Hormonal and metabolic response to hypoglycaemia in small for gestational age infants.

Abstract

Little is known of the ability of hypoglycaemic infants who are small for gestational age (SGA) to mount the coordinated hormonal and metabolic counterregulatory response that is seen in healthy older subjects during glycopenia. This response was studied in 22 SGA infants (birth weight <10th centile) by measuring the blood concentrations of glucose, intermediary metabolites, and glucoregulatory hormones.Plasma non-esterified fatty acid and blood ketone body concentrations were low, even when blood glucose concentrations were low. Plasma insulin and glucagon varied widely (<1.0-53.1 mU/l and 16-6-87 1 pmol/, respectively). Concentrations of noradrenaline and glucagon were raised, but cortisol and adrenaline were lower than those found in hypoglycaemic adults. There was no relationship between the concentration of any hormone and blood glucose concentration.We postulate that hypoglycaemia and the failure to mobilise alternative fuels in some SGA infants is secondary both to a poorly coordinated counterregulatory hormone response and to a peripheral insensitivity to the actions of the hormones. Those infants, who fail to mount a counterregulatory response, should be identified by accurate and reliable blood glucose monitoring, and an adequate exogenous supply of energy, either enteral or parenteral, should be ensured.

Severe Hypoinsulinaemic Hypoglycaemia in a Premature Infant Associated with Poor Weight Gain and Reduced Adipose Tissue

“…The increased risk of hypoglycaemia in preterm and IUGR infants isrelated to the limited adipose tissue and glycogen stores, a high brain:body mass ratio (with corresponding increase in glucose consumption), failure of glucose counter regulatory hormones, immaturity of hepatic enzyme systems regulating glycogenolysis and gluconeogenesis, hyperinsulinism and/or increased sensitivity to insulin [1,2,3,4,5]. …”

Hipoglicemia na infância: resultados de um protocolo de avaliação prospectiva em crianças com até 1 ano de idade

“…do em prematuros e pequenos para a idade gestacional (PIG), em filhos de mães diabéticas, em crianças com hiperinsulinismo, pacientes com sepse, hipotermia, anó-xia perinatal e cardiopatia congênita (4,5). Aproximadamente 50% desses episódios hipoglicêmicos são assintomáticos e detectados devido a algum fator predisponente associado (6).…”

Glucose, the Brain and the Paediatric Endocrinologist

“…These adaptive changes to low blood glucose levels in the first hours are not seen in prematurely born infants nor in those born light for dates [13][14][15], but the imme diate provision of nutritional support and/or intravenous glucose at a rate sufficient to match glucose utilisation prevents the development of the low blood glucose levels traditionally seen in newborn nurseries [13]. Practical rec ommendations for the management of different groups of neonatal infants have been presented recently [16,17], and will not be discussed further in this paper.…”