Newborn hypoglycemia

Abstract

Neonatal hypoglycemia is a common problem encountered by both term and preterm infants. It can be either symptomatic or asymptomatic. Prolonged hypoglycemia may result in permanent neurologic impairment and death. Definitions of hypoglycemia vary and remain controversial. Underlying causes of hypoglycemia include (a) inadequate glucose production; (b) increased glucose utilization; (c) abnormalities of endocrine regulation; and (d) other causes. Nurse practitioners must be aware of infants at risk for hypoglycemia so they can provide appropriate interventions. In this article the clinical characteristics of hypoglycemia are reviewed, various causes for hypoglycemia are identified, and an infant with prolonged hypoglycemia is described. In addition, the role of the nurse practitioner in the care and management of these infants is addressed.

Should Routine Peripheral Blood Glucose Testing Be Done for All Newborns at Birth?

“…Although a number of risk factors and signs and symptoms are often noted in the literature as occurring with hypoglycemia (Armentrout & Caple, 1999;Eidelman, 2001;Rozanace & Hay, 2006;Sunehag & Haymond, 2002;WHO, 1997), this study found that only 6 of 23 common screening factors were positive in more than 7 of the 220 subjects in our study (maternal diabetes history, GA < 38 weeks, large for gestational age (LGA) or small for gestational age (SGA) size, hypothermia, jitteriness, and tachypnea). Only two of those screening factors were found to be statistically associated with the infant's PBG values: infant jitteriness and tachypnea.…”

“…The incidence of hypoglycemia is highest in newborn infants of diabetic, preeclamptic, and/or substance abusing mothers, and in infants with low or high birthweight for their gestational age (GA), hypoxemia, cyanosis, hypothermia, and/or those born early (Alkalay et al, 2006;Armentrout & Caple, 1999;Eidelman, 2001;Sunehag & Haymond, 2002;WHO, 1997).…”

“…Several national/international groups of experts (American Academy of Pediatrics [AAP], Section on Breast Feeding, 2005;Armentrout & Caple, 1999;Canadian Paediatric Society, Fetu and Newborn Committee [CPS], 2004;Cornblath & Ichord, 2002;Eidelman, 2001;National Childbirth Trust, United Kingdom, 1997;Sunehag & Haymond, 2002;WHO, 1997;Williams, 2005) have suggested that routine screening for hypoglycemia should first include an assessment of the mother and infant for the presence of risk factors for hypoglycemia and assessment of the infant for any signs or symptoms of hypoglycemia (Table 1). In addition, testing of peripheral blood glucose (PBG) levels with point-of-care (POC) or laboratory methods should only be done in infants with positive risk factors or signs/symptoms of hypoglycemia and not for routine screening purposes in infants without risk factors or signs/symptoms of hypoglycemia.…”

“…In addition, each glucose analysis results in a charge for laboratory services. Although clinicians often consider the cost of POC glucose testing to be trivial, a recent study found costs to be higher for POC than for laboratory glucose analysis ($4.66 and $1.18, respectively) (Howanitz, 2004 Armentrout and Caple (1999), Eidelman (2001), Rozanace and Hay (2006), Sunehag and Haymond (2002). hypoglycemia in the infant shortly after birth, then the discomfort and costs of the test would not warrant requiring this test for all newborn infants.…”

Neurologic damage in hypoglycemia

“…Infants constitute another group at risk of hypoglycemia, which can be related to conditions such as inadequate glucose production, increased glucose utilization, and abnormal regulation of metabolism (Armentrout and Caple, 1999;Hawdon, 1999;Sperling and Menon, 1999;Glaser, 2000;Ozand, 2000). Neonatal hypoglycemia can also be the result of failure to adapt from the fetal state of continuous glucose supply through the placenta to the extrauterine state involving intermittent nutrient supply.…”