hypoglycemia in the newborn

what is hypoglycemia in the newborn?

blood glucose concentration inadequate to support neutologic, organ, and tissue function

what can happen with prolonged or severe hypoglycemia?

neurologic injury

what happen to the baby's source of glucose shortly after birth?

-source of glucose from mother is eliminated when the cord is clamped

-decrease in glucose as low as 30 during the first 1-2 hours

how can you promote normal glucose levels in the newborn?

early and regular feeding

who is at risk for hypoglycemia?

preterm or late preterm

SGA or LGA

babies whos mothers have diabetes

infants who experienced perinatal stress (asphyxia, cold stress, or respiratory distress)

when should babies at risk for hypoglycemia be fed?

within the first hour with glucose testing done 30 minutes after feeding

how can you promote thermoregulation and stabilization of glucose levels?

early and frequent breastfeeding and skin to skin contact for as long as possible after birth

what are s/s of hypoglycemia in the newborn?

-may be asymptomatic

-jitteriness

-lethargy

-poor feeding

-abnormal cry (high pitched)

-hypotonia

-temperature instability (hypothermia)

-respiratory distress

-apnea

-seizures

what should you do if you get a glucose level less than 45?

should be followed up with a stat glucose serum level prior to initiating treatment

why should a heel warmer by applied prior to every glucose assessment via heelstick?

if the extremity is cool, you can get a falsely low reading

what interventions should be done with an at risk newborn with no symptoms of hypoglycemia?

should be fed 1-5 mL/kg of breastmilk or infant formula

**for exclusively breastfed infants, if breastmilk is not available, dextrose gel 40% may be given sublingually

what should be given if levels remain low despite feeding?

IV dextrose

-goal is to maintain levels above 45 mg/dL

what should be done for a symptomatic neonate with hypoglycemia?

-notify PCP

-IV dextrose

-follow up glucose testing

why are SGA neonates at risk for hypoglycemia?

Malnutrition in utero / maternal vascular damage

why are LGA/IDM neonates at risk for hypoglycemia?

Increased blood glucose levels in utero

what is a complication of high glucose levels in utero?

decreases surfactant production

why are preterm neonates at risk for hypoglycemia?

Decreased storage and increased use of glucose

what is nursing care for a hypoglycemic neonate?

Hourly blood glucose monitoring

Feed within one hour of birth

Oral glucose water if not contraindicated

If symptomatic and unable to feed

orally, administer IV dextrose

Maintain BGL between 40 and 50mg/dL

when should glucose water be given?

only if other things fail (first should try to breastfeed)

what causes hypoglycemia in IDM?

hypertrophy and hyperplasia of the pancreatic islet cells and the transient state of hyperinsulinism

-high maternal blood glucose levels during fetal life provide a continual stimulus to the fetal islet cells for insulin production

-when the neonates glucose supply is removed abruptly at birth, the continued production of insulin soon depletes the blood of glucose, creating a state of hyperinsulinism and hypoglycemia within 0.5 to 4 hours

nursing care for IDMs?

-early exam for congenital anomalies

-signs or resp or cardiac probs

-adequate thermoregulation

-early carbohydrate feedings

-monitor glucose levels

what should symptomatic IDMs be given?

continuous IV 10% dextrose at 4-6 mg/min/kg unless glucose is less than 20

what should symptomatic IDMs with a glucose of less than 20 be given?

bolus of 10% dextrose given over 2-4 minutes then a continuous infusion of 10% dextrose and water

what are things to consider when giving IV glucose?

-careful monitoring of site (sugar attracts bacteria)

-monitor neonates reaction to therapy

-high glucose concentrations (>12.5) should be infused via central line