Neonatal Hypoglycemia

Overview
• Glucose physiology
• Glucose Homeostasis and Transitional hypoglycemia
• Differential diagnosis
• Risk factors for Hypoglycemia
• Criteria
• Diagnostic evaluation
• Management
Case Presentation
Case Presentation
Glucose Physiology
• In Utero:
• Glucose transferred from mother to fetus across placenta via
facilitated diffusion
• Maternal insulin does not cross the placenta

• Post-natally:
• Continuous glucose supply ceases and neonatal insulin concentrations
need to be regulated
• Lower blood glucose values 24-48 hours postnatally
Glucose homeostasis
• Brain depend on constant supply of glucose
• Healthy newborn requires higher GIR compared to adults due to
proportionally larger brain to body mass ratio
• Prolonged starvation:
• Liver produces ketone bodies
• Liver glycogen sotres rapidly depleted after birth
• Other tissues use free fatty acids
Neonatal Hypoglycemia
• Risk of neurological sequelae.
Signs and symptoms
•
Neurogenic (autonomic) symptoms result from changes due to neural
sympathetic discharge triggered by hypoglycemia.
• •Jitteriness/tremors
• •Sweating
• •Irritability
• •Tachypnea
• •Pallor
• Neuroglycopenic symptoms are caused by brain dysfunction from
impaired brain energy metabolism due to a deficient glucose supply.
• •Poor suck or poor feeding
• •Weak or high-pitched cry
• •Change in level of consciousness (lethargy, coma)
• •Seizures
• •Hypotonia
• In newborns, additional signs of hypoglycemia include apnea,
bradycardia, cyanosis, and hypothermia.
• Because these findings are nonspecific, further evaluation for other
possible causes (eg, sepsis) should be conducted if symptoms do not
resolve after normalization of the blood glucose concentration.
References
• https://www.uptodate.com/contents/pathogenesis-screening-and-dia
gnosis-of-neonatal-hypoglycemia?search=neonatal%20hypoglycemia
&topicRef=101425&source=see_link