Hypoglycemia in the preterm neonate: etiopathogenesis, diagnosis, management and long-term outcomes

Abstract

Glucose, like oxygen, is of fundamental importance for any living being and it is the major energy source for the fetus and the neonate during gestation. The placenta ensures a steady supply of glucose to the fetus, while birth marks a sudden change in substrate delivery and a major change in metabolism. Hypoglycemia is one of the most common pathologies encountered in the neonatal intensive care unit and affects a wide range of neonates. Preterm, small for gestational age (GA) and intra-uterine growth restricted neonates are especially vulnerable due to their lack of metabolic reserves and associated co-morbidities. Nearly 30-60% of these high-risk infants are hypoglycemic and require immediate intervention. Preterm neonates are uniquely predisposed to developing hypoglycemia and its associated complications due to their limited glycogen and fat stores, inability to generate new glucose using gluconeogenesis pathways, have higher metabolic demands due to a relatively larger brain size, and are unable to mount a counter-regulatory response to hypoglycemia. In this review we will discuss the epidemiology; pathophysiology; clinical presentation; management and neurodevelopmental outcomes in affected infants and summarize evidence to develop a rational and scientific approach to this common problem.

The fetus at the tipping point: modifying the outcome of fetal asphyxia

“…; Sharma et al . ), show highly variable blood glucose levels during the early period after birth, and a current clinical challenge is to understand what constitutes euglycaemia and how fluctuating glucose may contribute to NE and thus how best to manage changes in glucose (Ogilvy‐Stuart & Beardsall, ). Clinical data from term infants with HIE show adverse neurodevelopmental outcomes associated with both hyperglycaemia and hypoglycaemia during the first day after birth (Chouthai et al .…”

Prevalence and Risk factors of Hypoglycaemia in Neonates at St. Paul’s Hospital Millennium Medical College Neonatal Intensive Care Unit, Ethiopia: A Cross Sectional Study

“…The glucose levels then steadily rise over the rst few days of life with the help of different adaptation mechanisms. Failure of this adaptation will result in hypoglycaemia [2,3].…”

“…The overall prevalence of neonatal hypoglycaemia has been estimated to be 1 to 5 per 1,000 live births [4]. In at-risk populations it can reach as high as 30% -60% [3]. But the lack of consistent hypoglycaemia de nition resulted in different prevalence of neonatal hypoglycaemia as it is shown in many studies [5][6][7].…”

Preterm birth in women with diabetes mellitus

“…Однако на снижение выработки эндогенного инсу лина необходимо время, а так как глюконеогенез у новорожденного еще недостаточно развит, дисбаланс между концентрациями глюкозы и инсулина в крови плода ведет к его гипогликемии. У недоношенных новорожденных риск развития гипогликемии возрастает, что связано с высокой энергетической потребностью, неполноценным глюконеогенезом и малыми запасами гликогена и жиров [38]. Если в популяции относительно здоровых детей вероятность развития неонатальной гипогликемии составляет около 15 %, то в популяциях повышенного риска она может достигать 30-60 % [38].…”