hypoglycemia in newborn

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hypoglycemia

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Hypoglycemia in newborn

Hypoglycemia in newborn

Wikawee Sirisuk 5th year medical studentDefinition 40 mg/dl 28

Pathogenesis

GlycogenGlucoseGlycogen 3rd trimester10Pathogenesis

GlycogenSudden starvationglucose from maternal

Sudden hypoglycemiaStresscounterregulatory hormoneIncrease:1.Hepatic glycogenolysis2.Hepatic gluconeogenesis3.Adipose tissue lipolysis4.Muscle proteolysis5.Hepatic ketogenesisInsulinCauses1.Hyperinsulinism2.Limitted glycogen storage3.Increase Metabolism4.Genetics

1.HyperinsulinismInfant of DM mother ;IDMErythroblastosis fetalisDrug using in perinatalBeckwith-Wiedeman syndromeIslet cell adenoma Nesidioblastosis

Maternal DM(IDM)Glucose umbilical cord Increase insulin Hyperinsulinism

(newborn)Physiologic hypoglycemia(2-3hr.)Prolong hypoglycemia2.Limitted glycogen storagePretermPerinatal stressStarvation in pregnancySGA

3.Increase MetabolismAsphyxiaHypothermiaInfectionPolycythemia

4.GeneticsGalactosemiaGycogen storage diseaseMaple syrup urine disease

OthersLarge for gestational age, LGACongenital hypopituitarismAdrenal insufficiencyglucoseSigns & Symptoms1. Sympathetic system - HR, Sweating, , 2.CNS - , , , Diagnosis & no specific signs or symptoms glucose1.Plasma glucose2.Blood insulin level3.Human growth hormone level hypopituitarism4.Serum cortisol level adrenal insufficiency

Dx. Hypoglycemia in newbornCapillary blood gas (CBG) DTX < 50 mg/dl

Plasma glucose(blood sugar)< 40 mg/dlTreatmentGoalPlasma glucose > 60 mg/dl

1.hypoglycemia(ex. IDM,LGA,SGA) CBG - CBG>40mg/dl & : Early feeding , CBG - CBG60 mg/dl Hydrocortisone 5mg/kg/dose iv/im q 12 hrEpinephrine(1:1000) 0.01ml/kg SC hydrocortisone Diazoxide hyperinsulinism PHHIGlucagon glycogenolysis gluconeogenesis SGA glycogen Somatostatin hyperinsulinismCortisol growth hormone hypopituitarismPancreatectomy PHHI