Hypoglycaemia, Neonatal
Description Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: P70.4 DESCRIPTION Neonate presenting with whole blood glucose below 2.6 mmol/L. Risk factors include: prematurity, respiratory distress, small for gestational age, rhesus iso-immunisation, neonate of diabetic mother, hyperinsulinism, sepsis, post maturity, hypothermia/hyperthermia, feedi
Description
Diagnostic criteria
General and supportive measures
Medicine treatment
Referral
ICD-10 code: P70.4
DESCRIPTION
Neonate presenting with whole blood glucose below 2.6 mmol/L.
Risk factors include:
- prematurity,
- respiratory distress,
- small for gestational age,
- rhesus iso-immunisation,
- neonate of diabetic mother,
- hyperinsulinism,
- sepsis,
- post maturity,
- hypothermia/hyperthermia,
- feeding difficulties,
- perinatal asphyxia,
- polycythaemia,
- large for gestational age infants,
- hereditary defects in carbohydrate or amino acid metabolism.
DIAGNOSTIC CRITERIA
Clinical
Asymptomatic: Hypoglycaemia detected when screening neonates at risk.
Symptomatic:
- lethargy,
- poor feeding,
- hypotonia,
- respiratory distress,
- apnoea,
- cardiac failure,
- jitteriness,
- convulsions,
- irritability,
- metabolic acidosis, and
- coma.
Investigations
- Whole blood glucose (heel prick) < 2.6 mmol/L.
Monitor the blood glucose of all neonates who are at risk of hypoglycaemia regularly, at least 2 hourly, to prevent the development of hypoglycaemia.
GENERAL AND SUPPORTIVE MEASURES
- Determine and treat the underlying cause.
- Enteral feeding, oral or via oro/nasogastric tube, after exclusion of vomiting, ileus or obstruction.
MEDICINE TREATMENT
- Dextrose 10%, bolus IV, 2.5 mL/kg (250 mg/kg).
- Dextrose 10% = 10 g dextrose in 100 mL.
- Do not repeat dextrose bolus.
To raise heel prick blood glucose to a level of 2.6 mmol/L or more, follow with:
- Dextrose 10%, continuous IV infusion, 6–12 mg/kg/minute or more.
Dextrose dose (mg/kg/min) = (% dextrose solution x rate in mL/hour) divide by (weight x 6)
If heel prick blood glucose remains below 2.6 mmol/L:
- Dextrose 15%, IV via a central line, 15 mg/kg/minute or more.
- Dextrose 15% = 15 g dextrose in 100 mL.
If heel prick blood glucose is above 2.6 mmol/L after IV infusion has been started, continue infusion at maintenance rate.
Monitor blood glucose at least 2 hourly until blood glucose level stabilises at 2.6 mmol/L or above. To avoid rebound hypoglycaemia, reduce IV dextrose infusion gradually.
Before the IV infusion is finally discontinued, the neonate should receive all milk feeds orally or via oro/nasogastric tube. If enteral feeds are not tolerated, TPN should be given.
Suspect other serious underlying metabolic or biochemical abnormality if the neonate requires > 12 mg/kg/minute of dextrose to maintain a heel prick whole blood glucose > 2.6 mmol/L.
Use a central venous line for high concentrations of dextrose. Prior to referral, give the following, if available:
- Glucagon, IM/IV/SC, 0.2 mg/kg single dose.
REFERRAL
- Hypoglycaemia not responding to adequate treatment.
- Recurrent or persistent hypoglycaemia.
Also See: Hypoglycaemia in children.
Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 19: Prematurity And Neonatal Conditions, 19.7 Metabolic, 19.7.2 Hypoglycaemia, Neonatal