Group 5 Endocrine and Metabolic Complications of The Newborn SU 6.5

Endocrine and
MIDN411 : Study Unit 6.5
metabolic
complications of the
Izelle Nothnagel 34876332
newborn Marli Steyn 34738398

Olga van Dyk 34280286
Janade Shaw 34396217
Emsie Snyman 34610308
Bella Taljaard 35062207
Tarien Rossouw 34267182
Chantel Strydom 29624312
Learning outcomes
Define hypoglycaemia
Discuss the dangers of hypoglycaemia
Discuss the compensatory mechanisms in respect of hypoglycaemia of
the healthy neonate
Discuss the causes of hypoglycaemia
Discuss the signs and diagnosis of hypoglycaemia
Discuss the management of hypoglycaemia among healthy and high-
risk neonates and apply your knowledge
Briefly discuss hyperglycaemia
Hypoglycaemia
Identified as a low glucose level of … in the first 72hours after birth.
Less than 20mg/dL (<1mmol/L) in premature babies.
Less than 30mg/dL (<1,5mmol/L) in low birth neonates.
Less than 40mg/dL (<2,2mmol/L) in full term neonates.
(Fenichel, 2005:1-45)
According to Adamkin (2017:36-41) is Hypoglycemia a low glucose

level of less than 47 mg/dL (<2.6 mmol/L) in the first 48 hours after
birth.
Therefore, we want the glucose of the neonate to be at least:

2.7mmol/L – 7,8mmol/L.
Dangers of
hypoglycaemia
Can harm the brain’s ability to function normally
Severe or long-lasting hypoglycemia can cause:
• Neurologic damage
• Epilepsy/seizures
• Mental retardation
• Behavioral and personality disorders
• Death
(Stomnaroska et al.,2020)
Compensatory mechanisms
in respect of hypoglycaemia
of the healthy neonate
1. In the first hour of life, the infant’s blood
glucose levels will fall;
2. triggering the pancreas to stimulate the alpha
cells of the islets of Langerhans to produce
glucagon.
3. This will release glucose from glucogen
stores in the liver to
4. maintain a normal glucose level within
normal ranges.
(Marshall et al., 2014:623)

Causes of
●
hypoglycaemia
IUGR due to inadequate glucose metabolism caused by
low glycogen stores
● Prematurity due to inadequate glucose metabolism caused
by low glycogen stores
● Mother or infant is a known diabetic patient due to
excessive insulin production
● Infants with sepsis because it influence the brown fat
metabolism
● Respiratory distress or asphyxia
● Conduction, convection, radiation and evaporation
therefore the baby is not producing enough heat

(Harrison, 2012:276)
A PICTURE
IS WORTH A
THOUSAND
WORDS
The signs and diagnosis of
hypoglycaemia
• Blue or pale skin colour
• Breathing problems such as apnoea, rapid breathing or a
Signs •
grunting sound.
Irritability or restlessness
• Hypotonia
• Tremors, sweating or seizures.
• Poor feeding or vomiting
• Problems keeping the body warm
• Lethargic infant
Having a plasma glucose level below 1.65

mmol/L in the first 24 hours of life and less than
Diagnosis 2.5 mmol/L is seen as hypoglycaemia in the
infant (Hilarie Cranmer, 2022).
The Mx of hypoglycaemia among
healthy and high-risk neonates
Asymptomatic hypoglycaemia is the most common among infants who has high risk factors
and has always been treated by ensuring the infant is getting adequate nutrition, which
typically involves supplementation (banked breast milk or formula) as well as assisting mother
to maximize colostrum expression in the hours after birth. In some hospitals, they started
using oral dextrose gel to treat asymptomatic hypoglycaemia.
Symptomatic hypoglycaemia is less common. Immediate intervention is necessary in these

cases, with consideration of immediate IV dextrose in the infant who is not appearing well.
The correct method to correct the hypoglycaemia will be determined by observing the clinical
status of the infant and then how soon the interventions need to be put in place (how needed it
is). If an infant overall appears well, attempts can be made to correct hypoglycaemia by
feeding the infant and/or giving dextrose gel. Glucose absorption from rubbing dextrose gel on
a baby’s buccal mucosa (the inner lining of the cheeks) has similar response time to
administering IV dextrose.
(Anon., 2021)
The Mx of hypoglycaemia among
healthy and high-risk neonates
Within the first 4 hours Between 4 - 24
 ofglucose
Any life:level less than 25 mg/dL in a  hours
Any glucoseof life:
level less than 45 mg/dL in a
baby with severe symptoms requires immediate baby with severe symptoms requires an
IV fluid therapy. immediate IV fluid therapy.
 In an asymptomatic baby, an initial glucose level  "In an asymptomatic baby, a glucose level
(within the first 4 hours of life) of less than 25 of less than 45 mg/dL should prompt
mg/dL should prompt treatment with dextrose gel dextrose gel with immediate feeding, and
and an immediate feeding, with another glucose another glucose check in an hour."
check in an hour. (“Hypoglycemia | Newborn Nursery |
 If the subsequent test is still <25 mg/dL, IV Stanford Medicine”)
dextrose or repeating a dose of gel should be  If the subsequent test is still <45 mg/dL,
considered, depending on the clinical status of the further attempts to correct the glucose
infant. with up to 3 total doses of categorized as
 If the subsequent test is >25 but <35 mg/dL, the dextrose gel and continued supplemental
infant should again be given dextrose gel, fed and feeding should be attempted.
retested, although IV fluid therapy may be  Infants who have persistently low
indicated for some patients in this group. glucoses (<45 mg/dL) should be
considered for IV dextrose treatment.
Hyperglycaemia
• Hyperglycaemia is a much less threat compared to
hypoglycaemia.
• It occurs mostly in pre-term and severely IUGR babies.
• It is also seen in term babies in response to stress especially
following perinatal hypoxia ischemia, surgery or drugs.
• Usually treatment is not required, unless there is significant loss
of glucose in the urine that may cause osmotic diuresis.
• If treatment is required, the rate of glucose infusion can be
decreased.

Reference list
Adamkin, DH. 2017. Seminars in Fetal & Neonatal medicine. Elsevier 22(1), 36-41. https://www.sciencedirect.com/topics/medicine-and-
dentistry/neonatal-hypoglycemia Date of access: 31 Mar. 2023.
Anonymous. (2021, May 4). Stanford Medicine. Retrieved from Newborn Nursery at Lucile Packard Children's Hospital:
https://med.stanford.edu/newborns/clinical-guidelines/hypoglycemia.
Fenichel, G.M. 2005. Clinical Pediatric Neurology. A Signs and Symptoms approach. Elsevier. 5th ed.
https://www.sciencedirect.com/science/article/pii/B1416001697500020 Date of access: 1 Mar. 2023.
Harrison, V.C. 2012. The newborn baby. 6th ed Cape Town: Juta & Co Ltd
Hilarie Cranmer, M.D. (2022) Neonatal hypoglycemia, Practice Essentials, Background,Etiology. Medscape. Available at:
https://emedicine.medscape.com/article/802334-overview (Accessed: March 31, 2023).
Marshall JE, Raynor MD, Nolte AG. 2016. Myles Textbook for Midwives, 16e. African Edition, 3rd edition. Elsevier, South Africa.
Chapter 46
Stomnaroska, O., Dukovska, V. & Danilovski, D. 2020. Neuro Developmental Consequences of Neonatal Hypoglycaemia.
https://pubmed.ncbi.nlm.nih.gov/33011693/#:~:text=Neonatal%20hypoglycemia%20(HG)%20can%20cause,in%20development%20of
%20neurological%20damage. Date of access: 31 March 2023.
Villines, Z. (2021, December 22). Medical News Today. Retrieved from What to do for hypoglycemia in a newborn: https://
www.medicalnewstoday.com/articles/hypoglycemia-in-newborn
Villines, Z. (2021, December 22). Medical News Today. Retrieved from What to do for hypoglycemia in a newborn:
https://www.medicalnewstoday.com/articles/hypoglycemia-in-newborn
THANK
YOU!!!
ANY
QUESTI
ONS?

Group 5 Endocrine and Metabolic Complications of The Newborn SU 6.5

Uploaded by

Copyright:

Available Formats

Group 5 Endocrine and Metabolic Complications of The Newborn SU 6.5

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Group 5 Endocrine and Metabolic Complications of The Newborn SU 6.5

Uploaded by

Copyright:

Available Formats

Endocrine and

MIDN411 : Study Unit 6.5

newborn Marli Steyn 34738398

According to Adamkin (2017:36-41) is Hypoglycemia a low glucose

Therefore, we want the glucose of the neonate to be at least:

(Marshall et al., 2014:623)

(Marshall et al., 2016:689)

Having a plasma glucose level below 1.65

Symptomatic hypoglycaemia is less common. Immediate intervention is necessary in these

(Marshall et al., 2014:689)

You might also like