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A. Definition:
Blood sugar < 2.6 mmol/L (approximately 45 mg/dl) in a term or premature infant.
(iii) Immediate feeding for all well babies who are at risk.
If hypoglycaemic on admission, repeat glucometer 1 hour later after feeding.
Continue monitoring at 2 hours and 4 hours later. (i.e. O,1,2, 4 hours)
If normoglycaemic on admission feed and monitor 6-8 hourly till past stage of
hypoglycaemic risk
(iv) Unwell babies (e.g. birth asphyxia or premature): set up a 10% dextrose drip.
Monitor blood sugar Hourly X 2
Then 2 hourly X 2
Then 4 → 6 → 8 hourly until stable
C. If Hypoglycaemia is detected
3. When was the last feed given? Is the intravenous drip adequate and running
well? (i.e. not disconnected or extravasated)
D. Asymptomatic Hypoglycaemia
Once the blood glucose normalised, feeds can be reintroduced gradually and
infusion tailed off
F. If Hypoglycaemia persists
Increase the rate of dextrose infusion if possible (i.e. do not increase beyond
daily requirement).
Refer specialist
Consider
1. Glucagon 0.2 mg/kg IV (IM) bolus
2. Hydrocortisone 2.5 -5 mg/kg/dose bd IV
3. Diazoxide 5 mg bd orally
4. Adrenaline 500 ng/kg/min IV infusion
5. Somatostatin 1 - 4 microgram SC.
C Milk formula provide more energy/ml than 10% dextrose and supply important non-
glucose fuels, which have a glucose sparing role in neurological function.
(Energy content of formula milk is 2750 kJ/l while that of 10% D is 1600 kJ/l). It
promotes ketogenesis and gut maturation.
Breast-feeding should be encouraged as it is more ketogenic.
D. Milk feeds must not be discontinued or reduced when intravenous fluids are given
unless the child develops NEC or other causes of feeding intolerance. The
recommended practice is to feed the baby with as much milk as is tolerated and
to infuse glucose at a rate sufficient to prevent hypoglycaemia. The IV glucose is
then reduced slowly while milk feeds is maintained or increased. May need to
continue over a few days.
E. Ensure volume of intravenous fluid is appropriate for patient, taking into consideration
concomitant problems like cardiac failure, cerebral oedema and renal failure. If unable
to increase volume further, concentration of dextrose to be increased.
F. Plasma glucose is 13-18% higher than whole blood glucose. Arterial blood has higher
glucose concentration than venous blood. Capillary sampling can be unreliable in the
presence of poor peripheral circulation.
References
Koh G Aynsley-Green A 1988a Neonatal hypoglycaemia- the controversy definition. Arch Dis
Childhood;63:1386-1398
Koh G Aynsley-Green A Tarbit A Etre J 1988b Neural dysfunction during hypoglycaemia. Arch Dis
Childhood;63:1353-1358
DK Pal et al 2000 Neonatal hypoglycaemia in Nepal. Prevalence and risk factors Arch Dis
Childhood;82:F46-52
AA M Moris et al 1996 Evaluation of fast for investigating hypoglycaemia or suspected metabolic disease
Arch Dis Childhood;75:115-119
th
Gomella, Cunningham ,Eyal and Zenk: Neonatalogy 4 edition Lange