The first signs of hypoglycemia in newborns

There is still no definition of hypoglycemia based on systematic studies.

Risk factors include prematurity, low weight / size for gestational age, and perinatal asphyxia. The diagnosis is suspected empirically and is confirmed by a test with glucose. The prognosis depends on the underlying disease. Treatment is enteral nutrition or intravenous glucose.

According to a survey of neonatologists in England in the late 80s, the lower limit of normal glucose in the blood plasma, which determines the transition to a state of hypoglycemia, ranged from 18 to 42 mg / dL!

Previously acceptable "normal values" of blood glucose (GC) in newborns are in fact not a manifestation of tolerance to glucose deficiency, but are a consequence of the late onset of feeding of newborns in the 60s. As for premature and small to the term gestation of newborns, the risk of hypoglycemia in them is much higher than in healthy full-term newborns due to their small reserves of glycogen and the failure of glycogenolysis enzymes. With early start of feeding, the level of HA during the 1st week of life is within 70 mg / dL.

This purely statistical definition of hypoglycemia based on serial GC measurements in healthy, full-term newborns has recently faded into the background in favor of a more functional definition. The question is already formulated not “what is hypoglycemia”, but “what level of HA is necessary for the normal function of the organs of the child and especially the brain”?

Two studies performed independently of each other to assess the effect of a low level of GC on brain function made almost identical conclusions:

  • Lucas (1988) performed a neurological assessment in very premature newborns (n ​​= 661) and showed that in the group of children whose HA levels gradually decreased to numbers below 2.6 mmol / l for at least 3 days, but the symptoms absent, at the age of 18 months, neurological deficit was noted 3.5 times more often than in the control group. These results were subsequently confirmed by data from a study by Duvanel (1999) when assessing neurological function in children born preterm at the age of 5 years, and it was noted that the most severe damaging effects of repeated episodes of hypoglycemia have a psychomotor development of the child.
  • Koh (1988) in his study, using neurophysiological methods, evaluated the relationship between the level of HA and the presence of pathological acoustic potentials in newborns. At the same time, in children whose level of GC did not fall below 2.6 mmol / l, pathological potentials were not observed in any one, in contrast to the group of children with lower glucose numbers (n = 5).

Based on the results of these studies, the following conclusions can be drawn:

  • First, maintaining glycemia> 2.6 mmol / l prevents the development of acute and persistent neurological damage.
  • Secondly, repeated and long periods of hypoglycemia appear to be more serious for a newborn child than short-term or one-time. The absence of typical clinical symptoms in the period of the newborn is a common situation, and does not reflect a milder course of hypoglycemia. Therefore, symptomatic hypoglycemia should be considered as more complex and requiring further treatment and control.

Definition

Full-term and premature newborns (including SGA): GK 4300

  • Asphyxia, perinatal stress.
  • Increased need / hyperinsulinism:

    • Maternal drug therapy (thiazides, sulfonamides, β-mimetics, tocolytics, diazoxide, antidiabetic drugs, propranolol, valproate).
    • Child from a mother with diabetes (up to 30%).
    • Polyglobulia.
    • Wiedemann-Beckwith syndrome (1: 15,000).
    • Congenital hyperinsulinism (formerly: nezidioblastosis), insulinoma (extremely rare).
    • Leucine-sensitive hyperinsulinism.

    Reduced intake of glucose:

    Defects of gluconeogenesis enzymes:

    • fructose-1,6-bisphosphatase
    • phosphoenolpyruvate carboxykinase
    • pyruvate carboxylase

    Defects of glycogenolysis enzymes (glycogenosis with a tendency to hypoglycemia):

    • glucose-6-phosphatase (type I)
    • debranching enzyme (type III)
    • liver phosphorylase (type VI)
    • phosphorylase kinase (type IX)
    • glycogen synthetase (type 0).

    Defects in the metabolism of amino acids: for example, maple syrup disease, tyrosinemia.

    Organ acidemias: eg, propionic acidemia, methylmalonic acidemia.

    Galactosemia, fructose intolerance.

    Defects of fatty acid oxidation.

    Insufficient intake of glucose from food.

    Hormonal disorders: growth hormone deficiency, ACTH deficiency, glucagon deficiency, hypothyroidism, cortisol deficiency, isolated and combined pituitary disorders.

    Other reasons: error in conducting infusion therapy, a break in the conduct of infusion therapy on the background of high glucose subsidies, severe intestinal infection, exchange blood transfusion, peritoneal dialysis, indomethacin therapy, glucose infusion through an established high catheter in the umbilical artery.

    Symptoms and signs of hypoglycemia in newborns

    In many cases, the symptoms do not appear. Neuroglycopenic signs include seizures, coma, cyanotic episodes, apnea, bradycardia or respiratory failure and hypothermia.

    Attention: clinical symptoms may be absent with severe hyperglycemia, therefore, in case of doubt, always determine the HA!

    • Apathy, impaired sucking (atypical symptoms of hypoglycemia in older children).
    • Anxiety, sweating.
    • Cerebral seizures.
    • Tachycardia, fluctuations in blood pressure.
    • Tachypnea, apnea and bouts of cyanosis.
    • A sudden shrill scream.

    Diagnosis of hypoglycemia in newborns

    • Nightly glucose checks.

    All signs are non-specific and also occur in newborns with asphyxia, sepsis, hypocalcemia, or opioid withdrawal syndrome. Thus, newborns at risk with these signs or without them require immediate bedside glucose testing. Abnormally low levels are confirmed by examination of a sample of venous blood.

    Attention: hypoglycemia = used in the diagnosis!

    • How ?: Widely used in practice, test strips for glycemic control have deviations in the lower range of measurements from those obtained by the hexokinase method used in the laboratory, i.e., all pathologically low glucose figures from measurements using test strips should immediately be tested by laboratory method. Rule of thumb: GK 4300 g at birth, children from a mother with diabetes, premature newborns.
    • When? Control GC on an empty stomach, after 1/2, 1, 3 and 6 hours after birth, then according to the indications.

    Primary diagnosis: first exclude non-metabolic diseases, such as sepsis, defects.

    Recurrent / treatment-resistant hypoglycemia:

    • determination, on the background of hypoglycemia, of the key metabolite of P-hydroxybutyrate, free fatty acids, lactate and blood gases.
    • further differential diagnostic algorithm.
    • Purposeful diagnosis - guided by four subgroups.

    Treatment of hypoglycemia in newborns

    • Dextrose intravenously (for the prevention and treatment).
    • Enteral nutrition.
    • Sometimes intramuscular glucagon.

    Newborns of the highest risk group are treated preventively. Infants from diabetic women who use insulin often receive a 10% aqueous glucose solution from birth. Other newborns at risk who are not sick should start early feeding with mixtures to provide carbohydrates.

    If the level of glucose drops to 120 ml / kg / day for 6-8 feedings).

  • If it is impossible - glucose infusion 10% 4-5 ml / kg / hour.
    • Immediately bolus glucose 3 ml / kg 10% glucose, repeat if necessary.
    • After the bolus, a maintenance glucose infusion of 5 ml / kg / hour of 10% glucose solution.
    • Do not forget about additional oral glucose subsidy. Add maltodextrin to the milk mixture (stimulates insulin secretion to a lesser extent than glucose in / in).
    • In the absence of effect: a gradual increase in glucose donation in / in 2 mg / kg / min to a maximum of 12 mg / kg / min.
    • If, after performing the above measures, the success is not achieved: the introduction of the glitch gon: dose for healthy full-term newborns (eutrophic) 0.1 mg / kg IV, p / c or / m. Do not use with HH or SGA!

    Caution: strict control, because the effect is short-lived!

    Caution: big glucose bolus → strong stimulation of insulin production ↔ further decrease in blood glucose!

    If the effect is still not achieved:

    • Octreotide (an analogue of somatostatin) 2–20 mcg / kg / day of s / c for 3–4 administrations, it is also possible to / in the administration in the preoperative period with congenital hyperinsulinism.
    • As an extreme measure: diazoxide, chlorothiazide.

    Caution: significant GC fluctuations.

    • Nifedipine.
    • For several days, hydrocortisone. Action: stimulation of gluconeogenesis. Decreased peripheral glucose uptake. Previously, cortisol and insulin levels were measured during hypoglycemia.

    Summary: oral grants as far as possible, intravenous administration as necessary.

    Prevention of hypoglycemia in newborns

    In pregnant women with diabetes, the maintenance of the optimal level of glycemia, especially in late pregnancy

    Early and regular feeding from the 3rd hour of life, especially HH and SGA.

    Pay attention to further regular feeding, including after discharge (at least every 4 hours). In NN, which are preparing for discharge, in 18% of cases episodes of late hypoglycemia occur with delayed feeding.

    Medical expert articles

    Hypoglycemia is the serum glucose level of less than 40 mg / dL (less than 2.2 mmol / L) in full term or less than 30 mg / dL (less than 1.7 mmol / L) in premature newborns. Risk factors include prematurity and intrapartum asphyxia. The most common causes are insufficient glycogen stores and hyperinsulinemia. Symptoms of hypoglycemia include tachycardia, cyanosis, convulsions, and apnea.

    The diagnosis of "hypoglycemia" suggest empirically and confirm the determination of glucose levels. The prognosis depends on the cause, the treatment is enteral nutrition or inhaled glucose.

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    What causes hypoglycemia in newborns?

    Hypoglycemia in newborns may be transient or permanent. Causes of transient hypoglycemia are an insufficient amount of substrate or the immaturity of the function of enzymes, which leads to insufficient glycogen stores. The causes of persistent hypoglycemia are hyperinsulinism, a violation of contrainsular hormones and hereditary metabolic diseases such as glycogenosis, impaired gluconeogenesis, impaired fatty acid oxidation.

    Insufficient glycogen stores at birth are often found in premature infants with very low birth weight, children small for gestation due to placental insufficiency, and children experiencing intranatal asphyxia. Anaerobic glycolysis depletes glycogen stores in these children, and hypoglycemia can develop at any time in the first few days, especially if between feedings withstand a long interval or nutrient supply is low. Therefore, maintaining exogenous glucose intake is important to prevent hypoglycemia.

    Transient hyperinsulinism is most common in children from mothers with diabetes. It also often occurs under physiological stress in children small by the time of gestation. Less common causes include hyperinsulinism (transmitted by both autosomal-dominant and autosomal recessive mode of inheritance), severe fetal erythroblastosis, Beckwith-Wiedemann syndrome (in which islet cell hyperplasia is combined with signs of macroglossia and umbilical hernia). Hyperinsulinemia is characterized by a rapid drop in serum glucose in the first 1-2 hours after birth, when the steady flow of glucose through the placenta stops.

    Hypoglycemia can also develop if the intravenous administration of a glucose solution stops abruptly.

    Symptoms of hypoglycemia in newborns

    Many children have no symptoms of hypoglycemia. Prolonged or severe hypoglycemia causes both vegetative and neurological signs of central genesis. Vegetative symptoms include sweating, tachycardia, weakness, and chills or tremors. Central neurological signs of hypoglycemia include seizures, coma, episodes of cyanosis, apnea, bradycardia or respiratory distress, hypothermia. Drowsiness, poor appetite, hypotension and tachypnea may occur. All manifestations are non-specific and are also noted in newborns experiencing asphyxia, sepsis or hypocalcemia, or opioid withdrawal syndrome. Therefore, at-risk patients with or without these symptoms require immediate control of capillary blood glucose. An abnormally low level is confirmed by the determination of glucose in venous blood.

    Treatment of hypoglycemia in newborns

    Most high-risk newborns are treated preventively. For example, children from women with insulin-dependent diabetes mellitus often immediately after birth begin intravenous infusion of a 10% glucose solution or are given glucose orally, as well as in patients who are very premature, or children with respiratory distress syndrome. Newborns at risk should receive early, frequent feeding of the mixture to provide them with carbohydrates.

    For any newborn whose glucose level is less than or equal to 50 mg / dL, appropriate treatment should be initiated with enteral feeding or intravenous glucose solution with a concentration of up to 12.5%, at a rate of 2 ml / kg for more than 10 minutes, higher Concentrations can be administered, if necessary, through a central catheter. Then the infusion should be continued at a rate that provides 4-8 mg / (kg min) of glucose intake, that is, a 10% glucose solution at a rate of approximately 2.5-5 ml / (kg h). Serum glucose should be monitored to regulate the rate of infusion. With the improvement of the condition of the newborn, enteral feeding can gradually replace intravenous infusion, while the glucose concentration continues to be monitored. Intravenous glucose infusion should always decrease gradually, as sudden withdrawal can cause hypoglycemia.

    If it is difficult to start an intravenous infusion in a newborn with hypoglycemia, glucagon at a dose of 100-300 µg / kg intramuscularly (maximum 1 mg) usually quickly increases glucose levels, this effect lasts 2-3 hours, except for newborns with depletion of glycogen stores. Hypoglycemia, refractory to glucose infusion at high speed, can be treated with hydrocortisone at a dose of 2.5 mg / kg intramuscularly 2 times a day. If hypoglycemia is refractory to treatment, other causes should be excluded (for example, sepsis) and, possibly, an endocrinological examination should be prescribed to detect persistent hyperinsulinism and disorders of gluconeogenesis or glycogenolysis.

    Transient hypoglycemia: causes in newborns

    Oxygen and glucose are the main sources of life for the body.After hyperbilirubinemia, hypoglycemia of the newborn is considered the second factor requiring a long stay of the baby in the hospital after birth. A child with such a diagnosis requires a detailed examination, since many diseases can be accompanied by hypoglycemia.

    And the very low blood sugar level of a newborn and a child of the first year of life is considered to be a very dangerous condition for health. It significantly impairs the nutrition of the brain and all tissues.

    Transient (transient) hypoglycemia of the neonatal period

    When a baby is born, it is under great stress. During contractions and at the time the child passes through the birth canal of the mother, glucose is released from glycogen in the liver, and the blood sugar level in children is disturbed.

    This is necessary to prevent damage to the baby’s brain tissue. If the child has low glucose reserves, transient hypoglycemia develops in his body.

    This condition does not last long, because due to the mechanisms of self-regulation of the level of glucose in the blood, its concentration quickly returns to normal.

    Often this condition may develop due to the negligence of medical personnel (hypothermia), this is especially true for premature or very small children. When hypothermia hypoglycemia may occur in a strong baby.

    Gestational

    Full-term healthy children have large stores of glycogen in the liver. He easily allows the baby to cope with the stresses associated with birth. But if the intrauterine development of the fetus has proceeded with any abnormalities, hypoglycemia in such a child lasts much longer and requires additional correction with the use of drugs (the introduction of glucose).

    Prolonged hypoglycemia primarily develops in premature babies with small weight and in post-term babies.

    As a rule, this group of newborns has low reserves of protein, adipose tissue and hepatic glycogen.

    In addition, due to the lack of enzymes in these children, the mechanism of glycogenolysis (glycogen disintegration) is noticeably reduced. Those stocks that were received from the mother, quickly spent.

    Important! Special attention is paid to those children who are born to women with diabetes. Usually these babies are very large, and the concentration of glucose in their blood decreases very quickly. This is due to hyperinsulinemia.

    The same problems are experienced by newborns born in the presence of Rh-conflict. It turns out that with complicated types of serological conflict, hyperplasia of pancreatic cells can develop, which produces the hormone insulin. As a result, tissues absorb glucose much faster.

    Perinatal

    The condition of the newborn is assessed on the Apgar scale. This is how the degree of hypoxia of a child is determined. First of all, children suffer from hypoglycemia, whose birth was swift and accompanied by great blood loss.

    Hypoglycemic condition develops in children with heart rhythm disorders. It is also facilitated by the use of certain drugs by the mother during pregnancy.

    Other causes of transient hypoglycemia

    Transient hypoglycemia is very often caused by various infections. Any type of it (pathogen does not matter) leads to hypoglycemia. This is due to the fact that a large amount of energy is spent on the fight against infection. And, as you know, the source of energy is glucose. The severity of neonatal hypoglycemic symptoms depends on the severity of the underlying disease.

    Another large group consists of newborns who have congenital heart defects and blood circulation. In such a situation, hypoglycemia provokes poor circulation in the liver and hypoxia. The need for insulin injections disappears in any of the listed cases, subject to the timely elimination of violations of the secondary:

    • circulatory failure,
    • anemia,
    • hypoxia.

    Persistent hypoglycemia

    During many diseases in the body there is a violation of the metabolic processes. There are such situations in which there are irreversible defects that impede the normal development of the baby and endanger his life.

    After a thorough examination of these children, an appropriate diet and medical treatment are selected. Kids suffering from congenital galactosemia, its manifestations feel from the first days of life.

    A little later, children develop fructosemia. This is due to the fact that fructose is found in many vegetables, honey, juices, and these products are introduced into the diet of the child much later. The presence of both diseases requires a lifelong adherence to a strict diet.

    The development of hypoglycemia can trigger some hormonal disorders. In the first place in this regard is the failure of the pituitary and adrenal glands. In this situation, the child is under the supervision of an endocrinologist all the time.

    Symptoms of these pathologies can manifest themselves both in the newborn and at a later age. With the growth of pancreatic cells, the amount of insulin increases and, accordingly, the concentration of glucose in the blood decreases.

    It is impossible to correct this condition by traditional methods. The effect can be achieved only with surgery.

    Hypoglycemia and its symptoms

    1. Rapid breathing.
    2. Sense of anxiety.
    3. Excessive excitability.
    4. Tremor of the limbs.
    5. Insatiable feeling of hunger.
    6. Convulsive syndrome.
    7. Violation of breathing until it stops completely.
    8. Lethargy.
    9. Muscle weakness
    10. Drowsiness.

    For a child, cramps and breathing problems are most dangerous.

    Most often hypoglycemia is fixed in the first day of the baby's life.

    Diagnosis of the disease

    The following tests are taken from children in the first year of life and newborns to diagnose acute or prolonged hypoglycemia:

    • blood glucose concentration
    • free fatty acid rate
    • insulin level determination
    • determining the level of growth hormone (cortisol),
    • the number of ketone bodies.

    If a child is at risk, research is done in the first 2 hours of his life. Based on these indicators, the nature and degree of neonatal hypoglycemia is determined, which makes it possible to prescribe an adequate treatment for the baby.

    Who is at risk

    Hypoglycemia can occur in any child, but there is still a certain risk group that includes children:

    1. immature gestational age
    2. premature
    3. with signs of hypoxia,
    4. born to mothers with diabetes.

    So newborn blood sugar levels are determined immediately after birth (within 1 hour of life).

    It is very important to quickly identify hypoglycemia in the newborn, because timely treatment and prevention will protect the baby from the development of serious complications of this condition.

    The focus should be on adhering to the principles of perinatal development. It is necessary to start breastfeeding as soon as possible, to prevent the development of hypoxia, to prevent hypothermia.

    First of all, when neonatal hypoglycemia, pediatricians inject intravenously 5% glucose solution. If the baby is already more than a day, apply 10% glucose solution. After this, control tests of blood taken from the heel of the newborn directly to the test strip are performed.

    In addition, the child is given a drink in the form of a glucose solution or added to the milk mixture. If these procedures do not bring the desired effect, apply hormone treatment with glucocorticoids. It is equally important to identify the cause of hypoglycemia, this makes it possible to find effective methods for its elimination.

    Hypoglycemia in babies

    There are deviations in the glucose content in children in the blood at birth. The largest risk group among infants is premature babies. The less weeks the fetus, the more he is not ready for independent living. Low sugar levels indicate not only the presence of hypoglycemia, but also more serious complications. If the glucose level in a newborn is below 2.2 mmol / l, this is an alarming sign for doctors and parents.

    Free fatty acids are used as fuel in the liver, heart, and skeletal muscle, or they become the liver in very low density lipoproteins. Some reports have shown decreased tolerance to emulsions of intravenous lipids in young children for gestational age and newborns under 32 weeks of gestation. This is usually achieved by supplying lipids within 24 hours. A “lipid-free” window is not required, during which these nutrients are not administered to purify blood lipids.

    Both contain the same amount of phospholipid emulsifier of egg yolk and glycerin. However, each of them contains more phospholipids than is necessary for emulsification of triglycerides, the excess turns into bad particles into triglycerides with phospholipid bilayers and is known as liposomes. For any given dose of triglycerides, it is necessary to twice inject the emulsion volume at 10% versus 20%, therefore, for a fixed amount of triglycerides, an emulsion at 10% at least doubles and possibly up to four times more liposomes than an emulsion at 20%.

    Newborns with unrecognized or pronounced hypoglycemia often do not survive childbirth. This is one of the most common causes of infant mortality. With the correct diagnosis, the child must immediately be prescribed treatment. But even if the child was helped in time and survived, the consequences can be bitter. Some of these babies have cerebral palsy. Along with this disease, he is sometimes accompanied by mental retardation and underdevelopment, which can be considered much later. This is a difficult diagnosis, both for the child and for his entire family. It will require long-term treatment, and using the most modern techniques.

    A 10% emulsion has been shown to be associated with higher plasma triglyceride concentrations and an accumulation of cholesterol and phospholipids in the blood of premature babies, possibly as a result of higher phospholipid levels. Excess phospholipid liposomes in a 10% emulsion are thought to compete with triglyceride-rich particles to bind to lipase sites, resulting in slow hydrolysis of triglycerides. Recently, 10% lipid emulsions are available with half the previously used phospholipid emulsifier.

    In the study in premature babies, they were well tolerated, without a pathological increase in the concentration of triglycerides or serum cholesterol. There are reports of adverse side effects of intravenous lipid emulsions, which include the replacement of indirect bilirubin from albimine binding sites, which increases the risk of nucleus development, suppression of the immune system, infection with coagulase-negative staphylococci and mycosis, thrombocytopenia, and accumulation of lipids in macrophages and alveral arteries. pulmonary gas exchange.

    As they grow older, blood sugar in infants should be in line with the generally accepted standard for adults. In case of deviations from the expected boundaries from 3.1 to 5, 5 mmol / l, it is necessary to urgently carry out diagnostics and examination of the baby in order to identify the reasons for the deterioration of the tests. The sooner the blood is examined for the sugar content of the newborn and, if necessary, intensive treatment and the introduction of intravenous glucose infusion begin, the more hope is that the baby will be saved.

    With the introduction of lipids to newborns with hyperbilirubinemia, careful monitoring of plasma triglycerides is proposed. Lipid infections can have a positive effect. Co-administration of a lipid emulsion has a beneficial effect in the vascular endothelium of the peripheral veins, which leads to a longer period of venous permeability. Therefore, lipid venousysis can increase the effect of phototherapy and be a useful addition to it. Suppression of immune function and an increased risk of sepsis are usually associated with the use of intravenous lipid emulsions.

    Newborn Hypoglycemia

    After the baby is born, its energy needs are initially covered by maternal glucose, which was preserved in the umbilical vein, and glucose, which was formed as a result of glycogenolysis. However, glycogen stores are rapidly depleted, and all newborns in the first or second hour of life experience a drop in blood glucose concentration.

    Its lowest content falls on the first 30-90 minutes. In healthy, full-term infants who receive enteral nutrition in the first 4 hours of life, a gradual increase in blood glucose begins at 2 o'clock and reaches an average of over 2.2 mmol / l by the 4th hour, and over 2 at the end of the first day, 5 mmol / l.

    It should be noted that newborns, including premature babies, are able to actively produce and utilize glucose, and its formation can be quite intensive.

    However, in general, the regulation of blood glucose in the first week of life is not yet stable, which is manifested in its differences from hypoglycemia to transient hyperglycemia.

    Hypoglycemia of the newborn can affect the brain (from focal to diffuse changes), so the criteria for determining it are of great practical importance.

    Currently, most neonatologists are of the opinion that the criterion of hypoglycemia in newborns should be considered a decrease in blood glucose below 2 mmol / l in the first 2-3 hours of life and less than 2.22 mmol / l later. This indicator applies equally to full-term and premature babies.

    According to the pathogenetic feature, hypoglycemia of the newborn is divided into transient and persistent. The former are, as a rule, short-term in nature, usually limited to the first days of life, and after correction do not require prolonged preventive treatment, their causes do not affect the underlying processes of carbohydrate metabolism.

    The basis of persistent hypoglycemia of newborns are congenital anomalies, accompanied by organic disorders of carbohydrate or other types of metabolism and in need of long-term supportive glucose therapy. This form of hypoglycemia is one of the symptoms of the other, the main disease, and it should not be identified with the hypoglycemia of the newborn on any day of life.

    The reasonsthat cause transient hypoglycemia in newborns are conventionally divided into three groups.

    The first group includes factors that affect the carbohydrate metabolism of a pregnant woman: maternal insulin-dependent diabetes or taking a pregnant woman shortly before giving birth to a large amount of glucose.

    The second group reflects purely neonatal problems: intrauterine fetal hypotrophy, asphyxia during labor, cooling, infection and insufficient adaptation to extrauterine life.

    The third group includes iatrogenic causes: abrupt cessation of long-term infusion, containing a large amount of glucose solution, intravenous administration of indomethacin for open arterial duct and the use of prolonged-action insulin in the treatment of congenital diabetes mellitus.

    Intrauterine hypotrophy is the most common cause of transient hypoglycemia. Its genesis is due to the rapid depletion of glycogen stores. Longer infusion therapy is indicated for such patients.

    There are intermediate forms in which transient hypoglycemia of newborns and persistent hypoglycemia associated with congenital anomalies, in which prolonged and persistent hypoglycemia is noted, with one (thrones not related to congenital anomalies and not caused by transient hyperinsulinism, and on the other - requiring for normalization of the contents blood when using infusion therapy is very high glucose concentrations, over 12-15%. To normalize carbohydrate metabolism in these children requires a 10-day course solu-cortef.

    Symptoms of hypoglycemia in newborns

    In newborns, there are two forms of hypoglycemia: symptomatic and asymptomatic. The latter is manifested only by a decrease in blood glucose.

    Clinical manifestations of symptomatic hypoglycemia should be considered as an attack that does not go away with several symptoms and by itself without intravenous, oral administration of glucose or timely connection of feeding.

    The symptoms that are observed with hypoglycemia are not specific, they can be divided into somatic (shortness of breath, tachycardia) and neurological. The latter make up two opposite pole groups.

    The first includes signs of CNS arousal (irritability, twitching, tremor, convulsions, nystagmus), the second is symptoms of depression (muscle hypotension, hypodynamia, general lethargy, apnea or episodes of cyanosis, loss of consciousness).

    The highest manifestation of an attack of hypoglycemia in the first group of symptoms are convulsions, in the second - coma.

    Symptomatic hypoglycemia of newborns can develop gradually and erased, without clear manifestations, or proceed as an acute attack with a rapid, sudden onset. Clinical manifestations of hypoglycemia depend on the rate of decrease in glucose content and the drop in its level, the more pronounced these changes, the brighter the picture.

    In this regard, the development of a hypoglycemic attack in a newborn child against the background of the action of prolonged insulin in the treatment of congenital diabetes mellitus: sudden development, general muscle hypotension, weakness, loss of consciousness, coma is very illustrative.

    The count goes on seconds-minutes, and the same quick response to the intravenous jet injection of glucose solution.

    Of course, the clinical manifestations of hypoglycemia in newborns against the introduction of insulin proceed much brighter, but we observed about the same picture in a somewhat softer version without its use.

    Typically, symptomatic transient hypoglycemia of newborns with a developed clinical picture in the form of a pronounced attack during treatment with 10% glucose solution is quickly stopped and no longer resumes, and only single patients may have single or multiple relapses.

    Asymptomatic form, according to foreign authors, occurs in more than half of cases of transient hypoglycemia in newborns.

    A large percentage of asymptomatic forms of transient hypoglycemia in newborns and a favorable follow-up prognosis in these children seem to reflect the lack of a clear correlation between serum sugar content taken from the heel and its concentration in the arteries of the brain and CSF.

    The latter determine the true saturation of the brain with glucose. Increased need of the brain of newborns in glucose and its good digestibility in it and redistribute the concentration of sugar between the brain and the periphery.

    Diagnosis of symptomatic hypoglycemia in newborns with mild manifestations may present certain difficulties, since the symptoms characteristic of it are not specific and can equally occur in other pathologies, including concomitant ones. To ascertain it, two conditions are necessary: ​​the glucose content is below 2.2-2.5 mmol / l and the disappearance of the symptoms, which were regarded as “hypoglycemic”, after intravenous glucose administration.

    Forecast

    Symptomatic hypoglycemia in newborns can lead to various brain lesions. At the same time, the nature of the attack (seizures, depression syndrome), its duration and repeatability matter. The combination of these factors makes the prognosis more serious.

    Children at risk of developing transient hypoglycemia in newborns should receive a prophylactic intravenous glucose infusion from the first hours of life, regardless of whether they have had a blood sugar test or not.

    The risk groups are:

    • newborns with hypotrophy,
    • babies from mothers with type 1 diabetes,
    • children are large for gestational age or have a birth weight of more than 4 kg,
    • children who are not able to receive enteral nutrition.

    In the case of blind infusion, the concentration of glucose in it may not exceed 4-5 mg / (kg-min), which for 2.5% glucose solution is 2.5-3 ml / kg / h. Further tactics depend on the glucose content.

    In asymptomatic hypoglycemia, premature babies should receive infusion therapy with a 10% glucose solution of 4–6 ml / kg / h.

    With symptomatic hypoglycemia, 10% glucose solution is administered at 2 ml / kg per 1 minute, then at a rate of 6-8 mg / kg / min.

    Treatment of asymptomatic and especially symptomatic hypoglycemia of newborns should be carried out under the control of sugar content at least 3 times a day. After reaching a sugar level in the range of 3.5-4 mmol / l, the infusion rate is gradually reduced, and when stabilized at these values, the injection is completely stopped.

    The lack of effect of therapy raises doubts about the presence of normal transient hypoglycemia in newborns. Such children need additional examination to rule out congenital anomalies with secondary hypoglycemia.

    Causes, effects and treatment of hypo-and hyperglycemia in newborns

    Hypoglycemia in newborns is a rather rare condition, unless we are talking about a transient category of this pathology.

    Most pregnant women do not represent that lowering or raising glucose to critical elevations carries a great danger to the development of a baby.

    However, problems can be avoided if you know what symptoms hypoglycemia has in both an adult and a newly-born person. It is important to know which measures are used to normalize the condition.

    Effect of pregnancy on glucose levels

    Any mommy during pregnancy certainly thinks about the health of the baby. However, she does not always pay attention to the fetus’s dependence on its own condition.

    Due to excessive weight gain, a woman can build complexes and refuse to eat or follow a diet without consulting a specialist. In this case, the carbohydrate balance can change greatly.

    Female hormones during pregnancy undergo major changes, for example, the pancreas begins to produce more insulin under the influence of estrogen and prolactin, while people who are far from diseases such as diabetes do not always understand that glucose levels are inexorably falling.

    In severe cases, if there is a danger of developing a condition such as hypoglycemia in pregnant women, all internal organs will suffer, the likelihood of a threat to the physical and mental state of not only the fetus, but also of the mother is high.

    Or vice versa, because of the constant desire to eat something unusual, mommy is gaining weight and violating the balance of hormones on her own, thus provoking the development of diabetes. And also, as in the first case, it is not always possible to notice an increase in sugar - hyperglycemia during pregnancy is also dangerous.

    But the child develops and receives all the necessary substances from the mother, an overabundance or lack of glucose can adversely affect his health. Since he cannot control the level of sugar by pancreatic hormones by himself.

    Hyperglycemia in pregnant women can lead to hyperglycemia in newborns and the development of diabetes in babies from birth.

    That is why it is so important to control the diet of the expectant mother, to monitor the level of sugar, especially if she already has a diagnosis of diabetes or there is a likelihood of other metabolic disturbances.

    You also need to listen to the state of your own body, noticing excessive fatigue, constant thirst, you need to consult a doctor who is leading a pregnancy.

    Only born - already problems

    Problems with blood sugar levels in healthy newborns are less frequent. Hyperglycemia in newborns or hypoglycemia usually refers to premature babies with a low birth weight.

    It is necessary to take into account the fact that there is a transient hypoglycemia of newborns (which is transient) - a normal state in the first hours of a child’s life.

    Since the body has not yet developed its own glucose, in the first minutes of life it uses the reserve accumulated in the liver. When the supply is over and feeding is delayed, the lack of sugar develops. Usually in a few hours or days everything comes back to normal.

    Immediately visible when glucose is not enough

    A premature newborn is more susceptible to the development of hypoglycemia, with a number of signs of this condition.

    Symptoms for which hypoglycemia can be suspected are as follows:

    • weak cry at birth,
    • weak sucking reflex
    • regurgitation
    • cyanosis,
    • convulsions
    • apnea,
    • decrease in the tone of the eye muscles,
    • incoherent movements of the eyeballs,
    • general lethargy.

    Also hypoglycemic symptoms include increased sweating with dry skin, high blood pressure, and heart rhythm disturbances.

    Since the symptoms of hypoglycemia may not appear all, regular blood sampling for diagnosis is mandatory, since such signs may also speak about other serious pathologies.

    What are the causes of pathology?

    Risk factors for disease are always taken into account in the management of any pregnancy and at birth.

    If there are signs of hypoglycemia, specialists, first of all, determine the causes of the development of a dangerous pathology in order to choose the right treatment based on the information received.

    Hypoglycemia usually develops for the following reasons:

    1. The presence of diabetes in the mother, as well as her use of hormonal drugs. There is an early transient hypoglycemia, starting from 6-12 hours of life of the infant.
    2. Premature or multiple pregnancy with a mass of children up to 1500 g. May occur within 12-48 hours. The most dangerous is the birth of a baby on the 32nd week of pregnancy.
    3. Problems at birth (asphyxia, brain injury, hemorrhage). Hypoglycemia can develop at any time.
    4. Problems with the hormonal background of the child (adrenal dysfunction, hyperinsulism, tumors, impaired synthesis of proteins and carbohydrates). Usually, the sugar level drops a week later, after birth.

    In children at risk, blood for analysis is taken every 3 hours during the first 2 days of life, then the number of blood samples is reduced, but the sugar level is monitored for at least 7 days.

    Normalization condition

    Usually, no therapeutic manipulations are required, but in critical situations, when a lack of glucose can lead to disorders of the nervous system, emergency help is resorted to.

    If the condition does not return to normal after a few days, we are already talking not about transient, but about chronic hypoglycemia, which may be hereditary or inborn, due to severe childbirth with trauma.

    If the hypoglycemia of newborns is transient and has no obvious signs that interfere with life, according to the articles of AARP (American Academy of Pediatrics), the treatment applied gives the same result as the absence of therapy.

    According to the established WHO treatment measures, it is necessary for the newborn to receive regularly the required amount of nutrition, regardless of the therapy with glucose-containing drugs.

    At the same time, if the child constantly regurgitates or has no sucking reflexes, apply feeding through a probe.

    In this case, the newborn can be fed both with mother's milk and the mixture.

    When indicators of sugar level below the critical norm, intramuscular or intravenous administration of drugs is used to increase sugar.

    In this case, initially the minimum possible amount of glucose is used intravenously at the minimum infusion rate, if this effect is not observed, the rate is increased.

    Individual preparations and their dosages are selected for each child. If intravenous glucose does not give the desired result, corticosteroid therapy is administered.

    Moreover, if normoglycemia is not established for a long time, the child is not discharged from the neonatal department, additional tests are taken and the necessary therapy is selected.

    Normoglycemia is established if the glucose level does not change for 72 hours without the use of drugs.

    Attention! Danger!

    Transient hypoglycemia in newborns usually does not have dangerous consequences for the body and passes quickly.

    Then, as persistent hypoglycemia during pregnancy and immediately after birth, can seriously affect the physical, mental and mental development of children.

    Usually pathologically low blood sugar levels can lead to the following outcome:

    • mental retardation
    • brain tumors
    • development of epileptic seizures,
    • development of Parkinson's disease.

    Also, the most dangerous thing that can result in a drop in sugar is death.

    Pregnancy is a wonderful period of life and the opportunity to give the child all the necessary useful elements, while protecting him from danger.

    The same applies to the prevention of hypoglycemia or the maintenance of the necessary state of both the mother and the fetus during pregnancy and the newborn.

    Ask the author a question in the comments

    Newborn hypoglycemia

    Hypoglycemia of newborns is a very dangerous phenomenon. That it is considered one of the most common causes of severe disorders of the central nervous system, as well as infant mortality. Fortunately, it occurs quite rarely - medicine records 1-3 cases per thousand newborns.

    You should know that the problem can be prevented or recognized in time at the very beginning - then the process of treating hypoglycemia will be faster and more successful.

    What is newborn hypoglycemia?

    Speaking of hypoglycemia of newborns, we are talking about an insufficient level of serum glucose and plasma. In terms of numbers, this situation is described by the following indicators: 2.2 mmol / l and 2.5 mmol / l, respectively.

    Hypoglycemia is temporary and permanent. Temporary hypoglycemia is diagnosed in the maternity hospital, since it develops in the first 6-10 hours after the birth of the child. In this case, the forecast is most favorable - the problem dries up quickly. Without leaving a trace in the form of neurological disorders.

    Most often premature babies are exposed to this disease, among the other risk factors, the following problems should be highlighted.

    • Violation of carbohydrate metabolism in the mother,
    • Diabetes women
    • Other difficulties of gestation,
    • Problem delivery,
    • Hyperinsulinism,
    • Violation of the adrenal glands in an infant,
    • Pathologies received by the child by inheritance.

    The diagnosis of hypoglycemia puts only a doctor on the basis of a laboratory test. The first tests of a newborn who is at risk, necessarily include blood for this test. They are taken in the first hour after birth, and then another two days every 3 hours.To remove all doubts, the small patient remains under observation for two more days, during which the analysis is taken every 6 hours.

    Symptoms and treatment of newborn hypoglycemia

    Preliminary diagnosis of hypoglycemia in newborns can be carried out without testing. Symptoms of the disease include the following manifestations.

    • In a child, the tone of the eye muscles decreases, the neonatal oculocephalic reflex disappears, the eyes move in a circle along a floating trajectory.
    • The kid feels weak, therefore he refuses even to eat. Sucks weakly, eating, belching. A child becomes irritable, nervous, lethargic or, conversely, too agitated. There is an unemotional high-frequency cry and muscle tremor.
    • The body temperature of the child becomes unstable, the child becomes pale and sweats for no reason. Arterial hypotension and tendency to hypothermia are also noted.

    If treatment is not started or does not give the desired effect, the symptoms are aggravated. A child may fall into a stupor, depression of consciousness occurs, signs of tachycardia appear, cyanosis, apnea, etc. develop.

    The treatment of hypoglycemia in newborns consists of intravenous glucose infusions. Each case requires an individual approach and the injection scheme is made up by a specialist who is closely involved in a small patient.

    If the process is normal, recovery does not take much time - after 2-3 days glucose infusion is surely reduced. If the child's body is insensitive to such therapy, use hydrocartisone.

    Also practice frequent feedings with a mixture that increases the level of saturation with carbohydrates.

    The treatment of newborns in the high-risk zone is carried out preventively.

    Hypoglycemia in children and newborns causes and symptoms of a syndrome or attack

    Hypoglycemia in children - A condition characterized by low blood sugar, or an abnormally low blood glucose level. Hypoglycemia in newborns can be one of the types of physiological reactions of the body to a stressful change in environmental conditions.

    Hypoglycemia in medical terminology, also known as insulin shock, is a reaction of the body caused by an abnormally low blood glucose level (less than 4 mmol / l). Hypoglycemia syndrome occurs in children with type 1 diabetes, but in some cases it can occur in children and adolescents with type 2 diabetes.

    More commonly diagnosed in patients taking sulfonylureas. Improper diet, inadequate insulin dose, concomitant diseases or severe mental and physical activity without compensation of energy costs can be sufficiently promoted by an attack of hypoglycemia. If not stopped, it can lead to loss of consciousness.

    In very rare cases, coma may develop.

    A child with hypoglycemia can quickly become irritable, sweating, trembling, complaining that he is very hungry. In most cases, eating fast-acting carbohydrates (for example, juice or lozenges) corrects the situation.

    Glucose can also be used in the form of tablets or solution. A child who has lost consciousness due to an attack of hypoglycemia will quickly return to normal after intravenous glucose injection.

    This will help to quickly return blood sugar levels to normal.

    Reactive hypoglycemia in children

    A rare type of this syndrome, known as reactive hypoglycemia in children, can occur in people who do not have diabetes. With reactive hypoglycemia, the blood glucose level drops to 3.5 mmol / l about four hours after the last meal, causing the same symptoms of low blood sugar that can occur in people with diabetes.

    Also often manifested hypoglycemia on an empty stomach. This is a condition in which the blood sugar level is 3.5-4.0 mmol / l in the morning after waking up or between meals. Some medications and medical manipulations can cause hypoglycemia syndrome in children who are not suffering from diabetes.

    Among children with diabetes, hypoglycemia is much more common in patients with type 1 diabetes (also known as insulin-dependent diabetes or juvenile diabetes) than in patients with type 2 diabetes (previously classified as adult diabetes).

    Hypoglycemia and causes

    The causes of hypoglycemia are hidden in the mechanisms regulating carbohydrate and energy metabolism in the human body. With an excessive release of insulin into the blood of a child, an attack of hypoglycemia can be triggered, regardless of his predisposition to the development of diabetes.

    Hypoglycemia in children and adolescents with diabetes mellitus can be caused if too much insulin is injected with injections.

    Excess physical and mental exertion without proper food intake, certain medications, skipping meals and drinking alcohol can contribute to the development of an attack.

    Hypoglycemia in diabetes mellitus is a frequent occurrence with which the patient must be able to cope on time independently.

    Reactive hypoglycemia can be caused by an enzyme disorder after gastric bypass surgery.

    The causes of hypoglycemia in non-diabetic children can be insulin-producing tumors, certain hormonal disorders, medications (including sulfa drugs and large doses of aspirin), and severe somatic diseases. Unmotivated episodes of hypoglycemia are more common in children aged 10 years.

    Hypoglycemia and its symptoms

    Parents should remember that not all the symptoms of hypoglycemia can be recognized without a detailed blood test. You should be wary of any changes in the behavior and eating habits of your child. Especially if you suspect that he has a violation of glucose tolerance. Symptoms of hypoglycemia may include:

    • unsteadiness of gait,
    • nervousness and irritability
    • dizziness and drowsiness,
    • excessive sweating
    • confusion of speech, inability to pronounce individual words and letters,
    • feeling tired and apathetic,
    • hunger,
    • sense of anxiety.

    Hypoglycemia in diabetes mellitus: when to see a doctor

    Hypoglycemia in diabetes mellitus is caused by an excess of insulin and glucose deficiency in the baby’s blood. Children who experience frequent bouts of hypoglycemia should be shown to their doctor as soon as possible. It may be necessary to adjust the insulin, the dose of the medicine or other changes to the current treatment regimen.

    If a child or teenager with diabetes begins to show low blood sugar without any side effects, it may go completely unnoticed. However, the doctor should be aware of all changes in the condition of the sick child. Lack of timely medical care for hypoglycemia syndrome can lead to loss of consciousness.

    Causes of hypoglycemia

    Hypoglycemia in newborns can occur both permanently and occasionally.

    The causes of hypoglycemia, which manifests itself periodically, include:

    • inadequate substrate
    • the immature function of enzymes, which can lead to a deficiency in glycogen accumulation.

    Persistent hypoglycemia can occur for the following reasons:

    • hyperinsulinism in a child
    • violation of hormone production
    • hereditary metabolic disorders.

    Hypoglycemia in newborns may occur due to the abrupt interruption of intravenous infusions of aqueous glucose solutions. It can also be a consequence of an incorrect position of the catheter or umbilical sepsis.

    Hypoglycemia in newborns can be a symptom of a serious disease or pathology:

    • sepsis,
    • hypothermia,
    • polyglobulia
    • fulminant hepatitis,
    • cyanotic heart disease,
    • intracranial effusion.

    Hyperinsulinism often occurs for such reasons:

    • future mother was given drug therapy,
    • the baby was born from a woman who has diabetes,
    • polyglobulia found in the child,
    • congenital disease.

    In addition, hypoglycemia can cause hormonal disorders in the body of newborns.

    Symptoms of the disease in young children

    Unfortunately, there are no symptoms of this pathological condition. Some of the signs can be seizures, apnea, and bradycardia.

    If a baby has a severe stage of hypoglycemia, it will not have any symptoms, therefore it is necessary to measure the level of HA, and also pay special attention to the following signs:

    • baby sucks very weak breast or bottle,
    • the baby is restless and sweating a lot
    • cerebral convulsions worry the baby
    • your baby’s blood pressure jumps and tachycardia occurs,
    • the child may suddenly start crying hard.

    Feedback and Comments

    I have type 2 diabetes - insulin-independent. A friend advised me to lower blood sugar with DiabeNot. Ordered through the Internet. Begin reception. I follow a lax diet, I started walking 2-3 kilometers on foot every morning. During the last two weeks I have noticed a smooth decrease in sugar over the meter in the morning before breakfast from 9.3 to 7.1, and yesterday even to 6.1! I continue the preventive course. About accomplishments accomplish your goal.

    Serial concentrations of triglycerides should be evaluated during the development of a lipid emulsion, and then weekly. Newborns receiving parenteral nutrition should be controlled from a metabolic point of view due to disturbances that occur in the balance of fluids and electrolytes, glucose homeostasis, liver function and acid-base balance. Fat intolerance can simply be tested on the next day for the introduction of Intralipid, with the practice of micro-hematocrat in a capillary tube, observing the serum supernatant after centrifuging the sample.

    For normal and healthy functioning, the cells of the body should receive a certain amount of sugar and glucose. If adults receive the necessary dose from food, then newborns from breast milk, so the baby’s diet should be carefully monitored, especially when the mother has diabetes. In this case, the body will produce an excess amount of insulin, which helps reduce sugar.

    If the supernatant has a milky aspect, no other dose of Intralipid can be administered on this day, if it has a crystalline yellow color, the recommended dose for that day can be entered. Logically, the ideal is to practice the levels of free fatty acid, triglycerides and cholesterol in the blood.

    Do not leave the newborn quickly. Do not start oral administration too soon. Use a nasogastric tube in all newborns less than 32 weeks of gestational age. Do not increase the amount excessively. A child whose respiration rate exceeds 60 per minute or who is in hypothermia cannot be orally.

    Causes of low sugar in a newborn:

    • Premature birth.
    • Fetal hypotrophy of the fetus.
    • Mother has diabetes.
    • Birth, accompanied by asphyxia of the child.
    • Blood transfusion.
    • Hypothermia or infection in the body of the baby.
    • Insufficient amount of food, fasting, long intervals between breastfeeding.
    • Increased content of ketone bodies.

    Symptoms of this disease in newborns are absent, but sometimes manifested by the following symptoms:

    Do not give oral food to a newborn born with a history of maternal hydromnios or who has excess mucus until the tube is delivered to the stomach and not even a radiological study is performed. Keep a record of the intake in fluid and calories.

    In infants who are at risk of necrotizing enterocolitis, conduct a test to reduce the sugar in the feces at least once a day, especially if the patient has started orally. Try to keep the newborn in the ventral or lateral incision during feeding, as this accelerates gastric emptying and reduces the risk of regurgitation and aspiration.

    • Disturbed blood circulation.
    • Neurological pathology of central Genesis (detected during medical examinations).
    • Involuntary trembling of the limbs or fingers.
    • Feeling cold, shivering.
    • Excessive sweating.
    • Staining of the skin and mucous membranes in blue.
    • Stopping movements that characterize breathing for a long time - from 10 to 30 seconds.
    • A reduction in heart rate lower than 100 beats per minute.
    • Respiratory disorders. Manifest in failures between a sigh and exhalation.
    • Low body temperature, due to which the body of the newborn can not support healthy metabolic processes.

    Such manifestations are not individual in nature and are found in conjunction with the others, therefore, having noticed any symptom, you need to seek medical help. Also one of the signs of low blood sugar in a newborn is rapid shallow breathing. To control blood glucose at home, it is recommended to use special blood glucose meters, which measure blood sugar and provide a result for a minute.

    Always consult with the nurse before increasing the volume or change the method of filing. Teach the mother to feed or feed the baby. Never ask him to do something similar that he is not capable of doing. Birth Weight is used to calculate income before birth weight recovery.

    10% lipid emulsions should be avoided due to poor tolerance. It is necessary to assess the level of triglycerides in the serum before the start of the first lipid infusion, as the latter are administered, and then every week. The basic scheme of hydration and the proposed parenteral nutrition.

    Children who were born from mothers with diabetes have the first signs and symptoms of the disease in the first hours, and those born from healthy mothers - within three days.

    It is not always possible to diagnose low blood sugar in a child’s blood in a timely manner, since the symptoms of hypoglycemia have some similarities with respiratory distress syndrome when pulmonary insufficiency caused by a low content of the alveolar enveloping mixture is accompanied by shortness of breath, pale skin and wheezing during breathing. Similar symptoms also occur with intracranial hemorrhage.

    Causes, incidence and risk factors

    Reliably confirm its quality. After improving the article, delete this template. The prognosis is good for newborns who have no symptoms or who have hypoglycemia improves with treatment. However, hypoglycemia can return to a small percentage of babies after treatment. The condition is most likely to return when infants are removed intravenously, before they are fully prepared to take oral food. Causes of persistent hypoglycemia.

    In these children, anaerobic glycolysis consumes glycogen deposition and hypoglycemia can occur at any time during the first few days, especially if the interval between feed rations is delayed or if nutritional intake is low. Therefore, to prevent hypoglycemia, it is important to sustain a steady intake of exogenous glucose. Transient hyperinsulinism affects, in most cases, the children of diabetic mothers and is inversely proportional to the degree of control over diabetes.It is also common in newborns with physiological stress and unlikely for gestational age.

    What is fraught when the newborn has low sugar

    When a newborn has low sugar, what does it mean? What consequences? What threatens the disease? The effects of low sugar in the body of a newborn can be various diseases, including death, for example, damage to the blood vessels of the legs and hands, partial or complete loss of vision, cardiovascular diseases, and death due to the death of brain cells that are saturated with glucose. Since the newborn has low sugar, it is difficult to diagnose, the subsequent development of the disease can lead to the following complications:

    Less common causes are congenital hyperinsulinism, severe fetal erythroblastosis, and Beckwith-Wiedemann syndrome. Typically, hyperinsulinemia causes a rapid decrease in serum glucose in the first 1-2 hours after birth, when a continuous supply of glucose is interrupted through the placenta.

    Finally, hypoglycemia may be associated with a poor position of the umbilical catheter or sepsis. Many newborns remain asymptomatic. Adrenergic signs consist of sweating, tachycardia, lethargy or weakness and tremors. There may be apathy, poor nutrition, hypotension and tachypnea. Glucose control in the patient's bed. . All signs are not specific, and also appear in newborns with asphyxia, sepsis or hypocalcemia, or with the removal of opiates. Thus, in newborns with an increased risk, with or without these symptoms, immediate control of the serum glucose level in the patient's bed from a capillary sample is required.

    • The appearance of blood clots in the vessels.
    • The development of thrombophilia and varicose veins.
    • Violation of blood circulation, which may result in poor metabolism and insufficient saturation of the body with essential hormones and vitamins.
    • Internal organ failure due to acute lack of blood supply.
    • Tissue death
    • Impact on intelligence, thought process and memory. Sometimes the result of such deviations may be cerebral palsy. The inhibition of cognitive functions stops with timely compensation of sugar in the blood.
    • The defeat of the musculoskeletal system, which can later lead to disability.

    But timely prevention and preventive measures will help to get rid of the effects of hypoglycemia at the early stages of its development, because when the newborn has low blood sugar, you need to start treatment in time.

    Abnormally low concentrations confirm the venous sample. Prophylactic treatment is indicated for most high-risk newborns. Other newborns at risk who do not get sick should be fed early and often with infant formula to provide carbohydrates.

    Serum glucose levels should be monitored to determine infusion rate parameters. If hypoglycemia is resistant to treatment, consider other causes and, possibly, an endocrine evaluation, examine persistent hyperinsulinism and impaired gluconeogenesis or glycogenolysis is faulty.

    Prevention and treatment

    Preventing illness is a prerequisite for healthy functioning of the body and the absence of diseases. To prevent hypoglycemia, you must adhere to the following rules:

    • Exclusive breastfeeding. In cases when the child is premature, it is allowed to additionally feed with cereals, but only after permission of the doctor.
    • Lack of additional baby food. It is impossible for a newborn to eat something other than mother's milk.
    • Proper thermoregulation diapers, diapers, bed linen in the crib. Maintaining a healthy body temperature is imperative in the prevention of low sugar.
    • Breastfeeding should begin within an hour after delivery.
    • It is better to plan the baby’s diet on a schedule so that there is no over-or under-feeding, which may lead to illness. If the child does not show signs of hunger (a healthy child asks to eat at least 4-5 times a day), then this is a signal for a visit to the doctor.
    • Even if the age of the newborn is less than 32 weeks, and the weight is less than 1.5 kg, it is still recommended to breastfeed only with the exception of the recommendations of the doctor.
    • In case glucose level is less than 2.6 mol, then intravenous glucose infusion should be started immediately.

    Regardless of whether the newborn is sick or not, in the first hours of his life he should receive intravenous glucose in the body.

    Newborn puppies are born with an immature immune system, which must be built over time, starting with their mother's milk. Because of their immature organs and systems, puppies are prone to various aggressions, including infections and environmental, nutritional and metabolic factors. In addition, young animals still do not have strict regulation of body temperature, and body temperature can vary greatly in response to changes in temperature and humidity. Glucose control can also be bad, and blood glucose levels can fall below the normal range in the case of eating disorders, which leads to a state of hypoglycemia.

    The risk group includes children who have:

    • Disrupted digestion.
    • Body weight exceeds four kilograms.
    • Mother has type 1 diabetes.
    • There is no possibility of enteral nutrition.

    Causes and results

    Today, the development of hypoglycemia is extensive in both adults and children, including newborns. This is due to many factors that occur in the 21st century. No wonder this disease is called the plague of our time. Affecting the nervous system, the ailment smoothly passes to the psychomotor functions of the body and becomes the source of the development of associated diseases, which are accompanied by convulsions and impaired heart function.

    So, hypoglycemia without obvious signs can provoke a thrombosis or a heart attack, thus the symptom or prerequisites will not be visible. Therefore, at the first signs of low sugar, you need to contact the clinic and conduct appropriate blood tests that will help prevent the baby’s illness and subsequently save his life. Agree that the reasons for worrying are weighty.

    How to control hypoglycemia

    In order to control glycemia, there are special test strips. They can give not quite accurate results. If the test showed very low results, you should immediately contact the laboratory for diagnosis. It is important to know that treatment should be started immediately, without waiting for laboratory tests. The test can not completely eliminate the disease.

    It must be remembered that newborns weighing less than 2800 and more than 4300 grams, premature babies and those who are born by a woman with diabetes mellitus are at risk.

    Many are interested in the question: when do tests for glycemic indicators? Controlling blood glucose begins half an hour after birth, then an hour, three, six hours, always on an empty stomach. If there is evidence, control continues. When the first diagnosis is done, exclude congenital malformations and sepsis.

    Hypoglycemia in the newborn: treatment

    Treatment of hypoglycemia occurs in different ways: dextrose is administered intravenously, a decision is made on the appointment of enteral nutrition, there are cases when glucagon is injected intramuscularly.

    Babies born to a diabetic mom who takes insulin, in most cases after birth are given aqueous solutions of glucose. Other children who are at risk are advised by doctors to start feeding them as soon as possible and often so that more carbohydrates can be ingested into the body.

    When it is found that the level of glucose in the blood of a newborn is reduced, it is necessary to begin treating the baby. To do this, choose enteral nutrition and an aqueous solution of glucose, which is injected into a vein.

    After that, you need to constantly monitor the level of glucose and take the necessary measures very quickly.

    If the condition of the baby is normalized, you can switch to nutritional treatment, but control should not be stopped.

    It is very important to understand that any type of hypoglycemia, even if it goes away without any symptoms, must be treated. Control of the clock continues constantly until the baby does not go on the mend. Even if the indicators are not critical, it is still necessary to begin treatment.

    Hypoglycemia can be of two types: moderate and severe. If a newborn has the first type of disease, then 15% maltodextrin and mother's milk are administered to it. When this is not possible, prick glucose.

    In case of a severe form, a bolus is made, then glucose infusion, it is also added to the mixture. If this does not help, enter glucagon. In this case, it is necessary to strictly control the indicators, since it can only get easier for a while.

    It happens that all of the above does not give any result, then they resort to extreme measures and give diazoxide or chlorothiazide.

    Preventive measures for newborn babies

    Expectant mothers who have a history of diabetes mellitus, it is very important in the last months of pregnancy to ensure that glucose levels are normal.

    We must try as early as possible to start feeding the baby and make sure that meals are frequent. When the newborn gets home, it is necessary to continue regular feeding.

    The interval between feedings should not exceed four hours. Often there are situations that the newborn was discharged home healthy, and there due to the long breaks between feedings he developed late hypoglycemia.

    Hypoglycemia in newborns is a serious disease that requires strict control and immediate treatment. You need to properly monitor your baby to avoid serious trouble.

    We wish you and your child good health!

    Watch the video: Treating Low Blood Sugar. Hypoglycemia. Nucleus Health (March 2020).