Pathogenesis, screening, and diagnosis 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 may lead to neurologic sequelae.
This topic will discuss the normal transient neonatal low glucose levels, causes of persistent or pathologic neonatal hypoglycemia, and the clinical manifestations and diagnosis of neonatal hypoglycemia. The management of neonatal hypoglycemia, including evaluation of persistent hypoglycemia and outcome of neonatal hypoglycemia, is discussed separately. (See "Management and outcome of neonatal hypoglycemia".)
CHALLENGE OF DEFINING NEONATAL HYPOGLYCEMIA
Clinically significant neonatal hypoglycemia requiring intervention cannot be defined by a precise numerical blood glucose concentration because of the following:
●Normal low neonatal blood glucose levels − Low blood glucose concentrations normally occur in the first hours after birth and may persist for up to several days. Although most newborns remain asymptomatic despite very low blood glucose concentrations, some newborns become symptomatic at the same or even higher blood glucose concentrations than observed in asymptomatic infants. This variability in the clinical response in neonates to low blood glucose concentrations is due to a number of factors that include the infant's gestational age and postnatal age, the presence of other sources of energy (eg, lactate and ketone bodies), and circumstances that affect glucose metabolism and cerebral glucose uptake and utilization.
●Lack of outcome data − Ideally, clinically significant neonatal hypoglycemia would be defined as the blood glucose concentration at which intervention should be initiated to avoid significant morbidity, especially neurologic sequelae. However, this definition remains elusive because the blood glucose concentration and duration of hypoglycemia associated with poor neurodevelopmental outcome has not been established [1,2].
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- CHALLENGE OF DEFINING NEONATAL HYPOGLYCEMIA
- NORMAL TRANSITIONAL LOW GLUCOSE LEVELS
- PATHOLOGIC AND/OR PERSISTENT HYPOGLYCEMIA
- Diminished glucose supply
- - Inadequate glycogen stores
- - Impaired glucose production
- Inborn errors of metabolism
- Endocrine disorders
- Other causes
- Increased glucose utilization
- - Hyperinsulinism
- - Without hyperinsulinism
- CLINICAL MANIFESTATIONS
- Who should be evaluated?
- Timing and frequency of glucose screening
- How glucose testing is performed
- DIFFERENTIAL DIAGNOSIS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS