Update on neonatal hypoglycemia

Abstract

Purpose of Review Neonatal hypoglycemia is one of the most common biochemical abnormalities encountered in the newborn. However, controversy remains surrounding its definition and management especially in asymptomatic patients. Recent Findings New information has been published that describes the incidence and timing of low glucose concentrations in the groups most at risk for asymptomatic neonatal hypoglycemia. Furthermore, one large prospective study failed to find an association between repetitive low glucose concentrations and poor neurodevelopmental outcomes in preterm infants. But hypoglycemia due to hyperinsulinism, especially genetic causes, continued to be associated with brain injury. New advances were made in the diagnosis and management of hyperinsulinism, including acquired hyperinsulinism in small for gestational age infants and others. Continuous glucose monitoring remains an attractive strategy for future research in this area. Summary The fundamental question of how best to manage asymptomatic newborns with low glucose concentrations remains unanswered. Balancing the risks of over treating newborns with low glucose concentrations who are undergoing a normal transition following birth against the risks of under treating those in whom low glucose concentrations are pathological, dangerous, and/or a harbinger of serious metabolic disease remains a challenge.

Evaluation of Blood Glucose Monitoring System in Screening for Neonatal Hypoglycemia: Tighter Accuracy Standard

“…3 This provides a possible rationale to the poor performance of previous self-testing glucometers in neonatal care. 5,6 A tighter accuracy requirement, as proposed in current study (±10 mg/dl), is thus warranted to address the specificity of neonatal blood for effective diabetes management and glycemic control. …”

“…2,4 This cutoff value serves as a useful guideline for clinicians to take appropriate actions, including retesting and continued monitoring of blood glucose, and providing glucose source in oral feeding or intravenous administration, to aim at maintaining blood glucose levels of at least 47 mg/dl. 2,5 Previous blood glucose monitoring system (BGMS) failed to perform well in neonates; there are calls for the tightening of accuracy requirements. 5,6 A total of 300 neonates were recruited from 5 local hospitals in a multi-center clinical trial.…”

“…2,5 Previous blood glucose monitoring system (BGMS) failed to perform well in neonates; there are calls for the tightening of accuracy requirements. 5,6 A total of 300 neonates were recruited from 5 local hospitals in a multi-center clinical trial. Accuracy performance of a commercially available BGMS was evaluated against reference instrument (YSI 2300 PLUS Glucose Analyzer) in screening for neonatal hypoglycemia, and assessment was made based on the International Organization for Standardization (ISO) 15197:2013 and a tighter standard (±10 mg/dl).…”

Neonatal hypoglycemic brain injury is a cause of infantile spasms

“…Neonatal hypoglycemia is the most common metabolic disorder during the neonatal period and is a recognized trigger of infantile spasms (8)(9)(10). Previous studies have found that neonatal hypoglycemia may result in hypoglycemic neurological injuries, also known as neonatal hypoglycemic brain injuries (11)(12)(13)(14)(15)(16). Udani et al examined the etiology of remote symptomatic epilepsy with onset during the first 3 years of life and observed that neonatal hypoglycemia was the most common etiology, with spasms being the most common type of seizure (14).…”

A Concept Map of Neonatal Hypoglycemia

“…The cut off level which should prompt treatment remains unclear, especially in asymptomatic neonates [6].…”