Controversies Regarding Definition of Neonatal Hypoglycemia: Suggested Operational Thresholds

Cornblath, Marvin; Hawdon, Jane; Williams, Alexander; Aynsley-Green, A; Platt, Martin Ward; Schwartz, Robert; Kalhan, Satish C.

doi:10.1542/peds.105.5.1141

Cited by 583 publications

(463 citation statements)

References 25 publications

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“…Therefore, the plasma glucose concentrations are on average 11% higher compared to blood concentrations, depending on the hematocrit and the water component in blood. Also, hypoglycemia defined by a single number does not distinguish the different values at which an individual starts to compensate for inadequate glucose supply to the brain (Cornblath et al 2000).…”

Section: Discussionmentioning

confidence: 99%

Normoglycemic Ketonemia as Biochemical Presentation in Ketotic Glycogen Storage Disease

et al. 2015

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Background: According to the textbooks, the ketotic glycogen storage disease (GSD) types 0, III, VI, IX, and XI are associated with fasting ketotic hypoglycemia and considered milder as gluconeogenesis is intact.Methods: A retrospective cohort study of biochemical profiles from supervised clinical fasting studies is performed in ketotic GSD patients in our metabolic center. For data analysis, hypoglycemia was defined as plasma glucose concentration <2.6 mmol/L. Total KB was defined as the sum of blood acetoacetate and b-hydroxybutyrate concentrations. If the product of glucose and KB concentrations was greater than 10, a ketolysis defect was suspected.Results: Data could be collected from 13 fasting studies in 12 patients with GSD III (n ¼ 4), GSD VI (n ¼ 3), and GSD IX (n ¼ 5). Six patients remained normoglycemic with median glucose concentration of 3.9 mmol/L (range, 2.8-4.6 mmol/L) and median total KB concentration of 1.9 mmol/L (range, 0.6-5

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Section: Discussionmentioning

confidence: 99%

Normoglycemic Ketonemia as Biochemical Presentation in Ketotic Glycogen Storage Disease

et al. 2015

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“…For example, an attempt has been made to define 'operational thresholds' rather than a 'normal range' in neonatal blood glucose monitoring. 26 In blood pressure monitoring, the operational threshold is the value (diastolic, systolic or mean) at which the clinician should consider intervention. Ideally, this threshold value is based on the best evidence available in the literature and linked to improvements in organ perfusion and oxygen delivery, as well as to relevant clinical outcome measures.…”

Section: Definition Of Hypotensionmentioning

confidence: 99%

Definition of hypotension and assessment of hemodynamics in the preterm neonate

2009

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The complexity of postnatal cardiovascular transition has only recently been better appreciated in the very low birth weight neonate. As blood pressure in itself poorly represents systemic blood flow, especially when the fetal channels are open and the developmentally regulated vital organ assignment may not have been completed, efforts to measure systemic blood flow have resulted in a novel, yet incomplete, understanding of the principles and clinical relevance of cardiovascular adaptation during postnatal transition in this patient population. This article describes the definition of hypotension based on the principles of cardiovascular physiology, and reviews the tools available to the clinician and researcher at the bedside to examine the complex relationship among blood pressure, systemic and organ blood flow, and tissue oxygen delivery and oxygen demand in vital and non-vital organs in the very low birth weight neonate. Only after gaining an insight into these complex relationships and processes will we be able to design clinical trials of selected treatment modalities targeting relevant patient sub-populations for the management of neonatal cardiovascular compromise. Only clinical trials based on a solid understanding of developmental cardiovascular physiology tailored to the appropriate patient sub-population hold the promise of being effective and practical, and can lead to improvements in both hemodynamic parameters and clinically relevant outcome measures.

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“…Babies were monitored for hypoglycemia (defined by blood glucose level <40mg/dl regardless of gestational age). 9 Respiratory distress was defined by respiratory rate of ≥60/min and/or sub costal and intercostal retraction.…”

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confidence: 99%

“…Polycythemia was diagnosed if the venous hematocrit exceeds 65%; hypocalcaemia was defined as serum calcium <7mg/dl. [9][10][11][12] Billirubin level was estimated at the clinical appearance of jaundice or on day4 if not evident clinically and hyperbillirubinemia was diagnosed based on standard guidelines. 13 Chest X ray was done in all infants with respiratory problems and/or heart murmur.…”

mentioning

confidence: 99%

Adverse perinatal outcome in diabetic mother treated with oral hypoglycemic agents vs. insulin

Meher

Parida

Pradhan

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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Background: Insulin has been the primary mode of therapy in diabetic mother for glycemic control as oral hypoglycemic agents (OHA) were initially thought to have teratogenic effect. Recent data supports the use of certain OHA; this study was designed to compare the perinatal outcomes in infants born to diabetic mother treated with insulin vs. oral hypoglycemic agents and to find out the relation of adverse perinatal events to glycemic control in both groups. Methods: This prospective observational study was conducted in a tertiary care hospital. 108 neonates born to diabetic mother between October 2014 to September 2016 were taken for study immediately after delivery after excluding the mothers who were treated with lifestyle modification and/or dietary modification alone only. 60 mothers had received insulin and 48 OHA for glycaemic control. Glycemic control was assessed by HbA1C estimation on the day of delivery. The infants were followed up in neonatal care unit for perinatal complications. Main outcome measure(s): birth weight, gestational age, respiratory problems, birth injury, birth asphyxia, congenital anomalies, hypoglycemia, hypocalcaemia, hyperbillirubinemia. Results: Out of 108 infants, 27 were born to pregestational and 81 to gestational diabetic mothers. 60(55.5%) were treated with insulin and rest with OHA, 53(49.1%) had optimal glycemic control. Both the groups had similar glycemic control in the third trimester. None of the perinatal outcomes showed significant difference between insulin and OHA group except neonatal hyperbillirubinemia. (p=0.013, RR=8 and OR=0.106). Within the optimal glycemic control (HbA1C <8), LGA has significant association with the insulin group than OHA (p=0.012, RR=2.217 and OR=4.2018). Conclusions: As compared to insulin, oral hypoglycemic agents have similar glycemic control and no adverse perinatal outcomes and can be used in pregnant mothers with diabetes mellitus from poor socioeconomic and educational background for its low cost and better patient compliance. Within the glycemic control, maternal treatment with insulin showed significant difference in LGA compared to OHA which needs further studies for validation.

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Controversies Regarding Definition of Neonatal Hypoglycemia: Suggested Operational Thresholds

Cited by 583 publications

References 25 publications

Normoglycemic Ketonemia as Biochemical Presentation in Ketotic Glycogen Storage Disease

Normoglycemic Ketonemia as Biochemical Presentation in Ketotic Glycogen Storage Disease

Definition of hypotension and assessment of hemodynamics in the preterm neonate

Adverse perinatal outcome in diabetic mother treated with oral hypoglycemic agents vs. insulin

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