Friday, November 1, 2019

Neonatal Hypoglycemia

<40mg/dl and symptomatic (give IV glucose)

Birth to 4 hours of age:
Initial Screen: 25 mg/dl (Feed and check again in 1 hr)
< 25mg/dl (give iv glucose)
25-40 mg/dl ( refeed , i/v glucose as needed)
4 to 24 hours of age:
Continue feeds q2-3 hrly, screen glucose prior to each feed, e Target of >45mg/dl
<35mg/dl (feed and check in  1 hr)
<35 again ? (iv glucose)
35-45 mg/dl (refeed / iv glucose)

TREATMENT: target 40 to 50 mg/dl200mg/kg ( 10%DW 2ml/kg) Stat followed by+/-  5to8mg/kg/min(80-100 ml/kg/day)

Transient Neonatal Hypoglycemia is the most common cause.
It resolves by 48 hrs of life.
Risk factors for transient hypoglycemia are:
*Septic neonates
*Polycythemic neonates
*Cardiopulmonary instability

If GIR > 10, consider hyperinsulinism.