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 patientsTo continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Committee on Fetus and Newborn, Adamkin DH. Postnatal glucose homeostasis in late-preterm and term infants. Pediatrics 2011; 127:575.
- Stanley CA, Rozance PJ, Thornton PS, et al. Re-evaluating "transitional neonatal hypoglycemia": mechanism and implications for management. J Pediatr 2015; 166:1520.
- Adamkin DH, Polin RA. Imperfect Advice: Neonatal Hypoglycemia. J Pediatr 2016; 176:195.
- Menni F, de Lonlay P, Sevin C, et al. Neurologic outcomes of 90 neonates and infants with persistent hyperinsulinemic hypoglycemia. Pediatrics 2001; 107:476.
- Avatapalle HB, Banerjee I, Shah S, et al. Abnormal Neurodevelopmental Outcomes are Common in Children with Transient Congenital Hyperinsulinism. Front Endocrinol (Lausanne) 2013; 4:60.
- Thornton PS, Stanley CA, De Leon DD, et al. Recommendations from the Pediatric Endocrine Society for Evaluation and Management of Persistent Hypoglycemia in Neonates, Infants, and Children. J Pediatr 2015; 167:238.
- Cornblath M, Schwartz R. Outcome of neonatal hypoglycaemia. Complete data are needed. BMJ 1999; 318:194.
- McKinlay CJ, Alsweiler JM, Ansell JM, et al. Neonatal Glycemia and Neurodevelopmental Outcomes at 2 Years. N Engl J Med 2015; 373:1507.
- Haymond MW, Schreiner B. Mini-dose glucagon rescue for hypoglycemia in children with type 1 diabetes. Diabetes Care 2001; 24:643.
- Hartley M, Thomsett MJ, Cotterill AM. Mini-dose glucagon rescue for mild hypoglycaemia in children with type 1 diabetes: the Brisbane experience. J Paediatr Child Health 2006; 42:108.
- Miralles RE, Lodha A, Perlman M, Moore AM. Experience with intravenous glucagon infusions as a treatment for resistant neonatal hypoglycemia. Arch Pediatr Adolesc Med 2002; 156:999.
- Hawdon JM, Aynsley-Green A, Ward Platt MP. Neonatal blood glucose concentrations: metabolic effects of intravenous glucagon and intragastric medium chain triglyceride. Arch Dis Child 1993; 68:255.
- Zhou Y, Bai S, Bornhorst JA, et al. The Effect of Early Feeding on Initial Glucose Concentrations in Term Newborns. J Pediatr 2017; 181:112.
- Harris DL, Weston PJ, Signal M, et al. Dextrose gel for neonatal hypoglycaemia (the Sugar Babies Study): a randomised, double-blind, placebo-controlled trial. Lancet 2013; 382:2077.
- Harris DL, Alsweiler JM, Ansell JM, et al. Outcome at 2 Years after Dextrose Gel Treatment for Neonatal Hypoglycemia: Follow-Up of a Randomized Trial. J Pediatr 2016; 170:54.
- Weston PJ, Harris DL, Battin M, et al. Oral dextrose gel for the treatment of hypoglycaemia in newborn infants. Cochrane Database Syst Rev 2016; :CD011027.
- Hegarty JE, Harding JE, Gamble GD, et al. Prophylactic Oral Dextrose Gel for Newborn Babies at Risk of Neonatal Hypoglycaemia: A Randomised Controlled Dose-Finding Trial (the Pre-hPOD Study). PLoS Med 2016; 13:e1002155.
- Hegarty JE, Harding JE, Crowther CA, et al. Oral dextrose gel to prevent hypoglycaemia in at‐risk neonates. Cochrane Database Syst Rev 2017.
- Hume R, McGeechan A, Burchell A. Failure to detect preterm infants at risk of hypoglycemia before discharge. J Pediatr 1999; 134:499.
- Staffler A, Klemme M, Mola-Schenzle E, et al. Very low birth weight preterm infants are at risk for hypoglycemia once on total enteral nutrition. J Matern Fetal Neonatal Med 2013; 26:1337.
- Pertierra-Cortada A, Ramon-Krauel M, Iriondo-Sanz M, Iglesias-Platas I. Instability of glucose values in very preterm babies at term postmenstrual age. J Pediatr 2014; 165:1146.
- Mizumoto H, Honda Y, Ueda K, et al. Glycemic variability in preterm infants receiving intermittent gastric tube feeding: report of three cases. Pediatr Int 2013; 55:e25.
- Cornblath M, Hawdon JM, Williams AF, et al. Controversies regarding definition of neonatal hypoglycemia: suggested operational thresholds. Pediatrics 2000; 105:1141.
- Rozance PJ, Hay WW. Hypoglycemia in newborn infants: Features associated with adverse outcomes. Biol Neonate 2006; 90:74.
- Srinivasan G, Pildes RS, Cattamanchi G, et al. Plasma glucose values in normal neonates: a new look. J Pediatr 1986; 109:114.
- Hoe FM, Thornton PS, Wanner LA, et al. Clinical features and insulin regulation in infants with a syndrome of prolonged neonatal hyperinsulinism. J Pediatr 2006; 148:207.
- Arya VB, Flanagan SE, Kumaran A, et al. Clinical and molecular characterisation of hyperinsulinaemic hypoglycaemia in infants born small-for-gestational age. Arch Dis Child Fetal Neonatal Ed 2013; 98:F356.
- Boluyt N, van Kempen A, Offringa M. Neurodevelopment after neonatal hypoglycemia: a systematic review and design of an optimal future study. Pediatrics 2006; 117:2231.
- Burns CM, Rutherford MA, Boardman JP, Cowan FM. Patterns of cerebral injury and neurodevelopmental outcomes after symptomatic neonatal hypoglycemia. Pediatrics 2008; 122:65.
- Tam EW, Widjaja E, Blaser SI, et al. Occipital lobe injury and cortical visual outcomes after neonatal hypoglycemia. Pediatrics 2008; 122:507.
- Kaiser JR, Bai S, Gibson N, et al. Association Between Transient Newborn Hypoglycemia and Fourth-Grade Achievement Test Proficiency: A Population-Based Study. JAMA Pediatr 2015; 169:913.
- Lucas A, Morley R, Cole TJ. Adverse neurodevelopmental outcome of moderate neonatal hypoglycaemia. BMJ 1988; 297:1304.
- Kerstjens JM, Bocca-Tjeertes IF, de Winter AF, et al. Neonatal morbidities and developmental delay in moderately preterm-born children. Pediatrics 2012; 130:e265.
- Duvanel CB, Fawer CL, Cotting J, et al. Long-term effects of neonatal hypoglycemia on brain growth and psychomotor development in small-for-gestational-age preterm infants. J Pediatr 1999; 134:492.
- Tin W, Brunskill G, Kelly T, Fritz S. 15-year follow-up of recurrent "hypoglycemia" in preterm infants. Pediatrics 2012; 130:e1497.
- Goode RH, RettigantiM, Li J, et al. Developmental Outcomes of Preterm Infants With Neonatal Hypoglycemia. Pediatrics 2016.
- 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