Neonatal hypoglycemia

Adamkin DH. Neonatal hypoglycemia. Curr Opin Pediatr. 2016 Jan 15. [Epub ahead
of print]

“It becomes clear that a glucose threshold of 47 mg/dl is not a ‘magic’ number for treating neonatal hypoglycemia. The data on undetected ‘hypoglycemia’ with the interstitial monitoring also suggest that we need a considerable margin of safety in setting such a threshold, but unfortunately we cannot agree on where that should be. The report on outcome using the less than 47 mg/dl as a treatment threshold is at least reassuring in the sense that the protocol had many similarities to recommendations in the AAP Committee on Fetus and the Newborn report in 2011 and was recently ratified again [6]. The lower levels from the AAP document, along with enhanced vigilance to identify persistent hypoglycemia syndromes after 48 h, might be the best compromise to prevent overscreening, and thus overtreatment, while still committing to diagnosing persistent hypoglycemia after the transitional period before discharge from the hospital.”

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Thornton PS, et al. Recommendations from the Pediatric Endocrine Society for Evaluation and Management of Persistent Hypoglycemia in Neonates, Infants, and Children. J Pediatr. 2015 Aug;167(2):238-45.

“The Pediatric Endocrine Society convened an expert panel of pediatric endocrinologists and neonatologists to develop guidelines for managing hypoglycemia in neonates, infants, and children, but excluding children with diabetes. The goals of these guidelines are to help physicians recognize persistent hypoglycemia disorders, guide their expeditious diagnosis and effective treatment, and prevent brain damage in at-risk babies.”

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Rozance PJ. Update on neonatal hypoglycemia. Curr Opin Endocrinol Diabetes Obes. 2014 Feb;21(1):45-50.

RECENT FINDINGS: New information has been published that describes the incidence and timing of low glucose concentrations in the groups most at risk for asymptomatic neonatal hypoglycemia. Furthermore, one large prospective study failed to find an association between repetitive low glucose concentrations and poor neurodevelopmental outcomes in preterm infants. But hypoglycemia due to hyperinsulinism, especially genetic causes, continued to be associated with brain injury. New advances were made in the diagnosis and management of hyperinsulinism, including acquired hyperinsulinism in small for gestational age infants and others. Continuous glucose monitoring remains an attractive strategy for future research in this area.

SUMMARY: The fundamental question of how best to manage asymptomatic newborns with low glucose concentrations remains unanswered. Balancing the risks of overtreating newborns with low glucose concentrations who are undergoing a normal transition following birth against the risks of undertreating those in whom low glucose concentrations are pathological, dangerous, and/or a harbinger of serious metabolic disease remains a challenge.

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Sweet CB, Grayson S, Polak M. Management strategies for neonatal hypoglycemia. J Pediatr Pharmacol Ther. 2013 Jul;18(3):199-208.

While hypoglycemia occurs commonly among neonates, treatment can be challenging if hypoglycemia persists beyond the first few days of life. This review discusses the available treatment options for both transient and persistent neonatal hypoglycemia. These treatment options include dextrose infusions, glucagon, glucocorticoids, diazoxide, octreotide, and nifedipine. A stepwise, practical approach to the management of these patients is offered.

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More PubMed results on neonatal hypoglycemia.

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