Neonatal hypoglycemia

Hypoglycemia is a common condition in newborns.

NH is the most common metabolic disorder of infancy, affecting approximately 15% of newborns.

These infants are commonly screened and treated for hypoglycemia, initially with increased feeding or oral dextrose gel, and admitted to neonatal intensive care units if hypoglycemia is persistent or severe.

Some newborns with hypoglycemia have permanent brain injury especially those with persistent genetic hypoglycemia disorders such as congenital hyperinsulinism.

NH may cause permanent brain injury due to the relative dependence of the neonatal brain on glucose as an oxidative fuel.

Most infants have transit hypoglycemia due to delayed transition from placental to hepatic glucose supply, in the absence of an underlying genetic or metabolic disorder or severe illness.

Brain damage can occur in infants in newborns without a genetic hypoglycemic disorder, particularly if the hypoglycemia persists for many hours to days associated with acute brain dysfunction, such as lethargy, coma and seizures.

Risk factors for neonatal hypoglycemia include a mother with diabetes, preterm birth, or large for gestational age.

Hypoglycemia is defined as a glucose level, generally, of less than 47 mg milligrams per deciliter.

In a study of 480 children with hypoglycemia outcomes at age 9 to 10 years of executive function, visual motor function, psychosocial adaptation and general health did not have significant differences compared with infants without hypoglycemia (Shah R).

In another study of 1395 newborns with early and transient hypoglycemia there was an association between transient hypoglycemia and low academic achievement at 10 years of age (Kaiser JR).

Studies of the use of prophylactic oral dextrose gel in newborns is being investigated: among late preterm in term infants born at risk for neonatal hypoglycemia, prophylactic oral 40% dextrose gel at one hour of age, compared with placebo resulted in no significant difference in the risk of neurosensory impairment at two years (Edwards T).

The Children with Hypoglycemia in Their Later Development (CHYLD) study reported that among at risk infants who is screened and treated to maintain blood glucose concentrations of at least 47 mg with deciliter, children who develop hypoglycemia had similar development at two years but increased risk of low executive function and visual motor integration at age 4.5 years.

The CHYLD study, however, did not find that there was a lowered education achievement by mid childhood.

To explain why hypoglycemia was associated with adverse neurodevelopment at 4.5 years of age but not at 9-10 years suggests that brain development may have diminishing effects overtime due to neuroplasticity or delayed maturation with mid childhood catch up in neurocognitive function.

Another study also found the brief transitional  neonatal hypoglycemia was associated with academic underachievement at age 10 years (Kaiser JR).




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