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VOLUME 1 , ISSUE 1 ( January-March, 2022 ) > List of Articles

REVIEW ARTICLE

Neonatal Hypoglycemia

Raghavendra Bangrakulur Rao

Keywords : Hypoglycemia, Neonatology, Neurodevelopment, Newborn, Newborn infant, Preterm infants

Citation Information : Rao RB. Neonatal Hypoglycemia. 2022; 1 (1):151-157.

DOI: 10.5005/jp-journals-11002-0011

License: CC BY-NC 4.0

Published Online: 31-03-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Hypoglycemia is the most common metabolic problem in the neonatal period with a potential to cause brain injury. However, there are controversies in diagnosis, significance, and treatment of neonatal hypoglycemia. Several large-scale prospective and retrospective studies have reported the impact of neonatal hypoglycemia on neurodevelopment in high-risk infants. Significance of short-term hypoglycemia on neurodevelopment in healthy infants remains unresolved. There are also concerns that rapid correction of hypoglycemia may worsen brain injury. Conflicting recommendations from professional societies have further muddied the field. This review examines the current knowledge on the epidemiology of neonatal hypoglycemia, its impact on neurodevelopment, current screening and treatment recommendations, and the emerging role of dextrose gel for management of neonatal hypoglycemia.


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  1. Srinivasan G, Pildes RS, Cattamanchi G, et al. Plasma Glucose Values in Normal Neonates: A New Look. J Pediatr 1986;109(1):114–117. DOI: 10.1016/s0022-3476(86)80588-1.
  2. Harris DL, Weston PJ, Gamble GD, et al. Glucose Profiles in Healthy Term Infants in the First 5 Days: The Glucose in Well Babies (GLOW) Study. J Pediatr 2020;223:34–41 e4. DOI: 10.1016/j.jpeds.2020.02.079.
  3. Kaiser JR, Bai S, Gibson N, et al. Association Between Transient Newborn Hypoglycemia and Fourth-Grade Achievement Test Proficiency: A Population-Based Study. JAMA Pediatr 2015;169(10):913–921. DOI: 10.1001/jamapediatrics.2015.1631.
  4. Harris DL, Weston PJ, Harding JE. Incidence of Neonatal Hypoglycemia in Babies Identified as at Risk. J Pediatr 2012;161(5):787–791. DOI: 10.1016/j.jpeds.2012.05.022.
  5. Goode RH, Rettiganti M, Li J, et al. Developmental Outcomes of Preterm Infants With Neonatal Hypoglycemia. Pediatrics 2016;138(6). DOI: 10.1542/peds.2016-1424.
  6. Turner D, Monthe-Dreze C, Cherkerzian S, et al. Maternal Obesity and Cesarean Section Delivery: Additional Risk Factors for Neonatal Hypoglycemia? J Perinatol 2019;39(8):1057–1064. DOI: 10.1038/s41372-019-0404-z.
  7. Ennis K, Tran PV, Seaquist ER, et al. Postnatal Age Influences Hypoglycemia-Induced Neuronal Injury in the Rat Brain. Brain Res 2008;1224:119–1126. DOI: 10.1016/j.brainres.2008.06.003.
  8. Rao R, Ennis K, Long JD, et al. Neurochemical Changes in the Developing Rat Hippocampus during Prolonged Hypoglycemia. J Neurochem 2010;114(3):728–738. DOI: 10.1111/j.1471-4159.2010.06797.x.
  9. Ennis K, Dotterman H, Stein A, et al. Hyperglycemia Accentuates and Ketonemia Attenuates Hypoglycemia-Induced Neuronal Injury in the Developing Rat Brain. Pediatr Res 2015;77(1–1):84–90. DOI: 10.1038/pr.2014.146.
  10. Schrier AM, Wilhelm PB, Church RM, et al. Neonatal Hypoglycemia in the Rhesus Monkey: Effect on Development and Behavior. Infant Behav Dev 1990;1990(13):189–207.
  11. Moore H, Craft TK, Grimaldi LM, et al. Moderate Recurrent Hypoglycemia During Early Development Leads to Persistent Changes in Affective Behavior in the Rat. Brain Behav Immun 2010;24(5):839–849. DOI: 10.1016/j.bbi.2009.11.013.
  12. Lehmann AE, Ennis K, Georgieff MK, et al. Evidence for a Hyporesponsive Limbic-Hypothalamic-Pituitary-Adrenal Axis Following Early-Life Repetitive Hypoglycemia in Adult Male Rats. Am J Physiol Regul Integr Comp Physiol 2011;301(2):R484–R490. DOI: 10.1152/ajpregu.00678.2010.
  13. Alkalay AL, Flores-Sarnat L, Sarnat HB, et al. Plasma Glucose Concentrations in Profound Neonatal Hypoglycemia. ClinPediatr 2006;45(6):550–558. DOI: 10.1177/0009922806290610.
  14. Boluyt N, van Kempen A, Offringa M. Neurodevelopment After Neonatal Hypoglycemia: A Systematic Review and Design of an Optimal Future Study. Pediatrics 2006;117(6):2231–2243. DOI: org/10.1542/peds.2005-1919.
  15. Kerstjens JM, Bocca-Tjeertes IF, de Winter AF, et al. Neonatal Morbidities and Developmental Delay in Moderately Preterm-Born Children. Pediatrics 2012;130(2):e265–e272. DOI: 10.1542/peds. 2012-0079.
  16. McKinlay CJ, Alsweiler JM, Ansell JM, et al. Neonatal Glycemia and Neurodevelopmental Outcomes at 2 Years. N Engl J Med 2015;373(16):1507–1518. DOI: 10.1056/NEJMoa1504909.
  17. McKinlay CJD, Alsweiler JM, Anstice NS, et al. Association of Neonatal Glycemia With Neurodevelopmental Outcomes at 4.5 Years. JAMA Pediatr 2017;171(10):972–983. DOI: 10.1001/jamapediatrics.2017.1579.
  18. van Kempen A, Eskes PF, Nuytemans D, et al. Lower versus Traditional Treatment Threshold for Neonatal Hypoglycemia. N Engl J Med 2020;382(6):534–544. DOI: 10.1056/NEJMoa1905593.
  19. Shah R, Harding J, Brown J, McKinlay C. Neonatal Glycaemia and Neurodevelopmental Outcomes: A Systematic Review and Meta-Analysis. Neonatology 2019;115(2):116–126. DOI: 10.1159/000492859.
  20. Harris DL, Alsweiler JM, Ansell JM, et al. Outcome at 2 Years after Dextrose Gel Treatment for Neonatal Hypoglycemia: Follow-Up of a Randomized Trial. J Pediatr 2016;170:54-9 e1-2. DOI: 10.1016/j.jpeds.2015.10.066.
  21. Rasmussen AH, Wehberg S, Portner F, et al. Neurodevelopmental Outcomes After Moderate to Severe Neonatal Hypoglycemia. Eur J Pediatr 2020;179(12):1981–1991. DOI: 10.1007/s00431-020-03729-x.
  22. Adamkin DH. Postnatal glucose homeostasis in late-preterm and term infants. Pediatrics 2011;127(3):575–579. DOI: 10.1542/peds. 2010-3851.
  23. Thornton PS, Stanley CA, De Leon DD, et al. Recommendations from the Pediatric Endocrine Society for Evaluation and Management of Persistent Hypoglycemia in Neonates, Infants, and Children. J Pediatr 2015;167(2):238–245. DOI: 10.1016/j.jpeds.2015.03.057.
  24. Narvey MR, Marks SD. The screening and Management of Newborns At Risk for Low Blood Glucose. Paediatr Child Health 2019;24(8):536–554. DOI: 10.1093/pch/pxz134.
  25. Wackernagel D, Gustafsson A, Edstedt Bonamy AK, et al. Swedish National Guideline for Prevention and Treatment of Neonatal Hypoglycaemia in Newborn Infants with Gestational Age >/=35 Weeks. Acta Paediatr 2020;109(1):31–44. DOI: 10.1111/apa.14955.
  26. Britsh Association of Perinatal Medicine. Identification and Management of Neonatal Hypoglycaemia in the Full Term Infant (2017)–a BAPM Framework for Practice. http://www.bapm.org/publications.
  27. Glasgow MJ, Harding JE, Edlin R, Children with H, Their Later Development Study T. Cost Analysis of Treating Neonatal Hypoglycemia with Dextrose Gel. J Pediatr 2018;198:151–155 e1. DOI: 10.1016/j.jpeds.2018.02.036.
  28. Levene I, Wilkinson D. Identification and Management of Neonatal Hypoglycaemia in the Full-Term Infant (British Association of Perinatal Medicine-Framework for Practice). Arch Dis Child Educ Pract Ed 2019;104(1):29–32. DOI: 10.1136/archdischild-2017-314050.
  29. Harris DL, Gamble GD, Weston PJ, et al. What Happens to Blood Glucose Concentrations After Oral Treatment for Neonatal Hypoglycemia? J Pediatr 2017;190:136–141. DOI: 10.1016/j.jpeds.2017.06.034.
  30. Harris DL, Weston PJ, Signal M, et al. Dextrose gel for Neonatal Hypoglycaemia (the Sugar Babies Study): A Randomised, Double-Blind, Placebo-Controlled Trial. Lancet 2013; 382(9910): 2077–2083. DOI: 10.1016/S0140-6736(13)61645-1.
  31. Plummer EA, Ninkovic I, Rees A, et al. Neonatal Hypoglycemia Algorithms Improve Hospital Outcomes. J Matern Fetal Neonatal Med 2020 Jul 20;1–8. DOI: 10.1080/14767058.2020.1785421. Online ahead of print.
  32. Sen S, Andrews C, Anderson E, et al. Type of Feeding Provided with Dextrose Gel Impacts Hypoglycemia Outcomes: Comparing Donor Milk, Formula, and Breastfeeding. J Perinatol 2020;40(11): 1705–1711. DOI: 10.1038/s41372-020-00776-y.
  33. Weston PJ, Harris DL, Battin M, et al. Oral Dextrose Gel for the Treatment of Hypoglycaemia in Newborn Infants. Cochrane Database Syst Rev 2016(5):CD011027. DOI: 10.1002/14651858.CD011027.pub2.
  34. Edwards T, Liu G, Hegarty JE, et al. Oral Dextrose Gel to Prevent Hypoglycaemia in At-Risk Neonates. Cochrane Database Syst Rev 2021;5:CD012152. DOI: 10.1002/14651858.CD012152.pub3.
  35. Standards for improving quality of care for small and sick newborns in health facilities. Geneva: World Health Organization; 2020.
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