Hypoglycaemia is a glucose concentration in the serum of <40 mg / dl (<2.2 mmol / l) at the newborn and of <30 mg / dl (<1.7 mmol / l) in front of prematurity. Risk factors include prematurity, SGA, maternal diabetes and perinatal asphyxia. The most common causes are too low glycogen stores, delayed breastfeeding and hyperinsulinism. Symptoms include tachycardia, cyanosis, seizures and apnea. The diagnosis is suspected because of the clinical picture and confirmed by determining the blood glucose concentration. The prognosis depends on the underlying disease. The treatment is effected by feeding or by i.v. Administration of dextrose.

Hypoglycaemia is a glucose concentration in the serum of <40 mg / dl (<2.2 mmol / l) at the newborn and of <30 mg / dl (<1.7 mmol / l) in front of prematurity. Risk factors include prematurity, SGA, maternal diabetes and perinatal asphyxia. The most common causes are too low glycogen stores, delayed breastfeeding and hyperinsulinism. Symptoms include tachycardia, cyanosis, seizures and apnea. The diagnosis is suspected because of the clinical picture and confirmed by determining the blood glucose concentration. The prognosis depends on the underlying disease. The treatment is effected by feeding or by i.v. Administration of dextrose.

(See also general discussion hypoglycemia.) Hypoglycaemia is a glucose concentration in the serum of <40 mg / dL (<2.2 mmol / l) at newborns and of <30 mg / dL (<1.7 mmol / l) in front of preterm infants. Risk factors include prematurity, SGA, maternal diabetes and perinatal asphyxia. The most common causes are too low glycogen stores, delayed breastfeeding and hyperinsulinism. Symptoms include tachycardia, cyanosis, seizures and apnea. The diagnosis is suspected because of the clinical picture and confirmed by determining the blood glucose concentration. The prognosis depends on the underlying disease. The treatment is effected by feeding or by i.v. Administration of dextrose. Etiology, hypoglycaemia may transiently in newborns or occur persistently. Causes of temporary hypoglycemia are Insufficient substrate (eg. B. glycogen) An immature enzyme function leads to defective glycogen storage Decreased glycogen stores at birth are in VLBW premature infants, in children who are small, based on the age of maturity Due to placental insufficiency and in children with perinatal asphyxia often. By anaerobic glycolysis glycogen stores are emptied in these children, so that can develop hypoglycemia during the first few hours or -tagen any time, v. a. if the time interval between two feedings large or drinking behavior is poor. The continued supply of exogenous glucose is therefore important to prevent hypoglycemia. Causes of persistent hypoglycemia include hyperinsulinism Disturbed counter-regulatory hormones (growth hormone, corticosteroids, glucagon, catecholamines) Inherited disorders of metabolism (for. Example, glycogen storage diseases, disorders of gluconeogenesis, fatty acid oxidation disorders) A hyperinsulinism occurs most often in children of diabetic mothers and extends inversely proportional to the quality of the maternal blood sugar control. If a mother has diabetes, her fetus is at increased glucose levels due to increased maternal blood sugar levels. The infant responds by producing increased levels of insulin. If the umbilical cord is cut, the infusion of glucose to the newborn stops, and it may take hours or even days to the newborn reduces its insulin production. Hyperinsulinism is also common in physiologically stressed children who are small for their gestational age. In both cases the hyperinsulinism is transient. Less frequent and longer-lasting causes of congenital hyperinsulinism (both autosomal dominant and recessive), the severe fetal erythroblastosis and Beckwith-Wiedemann syndrome (which is characterized in addition to a Inselzellhyperplasie by a macroglossia and umbilical hernia). The hyperinsulinism expressed typically in a rapid decrease in serum glucose concentration in the first two hours after the continuous supply has been cut through the placenta. Blood glucose levels are dependent on several interacting factors. Although insulin is the primary factor that sugar levels are also dependent on growth hormones, cortisol and thyroid hormone levels. Every circumstance that disturbs the appropriate secretion of these hormones can lead to hypoglycaemia. Hypoglycaemia may also occur when a glucose infusion is abruptly interrupted. Finally, hypoglycemia can occur due to a misalignment of an umbilical catheter or sepsis. Symptoms Many children remain asymptomatic. A persistent or severe hypoglycemia causes both adrenergic and neurological symptoms. Among the adrenergic symptoms include Fahörigkeit, tachycardia, weakness, uncertainty and tremors. Neurological symptoms of hypoglycaemia include. a. Seizures, loss of consciousness, cyanotic episodes, apnea, bradycardia, dyspnea and hypothermia. Also, lethargy, poor feeding, hypotension, and tachypnea may occur. Diagnostic Bedside glucose check all symptoms are nonspecific and also occur in neonates with asphyxia, sepsis or hypocalcemia, and in opioid withdrawal. It is therefore necessary with risk factors, regardless of the presence of clinical symptoms in patients, a bedside blood glucose test (test strips) perform with capillary blood. Pathologically low values ??should then be confirmed by venipuncture. Therapy dextrose i.v. (For the prevention and treatment) Enteral Nutrition Sometimes glucagon i.m. The majority of infants with an increased risk of hypoglycemia is treated prophylactically. So z. B. children requiring insulin diabetic mothers often infused immediately after birth, a 10% dextrose solution as a continuous drip or p.o. given, as all sick or extremely immature neonates and those with dyspnea. Even those newborns who are not sick, but still have an increased risk of hypoglycaemia should be fed early and regularly with commercial infant formula to ensure an adequate carbohydrate supply. Each newborns whose serum glucose value of ? 50 mg / dl (? 2.75 mmol / l) falls, should immediately start of enteral feeding or an i.v. Infusion of up to 12.5% ??glucose in an amount of 2 ml / kg are supplied over 10 min; if required, even higher concentrations may be infused through a central catheter. Subsequently, the infusion is continued so that the administration of 4-8 mg / kg / min glucose (eg., 10% glucose with about 2.5-5 ml / kg / h) is ensured. Blood glucose levels must be monitored so that the infusion rate can be adjusted accordingly. When the state of the newborn has improved, the infusion can be gradually replaced at regular blood sugar checks by enteral feeding. Glucose infusions should be reduced slowly ever since abrupt discontinuation may cause hypoglycemia result. If it is difficult to start immediately with a hypoglycemic newborns with an infusion therapy, glucagon can be used in a dosage of 100-300 mcg / kg i.m. (Maximum 1 mg) increase blood sugar levels rapidly. This effect lasts, except in newborns with empty glycogen stores, about 2-3 h at. An intractable on high doses of glucose hypoglycemia can i.m. 2.5 mg hydrocortisone be treated 2 times a day. If hypoglycemia continues to not respond to the therapy, other causes must (z. B. sepsis) are searched and, if carried out an endocrinological evaluation in terms of a persistent hyperinsulinism, Glukoneogenese- or Glykogenolysestörungen. Important Points Small and / or premature babies often have low glycogen stores and are hypoglycemic, when early and often fed. Infants of diabetic mothers have hyperinsulinemia, caused by high sugar levels mother; they can develop a transient hypoglycemia after birth when maternal glucose is withdrawn. Possible symptoms include diaphoresis, tachycardia, lethargy, refusal of food, hypothermia, seizures and coma. Treat infants of diabetic mothers, very premature infants and infants with respiratory distress preventive (using edible oral or iv glucose). i.v. if the serum glucose value to ? 50 mg / dl falls (? 2.75 mmol / l) should be started with the enteral feeding immediately or with a Infusion of 10% up to 12.5% ??D / W, 2 ml / kg over 10 min; follow this bolus with additional i.v. or enteral glucose and draw the glucose level on closely.

Health Life Media Team

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