Neonatal hypoglycemia: A discussion

Beard, Alice G.; Cornblath, Marvin; Gentz, J.; Kellum, M.; Persson, Bengt; Zetterström, Rolf; Haworth, J. C.

doi:10.1016/s0022-3476(71)80123-3

Cited by 45 publications

(31 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The role of lactate in cerebral energy metabolism of the human neonate has been a subject of speculation for some years (3,27), but previous attempts to document cerebral lactate uptake in the fetal and neonatal period have been largely unsuccessful. In particular, the brains of hypoglycemic fetal sheep apparently do not take up lactate (12, 17).…”

Section: Cerebral Cortex Blood N O W Oxygen Consumption and Uptakementioning

confidence: 99%

Fasting Plasma Levels of Glucose, Acetoacetate, D-β-Hydroxybutyrate, Glycerol, and Lactate in the Baboon Infant: Correlation with Cerebral Uptake of Substrates and Oxygen

et al. 1977

View full text Add to dashboard Cite

Summarydata obtained in the stressed low birth weight human neonate.The energy-rich substrates available to the fasting stressed baboon neonate ~n d infant are quantitatively similar to the metabolic fuels presented to the stressed low birth weight human newborn. Within a few hours after birth, fasting arterial plasma glucose levels in the baboon neonate approximate those of 4-6-week-old baboon infants after a 20-hr fast. Lactate levels are high and comparable for both age groups. In contrast, /3-hydroxybotymte is quite low in the immediate neonatal period, but rises to significantly higher levels (P < 0.001) after a fast at 4-6 weeks. In addition, glycerol levels are higher (P < 0.02) in the fasted older infant compared with the fasting neonate.Computation of mean cerebral blood arteriovenous differences and oxygen equivalents for animals studied in the first 50 hr of life demonstrates that glucose uptake can account for 50% or less of cerebral oxygen consumption in the newborn period. In confirmation, the respiratory quotient in these animals is 0.52 * 0.06.Cerebral oxygen consumption in the immediate neonate is greater than can be explained by utilization of glucose and the small quantities of acetoacetate and &hydroxybutyrate available at this time. At birth, cerebral uptake of lactate is noted, but this phenomenon is not observed at 6 and 12 weeks of age. SpeculationThe baboon model for dynamic studies of neonatal energy metabolism may permit investigations of greater clinical relevance than those in lower mammalian model systems. It is suggested that lactate may be a significant cerebral energy source in the immediate neonatal period.Physiologic adaptation of the newly born infant to extrauterine life has been the subject of intensive investigation. Homeostatic adjustments in energy metabolism which occur postnatally have been of particular concern because of the clinical significance of disordered energy metabolism in the human neonate. Studies of these neonatal adaptations have been carried out in a number of mammalian species including the rat, lamb, and pig (4,12,29,32). Conclusions drawn from these studies have on occasion been applied to the human newborn.In an attempt to develop a clinically relevant model for investigation of metabolic alterations in the neonate, we have turned to a subhuman primate, the baboon. This animal has a gestational period of 184 2 10 days. At birth, it resembles the smallfor-gestational age human infant in terms of responses to fasting and diminished body fat. We have examined fasting arterial plasma levels of energy substrates and have compared these with Further, as an initial step in defining the usefulness of this preparation, studies of cerebral uptake of energy substrates have been carried out. METHODSTwenty baboon infants were studied. Infants were the products of timed matings. Fourteen baboon neonates were delivered by cesarean section at term after a gestation of 172 k 1 days, and six were delivered spontaneously after a gestation of 175 * 4 days. The mean birth...

show abstract

Section: Cerebral Cortex Blood N O W Oxygen Consumption and Uptakementioning

confidence: 99%

Fasting Plasma Levels of Glucose, Acetoacetate, D-β-Hydroxybutyrate, Glycerol, and Lactate in the Baboon Infant: Correlation with Cerebral Uptake of Substrates and Oxygen

et al. 1977

View full text Add to dashboard Cite

show abstract

“…Lubchencho and Bard also showed that preterm IUGR had a significantly lower mean blood glucose concentration in the first few postnatal hours than the term IUGR (p<0.05) 13 . Among the features of hypoglycaemia in 6 symptomatic cases jitteriness, hyper-alertness, tachypnoea , and lethergy were observed most commonly in our study.…”

Section: Discussionmentioning

confidence: 88%

“…Beard and Cornblath showed that 20% of the hypoglycaemic infants were symptomatic and the remaining 80 % of infants were asymptomatic 13 . This study also showed that there was no significant difference between blood glucose levels of symptomatic and asymptomatic hypoglycaemic LBW neonates in the first 48 hours of age.…”

Section: Discussionmentioning

confidence: 99%

Hypoglycaemic Status in Low Birth Weight Neonates During First 48 Hours of Life

BanglaJOL¹

2014

J. Armed Forces Med. Coll.

View full text Add to dashboard Cite

Introduction: In developing countries more than 90% infants are born with low birth weight (LBW). In Bangladesh the incidence is about 30%. Newborn baby has got a definite difference in metabolic profile from the adult; this difference is much more pronounced in case of LBW newborn. Infants born prematurely or following intrauterine malnutrition may develop abnormally low plasma glucose concentration for a prolonged period as a result of the failure to adapt a metabolic and endocrine response.Glucose is an essential nutrient for the brain. Abnormally low levels (hypoglycaemia) can cause encephalopathy and have the potential to produce long-term neurological injury. Adequate knowledge about neonatal physiology is important in the management of LBW neonates in the neonatal nursery specially in the first 48 hours of life as most of the neonatal deaths occur in this critical period of time. Objectives: To evaluate the clinical features of hypoglycaemic low birth weight (LBW) neonates in the first 48 hours of life. Methods: This cross-sectional study was conducted on 56 LBW neonates in the inpatient departments of Paediatrics and Obstetrics of Combined Military Hospital (CMH), Dhaka between 15th September 2010 to 14th March 2011. LBW (Weight <2500gm) neonates, both term and preterm, from birth to 48 hours of age and who were well at the time of blood collection were included in this study. After enrollment of the newborn, with all aseptic precaution blood samples were taken from cord (as basal) at birth, from venous blood at 2 hours and then from capillary blood at 4 hours, in between 12-24 hours and in between 24-48 hours by heel prick from each case . Cord and capillary blood glucose were measured by using Accu-Check-Active- glucometer. Blood glucose concentrations less than 2.6 mmol/L irrespective of weight and gestational age were considered as low for the purpose of analysis. Results: It was revealed from the study that the mean birth weight was 1.77 gm mean gestational age was 36.09 weeks. 30 ( 53.57% ) were intrauterine growth retarded (IUGR) and 26 (46.43% ) were appropriate for gestational age (AGA). Out of thirty IUGR, 24 (51.79%) infants had low blood glucose (<2.6 mmol/L) levels. Twenty-two (75.86%) of 29 low birth weight infants showed low blood glucose at one of the five time points, 07 (17.07%) had low values on two hypoglycemia at 12-24 hours of age.The mean blood glucose concentration in LBW infants were 4.03 mmol/L at birth (cord), 2.33mmol/L at 2 hours, 2.96mmol/L, at 4 hours 3.14mmol/L, at 1224hours and 3.43mmol/ L at 2448hours of age. In the first 48 hours, the lowest blood glucose (mean) concentrations were found at 2 hours after delivery.Hypoglycaemia was most common among the preterm intrauterine growth retarded (IUGR) neonates at 2 hours after delivery. Most 23 (79.31%) of the hypoglycaemic infants were asymptomatic and 6 (20.69%) had symptoms.Early feeding prevents hypoglycaemia and appears to influence subsequent glucose values. Among the manifestations jitteriness, hyperalert, tachypnoea, high pitched cry, lethargy, apnoea and poor feeding were observed. Conclusion: The study findings may be helpful in the management of LBW neonates with hypoglycaemia and will encourage the mother in initiation of feeding immediately after delivery. DOI: http://dx.doi.org/10.3329/jafmc.v9i1.18726 Journal of Armed Forces Medical College Bangladesh Vol.9(1) 2013: 49-56

show abstract

“…These hypo glycemias occurring mainly in the so-called 'small-for-gestational age' and in premature infants are thought to be due to the low glycogen supply [2,6,7,23] and an insufficiently developed gluconeogenesis [2,5]. For treatment of the neonatal hypoglycemias, glucose infusions are preferred almost exclu sively: only occasionally, therapy is supported by the administration of glu cocorticoids [2, 25, and others].…”

mentioning

confidence: 99%

“…For treatment of the neonatal hypoglycemias, glucose infusions are preferred almost exclu sively: only occasionally, therapy is supported by the administration of glu cocorticoids [2, 25, and others]. Individual suggestions were made to substi tute glucose by fructose for different reasons, for instance for the prevention of stimulation of insulin secretion [2,6], These suggestions were not widely accepted, whereas the polyol sorbitol is relatively widely used during the neonatal period, because of its low price and its practical advantages.…”

mentioning

confidence: 99%

Turnover Kinetics and Influence of Sorbitol on the Concentrations of Blood Glucose and Lactate and on the Acid-Base Balance in Newborns

Willgerodt¹,

Beyreiss²

1974

Neonatology

View full text Add to dashboard Cite

The turnover conditions of sorbitol and its influence on the glucose and lactate levels and on the acid-base state have been studied after intravenous intake of 0.5 and 1.0 g/kg body weight in the form of rapid injections and of 0.5, 0.75, and 1.0 g kg^-1 h^-1 as permanent infusion for 3 h in 34 infants aged 1–10 days. After rapid injection of sorbitol, the glucose blood level shows a delayed increase, and the lactate concentration rises. These effects are more marked after administration of 1.0 g/kg than 0.5 g/kg. With continuous infusions, the optimal turnover range for sorbitol is at intake rates of 0.5 g kg-¹ h^-1. With this intake rate the total clearance amounts to 23.7 ± 10.7 ml kg^-1 min^-1. A decrease of the total clearance values with increased intake rates during permanent infusion as well as a decrease of the k₂ values after increased doses with rapid injections suggest a decrease of the sorbitol transfer with increased intake. During the permanent intravenous infusion of sorbitol, an increase of the fructose blood level develops with dependence on the intake rate. The application of sorbitol instead of glucose for the treatment of hypoglycemias in hypoxic and otherwise impaired newborns is rejected because of the delayed rise of glucose, the decrease of the base excess, and the rise of the lactate concentration.

show abstract

Neonatal hypoglycemia: A discussion

Cited by 45 publications

References 20 publications

Fasting Plasma Levels of Glucose, Acetoacetate, D-β-Hydroxybutyrate, Glycerol, and Lactate in the Baboon Infant: Correlation with Cerebral Uptake of Substrates and Oxygen

Fasting Plasma Levels of Glucose, Acetoacetate, D-β-Hydroxybutyrate, Glycerol, and Lactate in the Baboon Infant: Correlation with Cerebral Uptake of Substrates and Oxygen

Hypoglycaemic Status in Low Birth Weight Neonates During First 48 Hours of Life

Turnover Kinetics and Influence of Sorbitol on the Concentrations of Blood Glucose and Lactate and on the Acid-Base Balance in Newborns

Contact Info

Product

Resources

About