Neonatal Hypoglycemia

Abstract

Lower blood glucose values are common in the healthy neonate immediately after birth as compared to older infants, children, and adults. These transiently lower glucose values improve and reach normal ranges within hours after birth. Such transitional hypoglycemia is common in the healthy newborn. A minority of neonates experience a more prolonged and severe hypoglycemia, usually associated with specific risk factors and possibly a congenital hypoglycemia syndrome. Despite the lack of a specific blood glucose value that defines hypoglycemia, concern for substantial neurologic morbidity in the neonatal population has led to the generation of guidelines by both the American Academy of Pediatrics (AAP) and the Pediatric Endocrine Society (PES). Similarities between the 2 guidelines include recognition that the transitional form of neonatal hypoglycemia likely resolves within 48 hours after birth and that hypoglycemia that persists beyond that duration may be pathologic. One major difference between the 2 sets of guidelines is the goal blood glucose value in the neonate. This article reviews transitional and pathologic hypoglycemia in the neonate and presents a framework for understanding the nuances of the AAP and PES guidelines for neonatal hypoglycemia.

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

“…This homeostasis is maintained not only by insulin and glucagon but also by hormones such as catecholamines, growth hormone, and cortisol that determine its uptake and utilization. Ingestion of feed or infusion of glucose in the form of carbohydrate contributes to increasing glucose concentration in the body which in turn activates glucokinase and β cell glycolysis (14,15). This process eventually generates acetyl-coenzyme A (acetyl CoA) which is a common end product not only of glycolysis but also of protein degradation and lipolysis.…”

“…This process eventually generates acetyl-coenzyme A (acetyl CoA) which is a common end product not only of glycolysis but also of protein degradation and lipolysis. Acetyl Co-A enters the Kreb's cycle which then provides the adenosine triphosphate (ATP) and supports all cell functions (15,16).…”

Clinical and Epidemiological Features and Management of Neonatal Hypoglycemia at the University Teaching Hospital of Treichville (Abidjan-Côte d’Ivoire)

“…The diagnosis of significant neonatal hypoglycemia is based on the existence of an evocative clinical picture and biological hypoglycaemia (venous blood glucose). It is established in the newborn that the most common strategy used to reduce morbidity and the risk of neurodevelopmental sequelae and hypoglycaemia-related mortality is routine screening for any newborn who goes badly [7]. The acquisition and availability of capillary blood glucose monitors could be a viable alternative to this strategy.…”

Association between antenatal steroids for lung maturation and hypoglycaemia in the first 48 hours in premature infants between 26 and 34 weeks of gestational age

“…Hypoglycaemia is a frequent condition in neonatal care units, and its importance lies in its relationship with alterations in neurodevelopment [1][2][3][4][5][6]. The values defining it are still controversial, with the definitions proposed by the Paediatric Endocrinology Society and by the American Academy of Paediatrics being the most used [7][8][9][10]. The maternal risk factors which may trigger it include, among others: gestational diabetes, maternal obesity, the use of beta-blockers or hypoglycaemic agents, and associated hypertensive disorders in pregnancy [1,3,11,12].…”