- Newborns are at risk of hypoglycemia in the first few days of life as glucose levels fall after birth and then rise again. Hypoglycemia is defined as a blood glucose level below 40 mg/dL or 50 mg/dL for preterm infants. Infants at high risk include those with low birth weight, prematurity, or other conditions. - Symptomatic hypoglycemia can cause issues like tremors, apnea or seizures while asymptomatic hypoglycemia may not show symptoms. Treatment depends on whether hypoglycemia is symptomatic or asymptomatic and may involve oral feeds, IV dextrose solutions or other medications in more severe cases. Screening protocols are recommended for at-risk infants to monitor

1. HYPOGLYCEMIA IN
NEWBORN
AMRUTHA RAMAKRISHNAN
1ST YR MSc NSG

2. B Glucose levels in NBB
80
B Glucose (mg%)
• At birth – 60 – 70% (2/3)
of mother’s B glucose
level
• In first 24 hrs – Falls
• Next 24 hrs – Transient
rise
• 3 – 4 days of age –
Dangerously low levels
• Thereafter – Stability
achieved
70
60
50
40
30
20
10
1
2
3
4
Days of life

3. Hypoglycemia in Newborn?
• Serum glucose <40 mg%
• In preterm infants, repeated blood glucose
levels below 50 mg/dL may be associated
with neurodevelopmental delay.

4. • Definition
• The operational threshold for
hypoglycemia is defined as that
concentration of plasma or whole
blood glucose at which clinicians
should consider intervention, based on
the evidence currently available in
literature.

5. High risk
LBW
 Preterm infants
 (SGA)
 (IDM)
 (LGA)
 Rh-hemolytic disease

6. High risk
• therapy with terbutaline propranolol
lebatolol and oral hypoglycemic agents
• IUGR.
• sick neonate
• Infants on TPN

7. ETIOLOGY
• increased utilization of glucose
(Hyperinsulinism)
• decreased production or stores
• increased utilization &/ decreased
production / other causes

8. Hyperinsulinism
Diabetic mothers
 Maternal tocolytic therapy
Maternal chlorpropamide therapy
Beckwith- weidmann syndrome
Abrupt cessation of high glucose infusions
exchange transfusion of blood containing high
glucose concentration

9. Beckwith-Weidmann syndrome

10. Decreased production or stores
 Preterm (SGA & LGA)
 IUGR (Preterm & post term)
 Inadequate calorie intake

11. increased utilization &/
decreased production / other
causes
Perinatal stress
Defects in CHO metabolism
Endocrine deficiency
Polycythemia

12. Time schedule for screening
• IDMs
• asymptomatic hypoglycemia very early viz.
1 to 2 hours and rarely beyond 12 hours
• preterm and SGA may be at risk up to 36
h (range 0.8 to 34.2 h)

13. Symptomatology of
infants
Time schedule for
screening
At risk neonates
2, 6, 12, 24, 48, and 72 hrs
Sick infants
Sepsis, asphyxia, shock in
the active phase of illness
Every 6-8 hrs
Stable VLBW infants on
parenteral nutrition
Initial 72 h: every 6 to 8 hrs;
after 72 hrs in stable
babies: once a day

14. When should be screening is
stopped
INFANTS
TIME
At risk
End of 72 hrs
infant on IV fluids
Has two consecutive
values >50 mg/dL on total
oral feeds after
stopping of the IV fluids.
Consider at risk and
monitor for 48 hours
Infant whose blood sugar
normalized on oral feed

15. Method of Glucose estimation
• Bed side reagent strips (Glucose oxidase):
• Laboratory diagnosis

16. Clinical signs associated with
hypoglycemia
•Asymptomatic
•Symptomatic

17. Symptomatic
•
•
•
•
•
•
•
•
•
stupor,
jitteriness,
tremors,
apathy,
episodes of cyanosis,
convulsions,
intermittent apneic spells
tachypnea, weak
.

18. Symptomatic
•
•
•
•
•
•
•
•
and high pitched cry,
limpness and lethargy,
difficulty in feeding,
eye rolling
sweating,
sudden pallor,
hypothermia and
cardiac arrest

20. Management of asymptomatic
hypoglycemia
• Blood sugar •
20-40 mg/dL
•
•
•
•
•
asymptomatic
hypoglycemia
Trial of oral feeds (expressed breast
milk or formula) and
Repeat blood test after 1 hour.
If repeat blood sugar is more than 50
mg/dL, two hourly feeds is ensured
with 6 hourly monitoring for 48 hrs
If repeat blood sugar is <40 mg/dL, IV
Dextrose is started and
further management is as for
symptomatic hypoglycemia

21. asymptomatic
ASYMPTOMATIC
hypoglycemia
• Blood sugar levels <20
mg/dL
• IV Dextrose is started at 6
mg/kg/min of glucose;
• Further management is
as for symptomatic
hypoglycemia

22. symptomatic hypoglycemia
• including seizures, a bolus of 2 mL/kg of
10% dextrose (200mg/kg)
• Immediately after the bolus, a glucose
infusion at an initial rate of 6-8 mg/kg/min
should be started.
• Check blood sugar after 30 to 60 min and
then every 6 hour until blood sugar is >50
mg/dL.

23. symptomatic hypoglycemia
• Repeat subsequent hypoglycemic
episodes may be treated by increasing the
glucose infusion rate by 2 mg/kg/min until
a maximum of 12 mg/kg/min.
• After 24 hours of IV glucose therapy, once
two or more consecutive blood glucose
values are >50 mg/dL, the infusion can be
tapered off
• the rate of 2 mg/kg/min every 6 hours with
BGL monitoring.

24. symptomatic hypoglycemia
• oral feeds.
• 4 mg/kg/min of glucose infusion is
reached
• and oral intake is adequate and the blood
sugar values are consistently >50
mg/dL, the infusion can be stopped
without further tapering.

26. Recurrent / resistant
hypoglycemia
• when there is a failure to maintain normal
blood sugar levels despite a glucose
infusion of 12 mg/kg/min or when
stabilization is not achieved by 7 days of
therapy. High levels of glucose infusion
may be needed in the infants to achieve
euglycemia

27. Treatment
• Hydrocortisone 5 mg/kg/day IV or PO in
two divided doses for 24 to 48 hrs
• Diazoxide 10-25 mg/kg/day in three
divided doses PO.
• Glucagon 100 mg/kg subcutaneous or
intramuscular (max 300 mg)
• Octreotide (synthetic somatostatin in
dose of 2-10 μg/kg/day subcutaneously
two to three times a day.

28. Prevention
• Early feeding - as soon as the infant is
ready, preferably within 1 hour of birth.
• What feed? – Breastmilk (colostrum) Not
dextrose-water.
• Assess risk factors and symptoms.
Assess for presence of the following risk
factors and symptoms

29. Prevention