On the Diagnosis of Symptomatic Neonatal Hypoglycemia

Abstract

Summary Eighteen newborn infants, 11 males and 7 females, with hypoglycemia, i.e. with blood glucose concentration of less than 20 mg per 100 ml were studied. Twelve infants were diagnosed as cases of symptomatic and 6 as cases of asymptomatic hypoglycemia. All infants with asymptomatic hypoglycemia were small for gestational age, whereas the symptomatic group was heterogenous from a clinical point of view. The disappearance rate of intravenously administered glucose (kG‐value) was studied before any treatment was started. The kG‐values were high in all infants with symptomatic hypoglycemia, in 10 exceeding +2 s.D. for normal infants of the same age. The symptomatic infants were treated with hydrocortisone or human growth hormone in addition to continuous glucose infusion. After the institution of therapy there was a rapid normalization of the kG‐values. The 6 infants with asymptomatic hypoglycemia had normal kG;‐values. They were only given a high caloric supply by means of breast milk. In two infants with symptomatic hypoglycemia repeated simultaneous determinations of kG‐values and the plasma concentration of free fatty acids revealed no relationship. At follow‐up examinations at ages from 5 months to 2 years, 2 out of the 12 infants in the symptomatic group were found to have severe cerebral damage. All infants with asymptomatic hypoglycemia were completely normal. The findings seem to have some clinical applications. Determination of the disappearance rate of intravenously administered glucose, primarily given as a diagnostic test, may differentiate between symptomatic and asymptomatic hypoglycemia. If in a doubtful case the kG‐value is normal, the likely diagnosis is asymptomatic hypoglycemia. In cases of symptomatic neonatal hypoglycemia repeated determinations of the kG‐value may provide a sensitive guide as to the effect of treatment.

Perinatal Encephalopathies Caused by Maternal Diseases during Pregnancy

“…Those with symtomalic hypogly cemia later show signs of severe cerebral damage in a large percentage [14]. The structural cerebral changes are principally of the same type as those seen after hypoxia, and will be dealt with later.…”

Intravenous glucose tolerance test and its relation to a scoring System for the degree of diabetic fetopathy in newborn infants

“…The frequency of the neonatal criteria in IDM cemia [9] hyperbilirubinemia [9] and overweight are presented in Fig. 3 and also within brackets [8], while polycythemia [6], postnatal weight loss in the text. The criteria most commonly found [5], respiratory difficulties [5] and congenital were diabetic fetopathy [18] and hyperex-anomalies [3] were least frequent.…”

“…The outcome of the pregnancy depends not only on the duration and the severity of the diabetic s täte before pregnancy [16], but also on the occurrence of complications and the degree of blood sugar control during the pregnancy [13]. The infant of the diabetic mother (IDM) often presents a well-known clinical picture at birth and in the early neonatal period with e. g. high birth weight for gestational stage, a cushingoid face and stature, hypoglycemia, hyperbilirubinemia and polycythemia [3], Infants of healthy mothers (IHM) demonstrate a low carbohydrate tolerance during the first days of life [l, 5, 9], which is even more pronounced in preterm, small-for-gestational-age-infants [3,6]. IDM on the other hand have a more rapid removal of glucose from the circulation than IHM after i. v. injection of glucose suggesting a state of "hyperinsulinism" in the infant of the diabetic mother [l, 5, 9].…”

Acute Effects and Long-Term Neurological Consequences of Insulin-Induced Hypoglycaemia in the Newborn Rabbit

“…The onset of depressive signs leading to coma occurred at relatively high blood glucose levels although the lowest values ultimately encountered were comparable to those seen in man with hypoglycaemic coma. It is possible that the occur rence of signs may relate to the magnitude or rate of fall of blood glucose [7,10] rather than a particular level, but there may also be a species difference.…”