endocrine NICU

risk factors for hypoglycemia in newborns

pancreatic agenesis

A rare congenital condition where the pancreas is absent at birth, leading to insulin deficiency and high risk of hypoglycemia.

causes of neonatal onset of diabetes mellitus

include genetic mutations, autoimmune destruction of pancreatic beta cells, pancreatic agenesis, rare congenital disorders and exposure to maternal hyperglycemia during pregnancy.

transient neonatal diabetes mellitus (TNDM)

Transient neonatal diabetes mellitus (TNDM) is a rare, temporary monogenic condition appearing in the first weeks of life. About 90% of cases stem from chromosome 6q24 imprinting defects (overexpressing paternal genes PLAGL1 and HYMAI) or mutations in potassium channel genes (KCNJ11 and ABCC8). Symptoms typically resolve by 18 months. It is characterized by elevated blood sugar levels due to insulin deficiency.

symptoms:

• hyperglycemia

• severe dehydration

• low birth weight 2/2 IUGR

• poor weight gain

• rare ketoacidosis

pathologic

conditions resulting from illness or injury that adversely affect normal function in the body.

Transient hypoparathyroidism

of preterms is a temporary shortage of parathyroid hormone (PTH) common in premature and low-birth-weight infants. It leads to low blood calcium (hypocalcemia) because the immature parathyroid glands fail to respond properly to extrauterine mineral demands. It typically resolves on its own as the infant matures. [1, 2, 3, 4, 5]

hypoparathyroidism

 ↓ parathyroid hormone (PTH) →  ↓ blood calcium levels. It can be transient in neonates, particularly in preterm infants.

• hypocalcemia

• hyperphosphatemia

etiology

• removal of small neck glands during thyroid/throat surgery

• autoimmune attacks

• genetic conditions

• severe low blood magnesium

hyperparathyroidism

↑ PTH → ↑ blood calcium

• hypercalcemia

• hypophosphatemia

etiology

• primary hyperparathyroidism: autonomous, intrinsic overproduction of PTH independent of normal calcium feedback

  • single parathyroid adenoma: bening tumor on one gland

  • multigland hyperplasia: enlargement of two or more glands

  • multiple adenomas: less common cause of multi-glandular disease

  • parathyroid carcinoma: rare malignant tumor

  • genetic syndromes: multiple endocrine neoplasia type 1

• secondary hyperparathyroidism

  • physiologic compensatory response where low calcium or vitamin d levels persistently stimulate the glands to produce more PTH

  • CKD: most common cause, failing kidneys fail to activate vitamin D and clear phosphate → hypocalcemia

  • vitamin d deficiency

  • intestinal malabsorption: 2/2 bariatric surgery or other weight loss procedures can impair calcium and nutrient uptake

• tertiary hyperparathyroidism

  • autonomous hyperplasia: direct consequence of severe, prolonged secondary hyperparathyroidism (typically in ESRD)

  • gland autonomy: parathyroid tissue undergoes hyperplastic changes and loses responsiveness to normal calcium feedback, continuing to overproduce PTH even after initial secondary trigger or kidney failure is managed (such as post-kidney transplant)

IDM

infant of diabetic mother

LPT

late pre-term

if an LPT or term IDM/SGA infant has <40 mg/dL glucose and is symptomatic what nutrition intervention is indicated:

IV glucose

moro reflex

A reflex in infants characterized by a splaying of the arms and legs in response to sudden stimuli, such as a loud noise or feeling of falling.

what EN is first choice to treat hypoglycemia

mother’s colostrum