See guideline on management of hypoglycaemia

Persistent or severe hypoglycaemia (requiring more than 10mg/kg/min of glucose or lasting longer than 1 week) may require further investigation and management, e.g. with glucagon, diazoxide, steroids or surgery.  Consider discussing with Paediatric Endocrine Service.

In an emergency, particularly if there is difficulty in starting intravenous glucose infusion, glucagon 100 to 300μg/kg intramuscularly will stabilise blood glucose in most babies for one to two hours. The dose can be repeated, but subsequent doses are much less likely to be effective. (Glucagon mobilises glycogen stores. After the first dose, stores will probably be depleted).

Symptoms

• These are a poor guide to hypoglycaemia.
  • Half of hypoglycaemic infants are asymptomatic, and half of infants with symptoms are not hypoglycaemic.
• Hypoglycaemia should therefore be treated regardless of the presence of symptoms. Possible symptoms include:

 Other signs occur occasionally:

Causes of Hypoglycaemia

1. Transient neonatal hypoglycaemia.
   • Due to inadequate substrate stores and/or inability to mobilise these
     e.g. prematurity, intrauterine growth retardation, perinatal asphyxia, delayed or inadequate feeding.
   • Due to increased glucose requirements
     e.g. birth asphyxia, sepsis, congenital heart disease, hypothermia, neurological problems (periventricular haemorrhage, convulsions).
2. Hyperinsulinism
   • Maternal diabetes (see guideline on management on postnatal ward)
   • Erythroblastosis (e.g. severe Rhesus disease)
   • Leucine sensitivity
   • Islet cell hyperplasia or hyperfunction
   • Insulinoma
   • Beckwith-Wiedemann Syndrome
   • Maternal anti-diabetic drugs
   • Neonatal Hyperinsulinaemic Hypoglycaemia (nesidioblastosis)
3. Endocrine Causes
   • Panhypopituitarism
   • Hypothyroidism
   • Growth hormone deficiency
   • ACTH unresponsiveness
4. Inborn Errors of Metabolism
   • Carbohydrate metabolism
     1. Galactosaemia
     2. Glycogen Storage Disease Type I (Von Gierke’s), also III and VI
     3. Fructose Intolerance
   • Amino Acid metabolism
     1. Maple Syrup Urine Disease
     2. Proprionicacidaemia
     3. Methylmalonicacidaemia
     4. Hereditary Tyrosinaemia
5. Other Problems
   • Abrupt cessation of glucose infusion
   • Exchange transfusion without glucose replacement
   • Drugs (e.g. THAM, maternal β-blockers)

Investigations for Hypoglycaemia

At the time of low blood glucose (i.e. measure the glucose at the same time):

Can Be Done at Any Time:

References