Neonatal Hypoglycaemia

• Infant of diabetic mother: related to neonatal hyperinsulinism
• SGA / Preterm infant: related to glycogen storage
• Implications of hypoglycaemia: may cause permanent neurologic injury

Definition:
• Hypoglycaemia: Plasma glucose concentration low enough to cause symptoms and/or signs of impaired brain function

• Persistent Hypoglycaemia: Failure to maintain normal blood glucose despite glucose delivery >8 – 10 mg/kg/min

• Recurrent / Resistant Hypoglycaemia: Failure to maintain normal blood glucose despite glucose delivery >15 mg/kg/min

Types:
• Transitional hypoglycaemia
• Persistent hypoglycaemia / Onset first time beyond day 3 of life

Accepted range:
• < 4 hours of life: >1.5 mmol/L (provided infant is well, asymptomatic, tolerating feeds and repeat blood glucose is >2.6 mmol/L)
• <48 hours of life: >2.6 mmol/L
• >48 hours of life: >3.3 mmol/L

Other risks:
• Perinatal stress
• birth asphyxia / ischaemia; Caesarean delivery for fetal distress
• Maternal pre-eclampsia / eclapmsia / hypertension
• IUGR
• Meconium aspiration syndrome
• Polycythaemia
• hypothermia

• Jitteriness / Seizures
• Irritability
• Poor feeding
• Hypothermia
• Lethargy
• Apnoea / Cyanotic episodes
• Hypotonia
• High pitched cry

If Dxt consistently ≥2.6 mmol/L
• LGA infant & infant of diabetic mother: monitor dxt till 12 hours of life
→ Increased risk: monitored in postnatal ward
→ High risk: monitored in NICU for first 6 hours of life, then continue in postnatal ward

• SGA & preterm infants: monitor dxt till 24 hours of life
→ Increased risk: monitored in postnatal ward
→ High risk: monitored in NICU until 12 hours of life, then continue in postnatal ward

Any Dxt <2.6 mmol/L
• Monitor dxt for additional 24 hours until stable

Note: Duration & frequency of monitoring may be different in different center

First 4 hours of life + Blood glucose <1.5 // symptomatic
• IV Dextrose 10% 2 – 3 mL/kg bolus, then
• IVI Dextrose 10% 60 – 90 mL/kg/day
• If infant already on IVI Dextrose 10%, consider increasing IVI rate / glucose concentration (usually require 6 – 8 mg/kg/min glucose delivery)

First 4 hours of life + Blood glucose 1.5 – 2.5 AND asymptomatic
• Supplementary feed (EBM / formula) as soon as possible
• Re-check Dxt in 1 hour post-feeding
• If blood glucose remains <2.6 mmol/L and infant refused feeds, start IV Dextrose 10% drip

• If infant already on IVI Dextrose 10%, consider stepwise increment of glucose infusion rate by 2 mg/kg/min until blood glucose >2.6 mmol/L

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Glucose monitoring post-hypoglycaemia
• If below target level, re-check glucose every 30 mins
• If blood glucose level above target x2, then monitor hourlyx2, then 2 hourly x2, then 3 – 6 hourly pre-feeding

Feeding & Dextrose IV drip
• Increase feeding as tolerated
• Reduce IVI Dextrose 10% 1 hour after feeding increment

• Hypoglycaemia persisting >48 HOL // First time after 48 HOL are likely due to:
→ Infection
→ metabolic / endocrine disorders
• Ensure patency of vascular access !!!
• Send random blood sugar and critical sampling before correction of hypoglycaemia

• REFER tertiary center for treatment options e.g. SC Octreotide, IV Hydrocortisone, IM/SC/IV Glucagon etc.