Re-Evaluating “Transitional Neonatal Hypoglycemia”: Mechanism and Implications for Management

Abstract

2016-11-02T18:49:00

β1-Adrenergic receptor deficiency in ghrelin-expressing cells causes hypoglycemia in susceptible individuals

“…Other groups besides the young that are predicted to be susceptible to hypoglycemia and possibly death as a result of beta blocker-induced or other causes of reduced ghrelin secretion include cachectic individuals and individuals with anorexia nervosa, in whom high levels of ghrelin have been described and normally may serve a protective function (7,12,62,63). Consideration should also be given to the possible involvement of an insufficient ghrelin response in the more common condition of transitional neonatal hypoglycemia in normal newborns (64) or in cases of exercise-induced hypoglycemia in beta blocker-treated individuals (65). As mentioned in the Introduction, ghrelin has at its disposal several potential downstream effector hormones and tissues through which it may act to sustain blood glucose levels in fasted states.…”

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

“…During the process of adaptation to an intermittent supply of glucose after birth, the neonate is prone to episodes of hypoglycaemia. Transient postpartum decreases in BG concentrations are physiological and stimulate neonatal glucose production and appetite (2)(3)(4)(5)(6)(7). Hormone changes after birth up-regulate the metabolic pathways by impacting the transcription of genes for metabolic enzymes.…”

“…First, inadequate glucose supply appears when there is insufficient enteral or parenteral nutritional input (5-7). Secondly, low glycogen stores may be a problem in preterm neonates, because glycogen starts to form in the 3rd trimester of pregnancy (2,5,7,17), and also in the case of in utero growth restriction (IUGR) (2,7,18). Thirdly, impaired glucose production is the result of metabolic disturbances of glycogenolysis, gluconeogenesis, amino acid, carbohydrate and fatty acid metabolism (19).…”

“…Most often it is the consequence of unregulated maternal diabetes (type 1, type 2 or gestational) (25,26). Moreover, a transient increase in insulin concentration may be seen in some other conditions: in IUGR (7,18,27,28), after a stressful peripartum event (2,7,22,29), after maternal treatment with insulin or glucose during labour (30), and in the case of some foetal disorders: haemolytic disease of the newborn, hypothermia, heart failure (2, 7, 22) and in Beckwith-Wiedemann syndrome (BWS) (24,31,32).…”

Risk factors associated with hypoglycemia in neonates

“…La hipoglucemia sigue siendo un problema en Neonatología porque persisten las controversias sobre su definición, importancia clínica y manejo (22)(23)(24) clínico óptimo . La evidencia actual no especifica una glucemia que se considere normal o anormal, tampoco aquel valor que sea potencialmente dañino (25) para el sistema nervioso .…”