Management Strategies for Neonatal Hypoglycemia

Abstract

While hypoglycemia occurs commonly among neonates, treatment can be challenging if hypoglycemia persists beyond the first few days of life. This review discusses the available treatment options for both transient and persistent neonatal hypoglycemia. These treatment options include dextrose infusions, glucagon, glucocorticoids, diazoxide, octreotide, and nifedipine. A stepwise, practical approach to the management of these patients is offered.

Prevalence and severity of hypoglycemia in a sample of neonates in Erbil city

“…1,2 Approaches to defining hypoglyc emia have included a statistical approach with standard deviations, counter-regulatory responses with a metabolic approach, neurophysiological changes, and neurodevelopmental outcomes of symptomatic versus asymptomatic hypoglycemia. 3 Definitions varies from less than 30 mg/dl in the first 24 hours to less than 45 mg /dl 4,5 or from less than 2 mmol/ L to less than 2.6 mmol/L. 6,7 Accompanied symptoms include jitteriness, cyanosis, seizures, apneal episodes, tachypnea, weak or high-pitched cry, floppiness or lethargy, poor feeding, and eye-rolling.…”

2. Neonatal hypoglycaemia: History, clinical picture, investigations, management and outcome

“…In persistent hyperinsulinemic hypoglycaemia the first choice treatment is diazoxide, but if there is no response to it, octreotide may be used (44). In rare cases partial or total pancreatectomy is needed (2,33,45).…”

“…Glucagon is a short-acting agent, hence boluses have to be repeated or continuous infusion should be initiated (2,46). Therapy with glucocorticoids is time limited to 1 or 2 days because of their many side effects, except in adrenal insufficiency, where long-term supplemental therapy is needed (2,24,45). In persistent hyperinsulinemic hypoglycaemia the first choice treatment is diazoxide, but if there is no response to it, octreotide may be used (44).…”

“…infusion has to be adjusted to fluid demands. Moreover, glucose concentrations can be raised if necessary, to a maximum 12.5% in a peripheral approach and to maximum 25% in a central approach (2,6,7,24,45).…”

Hyperinsulinism in neonates of diabetic mothers: guardian of the brain?

“…Postnatal management of neonates of diabetic mothers continues to give cause for concern [1][2][3]. Gestational diabetes is connected with the risk of fetal and neonatal complications that are directly related to inadequate glycemic control during pregnancy [1,2].…”