NEONATAL PROBLEM 2

NABILAH NAJLAA

HYPOGLYCAEMIA
Blood glucose level is < 2.6 mmol/l in a term or preterm infant

Hypoglycemia is the most common metabolic problem in newborns. It occurs in approximately 1 - 3 out of every 1,000 births.

Babies need glucose for energy. Most of that glucose is used by the brain. The foetus gets glucose from the mother through the placenta. After birth, the baby gets glucose by producing it in the liver and from food. Glucose levels can drop if: There is too much insulin in the blood (hyperinsulinism). There is not enough glycogen The baby is not producing enough glucose. The babys body is using more glucose than is being produced.

ETIOLOGY: conditions associated with an increased risk for neonatal hypoglycemia include:

1. Decreased substrate availability: Intra-uterine growth retardation Glycogen storage disease Inborn errors (e.g., fructose intolerance) Prematurity

2. Hyperinsulinemia: Infant of diabetic mother Islet cell hyperplasia Erythroblastosis fetalis Exchange transfusion

3. Other endocrine abnormalities: Hypothyroidism Adrenal insufficiency 4. Increased glucose utilization: Cold stress Increased work of breathing Sepsis Perinatal asphyxia 5. Miscellaneous conditions: Polycythemia Congenital heart disease CNS abnormalities

Symptoms
Jitteriness and irritability Apnoea Cyanosis Hypotonia Poor feeding Convulsion Tremor Sweating Hunger, nausea, and vomiting

Management : Prevention and Early detection

Identify babies at risk For well babies who are at risk : -immediate feeding:first feed can be given at labour room -supplement feeding until breastfeeding established For unwell babies -set up dextrose 10% drip Regular glucometer monitoring -on admission and at 1,2,4 hours later -3 to 6 hourly pre feeding samples once glucose stable for 24-48 hours.

Treatment
Repeat the glucometer test and send Random Blood Sugar stat Examine and document any symptoms Note when the last feeding was given If on iv drip , check the iv infusion of glucose is adequate and running well If blood sugar level (BSL) < 1.5 mmol/l or if the baby symptomatic -intravenous bolus dextrose 10% at 2-3ml/kg -followed by dextrose 10% drip at 60-90 ml/kg/day ( for 1st day of life) to maintain normal blood glucose

if baby sugar level 1.5-2.5mmol/l -give supplementary feed as soon as possible -If BSL remains < 2.6mmol/l and baby refused to feed ,set up dextrose 10% drip. -if baby is on dextrose 10% drip , consider stepwise increment using glucose infusion rate by 2mg/kg/min until blood sugar is

Glucose monitoring
-if capillary blood sugar is < 2.6 mmol/l,check the glucometer half hourly If capillary blood sugar >2.6 mmol/l for 2 readings : Monitor hourly x 2,then 2 hourly x 2,then 4-6 hourly if blood sugar remains normal. Start feeding when capillary blood sugar remains stable and increase as tolerated. Reduce the iv infusion rate one hour after feeding increment.

Complications
Severe or long-term hypoglycemia may lead to : Brain damage Developmental delay Heart failure Seizures

Prognosis
The outlook is good for newborns who do not have symptoms, or who have hypoglycemia that gets better with treatment. However, hypoglycemia can return in a small percentage of babies after treatment. The condition is more likely to return when babies are taken off intravenous feedings before they are fully ready to eat by mouth. Babies with symptoms are more likely to develop problems with learning. This is especially true for babies with lower-thanaverage weight or whose mothers have

2. INFANT OF DIABETIC MOTHER

An infant of a diabetic mother is a baby born to a mother who has diabetes. The phrase specifically refers to a baby who is born to a mother who had persistently high blood glucose levels during pregnancy.

Causes, incidence, and risk factors

High blood sugar levels in pregnant women often have specific effects on their infants. Infants born to mothers who have diabetes are generally larger than other babies. They may have large organs, particularly the liver, adrenal glands, and heart. These infants may have episodes hypoglycemia shortly after birth because of increased insulin.The infant will need close monitoring of blood sugar levels.

Symptoms
The infant is usually large for gestational age. Other symptoms may include: Blue or patchy (mottled) skin color, rapid heart rate, rapid breathing (signs of immature lungs or heart failure) Newborn jaundice Poor feeding, lethargy, weak cry (signs of severe low blood sugar) Puffy face Reddish appearance Tremors or shaking shortly after birth

Signs and tests

An ultrasound performed on the mother in the last few months of pregnancy shows that the baby is large for gestational age. Lung maturity testing may be performed on the amniotic fluid if delivery is being considered more than a week before the due date. After birth, tests may show that the infant has low blood sugar and low blood calcium. An echocardiogram may show an abnormally large heart, which can lead to heart failure.

Complications
Macrosomia Congenital heart defects Heart failure Small left colon syndrome - causes symptoms of intestinal blockage Hyperbilirubinemia -- may cause permanent brain damage Immature lungs lack of surfactant Neonatal polycythemia -- this may cause a blockage in the blood vessels Severe hypoglycemia- may cause permanent brain damage Stillbirth

Treatment
All infants who are born to mothers with diabetes should be tested for low blood sugar (hypoglycemia), even if they have no symptoms. If an infant had one episode of low blood sugar, tests to check blood sugar levels will be done over several days. This will continue until the infant's blood sugar remains stable with normal feedings. Early feeding may prevent low blood sugar in mild cases. Persistent low blood sugar is treated with glucose given through a vein.

Prognosis
Better control of diabetes and early recognition of gestational diabetes has decreased the number and severity of problems in infants born to mothers with diabetes. Usually, an infant's symptoms go away within a few weeks. However, an enlarged heart may take several months to get better.