberant, the posture lordotic (Figure 59.4), and the gait broad-based and rolling or swinging, all apparent consequences of the hepatomegaly. With time and growth, the abdomen tends to become less prominent.
Postoperative management of the surgical neonate
Published in Prem Puri, Newborn Surgery, 2017
Metabolism—Glucose metabolism is immature in the newborn period, and the sick infant may develop hypoglycemia rapidly. This is as a result of diminished glycogen stores (inadequate hepatic stores in the premature infant or depletion from catecholamine-stimulated breakdown in stress) or due to hyperinsulinism in diabetic mothers. Infants born with intrauterine growth retardation are also vulnerable to development of hypoglycemia due to reduced hepatic gluconeogenesis. Failure to recognize and treat neonatal hypoglycemia results in seizures and cerebral injury. Neonates who are not feeding require maintenance fluid containing dextrose, usually 10%. Blood glucose measurement should be performed regularly as part of normal nursing care. Glucagon and steroid administration is occasionally required to bring the blood sugar level into the normal range (2–6 mmol). Infants receiving intravenous dextrose or total parenteral nutrition may experience rebound hypoglycemia if the infusion is stopped abruptly due to increased blood insulin levels.
Prescribing patterns and outcomes among patients treated for gestational diabetes mellitus
Published in Baylor University Medical Center Proceedings, 2022
Heather Hay, Delaney Ivy, Kiumars Zolfaghari
Of the 368 patients, 53 experienced fetal macrosomia and 60 had preterm labor. Neonatal hypoglycemia was observed in 211 newborns. Fifty-nine patients had treatment failure with their initial medication and required additional therapy. Fewer patients on glyburide had treatment failure compared to insulin and metformin (11.0% vs 33.3% vs 30%, P < 0.0001) (Table 1). There were no significant differences in age or race among patients who had treatment failure with their initial medication. However, patients who had treatment failure with their initial medication had a higher initial weight and body mass index at the start of pregnancy and at delivery in comparison to the patients who did not. Additionally, treatment failure with the initial medication was associated with a higher preterm delivery rate (28.8% vs 13.9%, P = 0.005) (Table 1). Recipients of basal/bolus insulin had higher rates of preterm delivery relative to recipients of glyburide and metformin (41.2% vs 14.1% vs 16.0%, P = 0.01). Basal/bolus insulin therapy was associated with less neonatal hypoglycemia compared to single insulin therapy (41.2% vs 76.9%, P = 0.05) (Table 2).
The association between novel glucose indices in parturients with type 1 diabetes mellitus and clinically significant neonatal hypoglycemia
Published in Gynecological Endocrinology, 2020
Rakefet Yoeli-Ullman, Ayala Maayan-Metzger, Roni Zemet, Nimrod Dori Dayan, Shali Mazaki-Tovi, Ohad Cohen, Lotem Weiss, Tali Cukierman-Yaffe
Several limitations of this study should be noted. First, the definition of neonatal hypoglycemia used in the present study was not according to a specific glucose threshold but rather a clinically significant outcome (glucose IV treatment). Thus, comparison with other publications is more challenging. However, this was done in order to overcome the variation of neonatal hypoglycemia definition in the literature [21] and to evaluate a clinically significant neonatal outcome rather than an arbitrary cutoff. Second, the relatively low mean maternal glucose levels (106.6 mg/dl) may limit the ability to detect a difference between groups in this index. Nevertheless, it well may be that this limitation enabled the detection of the difference in glucose variability indices. Finally, patients included in this study were treated in multidisciplinary team in a designated Type 1 diabetes mellitus clinic at a tertiary referral center. This may potentially limit the external validity of the study.
Monitoring the Frequency and Duration of Hypoglycemia in Preterm Infants and Identifying Associated Factors
Published in Fetal and Pediatric Pathology, 2021
María del Mar Fernández Martínez, José Luis Gómez Llorente, Jeronimo Momblan de Cabo, María Angeles Vazquez López, María del Carmen Olvera Porcel, Javier Diez Delgado Rubio, Antonio Bonillo Perales
Neonatal hypoglycemia has been widely studied, but as yet there is no consensus on the definition. Nevertheless, many authors define hypoglycemia as glucose levels below 40–50 mg/dL (2.2–2.8 mmol/L) [7,8]. However, immediately following birth there is a transition period during which blood glucose may fall to 30 mg/dL or less, after which it usually recovers [6]. Accordingly, hypoglycemia may be transient, representing an adaptation to postnatal life, in which case extraordinary measures should probably not be taken [2,6].