HWN Suggests

Neonatal Hypoglycemia Studies — Is There a Sweet Story of Success Yet?

For over half a century, neonatal hypoglycemia has been a contentious topic. Although there is agreement that recurrent severe hypoglycemia causes brain injury, there have been few high-quality studies providing data that inform the management or report the neurodevelopmental outcomes of transient neonatal hypoglycemia. Much of the controversy about neonatal hypoglycemia has focused on the question of number — that is, What glucose level should be used to “define” hypoglycemia in neonates?

Because the validity of statistical definitions of neonatal hypoglycemia has been appropriately criticized, an alternative approach has been to evaluate long-term outcomes, such as those in the recent…

read full article

Featured

 Management

Mild <40 mg/dL Oral: If developmentally capable of feeding orally, and if clinical condition permits (i.e., no significant respiratory distress, etc.), immediately offer ad lib oral glucose solution (D5W), infant formula, or allow breast-feeding. If enteral feeding is not possible, treat parenterally. Symptomatic Infants: Immediate Bolus: 0.20 grams of glucose/kg, i.e., 2 ml/kg of i.v. 10% glucose, given over 1-2 minutes. (Do not use D25W or D50W.) Continuous Infusion: 6-8 mg glucose/kg/min using D10W (or D5W); this is equivalent to 90-120 ml/kg-day as 10% dextrose in water...

Articles of Interest

Buccal administration of dextrose gel effective for neonatal hypoglycemia

The authors of this study examined the use of buccal dextrose gel as a possible intervention given its effectiveness in the treatment of hypoglycemia in conditions such as adult diabetes and malaria in children. They found that buccal administration of 40% dextrose is effective at treating hypoglycemia in infants less than 48 hours old.

Dextrose gel for neonatal hypoglycaemia (the Sugar Babies Study): a randomised, double-blind, placebo-controlled trial

Treatment with dextrose gel is inexpensive and simple to administer. Dextrose gel should be considered for first-line treatment to manage hypoglycaemia in late preterm and term babies in the first 48 h after birth.

Guidelines on neonatal hypoglycemia

Few newborn conditions generate greater controversy than neonatal hypoglycemia (low blood sugar), particularly when it occurs in breastfed infants.

Management Strategies for Neonatal Hypoglycemia

This review discusses the available treatment options for both transient and persistent neonatal hypoglycemia. These treatment options include dextrose infusions, glucagon, glucocorticoids, diazoxide, octreotide, and nifedipine.

Oral Dextrose Gel Reduces the Need for Intravenous Dextrose Therapy in Neonatal Hypoglycemia

Use of dextrose gel with feeds reduced the need for IV fluids, avoided separation from the mother and promoted breastfeeding.

Resources

Congenital Hyperinsulinism International

Congenital Hyperinsulinism (HI) is the most frequent cause of severe, persistent hypoglycemia in newborn babies and children. In most countries it occurs in approximately 1/25,000 to 1/50,000 births. About 60% of babies with hyperinsulinism develop hypoglycemia during the first month of life.

Clinical Advisor

What every practitioner needs to know about Neonatal Hypoglycemia.

Pediatrics in Review

In term infants who have asymptomatic mild hypoglycemia, an initial attempt at enteral feeding may be successful in reaching target blood glucose values. It is estimated that blood glucose concentrations should increase by approximately 1.67 mmol/L (30 mg/dL) within the first hour after a feeding of 30 to 60 mL of standard infant formula.

UCSF Children's Hospital

•Glucometer reading: (a) <20 mg/dL or (b) <40 mg/dL and NPO or preterm or (c) <40 mg/dL after feeding or (d) <40 mg/dL and symptomatic -Draw blood for stat glucose measurement. -Give IV bolus of 2-3 mL/kg of D10W. -Begin continuous infusion of D10W at 4-6 mg/kg/min. -If infant of diabetic mother, begin D10W at 8-10 mg/kg/min (100-125 cc/kg/d). -Repeat blood glucose in 20 min and pursue treatment until blood sugar >40 mg/dL