Management and outcome of neonatal hypoglycemia
- Paul J Rozance, MD
Paul J Rozance, MD
- Associate Professor of Pediatrics, Neonatal Medicine
- University of Colorado Denver
- Section Editors
- Joseph A Garcia-Prats, MD
Joseph A Garcia-Prats, MD
- Section Editor — Neonatology
- Professor of Pediatrics
- Baylor College of Medicine
- Joseph I Wolfsdorf, MB, BCh
Joseph I Wolfsdorf, MB, BCh
- Section Editor — Pediatric Endocrinology
- Professor of Pediatrics
- Harvard Medical School
During the normal transition to extrauterine life, blood glucose concentration in the healthy term newborn falls during the first two hours after delivery, reaching a nadir that usually is no lower than 40 mg/dL. It is important to differentiate this normal physiologic transitional response from disorders that result in persistent or recurrent hypoglycemia, which if left untreated may lead to significant neurologic and developmental sequelae.
This topic will discuss the outcome and management of neonatal hypoglycemia, including evaluation of persistent hypoglycemia. The physiology of normal transient neonatal low blood glucose levels, causes of persistent or pathologic neonatal hypoglycemia, and the clinical manifestations and diagnosis of neonatal hypoglycemia are discussed separately. (See "Pathogenesis, screening, and diagnosis of neonatal hypoglycemia".)
GOALS AND CHALLENGES
The goals of managing neonatal hypoglycemia are:
●To correct blood glucose levels in symptomatic patients (see "Pathogenesis, screening, and diagnosis of neonatal hypoglycemia", section on 'Clinical manifestations')
●To prevent symptomatic hypoglycemia in at-risk patients
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- GOALS AND CHALLENGES
- Target blood glucose levels
- MANAGEMENT APPROACH
- Symptomatic patients
- - Parenteral glucose (dextrose) infusion
- - Glucagon
- - Other therapeutic options
- Persistent hyperinsulinemic hypoglycemia
- - Transition to oral feeds
- - Need for further evaluation
- Asymptomatic term or late preterm infants
- - Oral feeds
- Preterm infants
- Persistent hypoglycemia
- - Definition and timing of evaluation
- - Evaluation
- Physical findings
- Laboratory testing
- - Who should be tested?
- - When should testing be performed ("critical" blood test sampling)?
- - What tests to obtain?
- Discharge criteria
- NEURODEVELOPMENTAL OUTCOME
- Symptomatic hypoglycemia
- Asymptomatic hypoglycemia
- - Preterm infants
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS