pediatrics
Neonatal Hypoglycemia
Treatment of Neonatal Hypoglycemia
IVdextrose(for prevention and treatment) Enteral feeding Sometimes IMglucagon Most high-risk neonates are treated preventively. For example, infants of diabetic women who have been usinginsulinare often started at birth on a 10% D/W infusion IV or given oral glucose, as are those who are sick, are extremely premature, or have respiratory distress. Other at-risk neonates who are not sick should be started on early, frequent formula feedings to provide carbohydrates. Any neonate whose glucose falls to≤50 mg/dL (≤2.75 mmol/L) should begin prompt treatment with enteral feeding or with an IV infusion of up to 12.5% D/W, 2 mL/kg over 10 minutes; higher concentrations ofdextrosecan be infused if necessary through a central catheter. The infusion should then continue at a rate that provides 4 to 8 mg/kg/minute of glucose (ie, 10% D/W at about 2.5 to 5 mL/kg/hour). Serum glucose levels must be monitored to guide adjustments in the infusion rate. Once the neonate’s condition has improved, enteral feedings can gradually replace the IV infusion while the glucose concentration continues to be monitored. IVdextroseinfusion should always be tapered, because sudden discontinuation can cause hypoglycemia. If starting an IV infusion promptly in a hypoglycemic neonate is difficult,glucagon100 to 300 mcg/kg IM (maximum, 1 mg) usually raises the serum glucose rapidly, an effect that lasts 2 to 3 hours, except in neonates with depleted glycogen stores. Hypoglycemia refractory to high rates of glucose infusion may be treated withhydrocortisone12.5 mg/m2every 6 hours. If hypoglycemia is refractory to treatment, other causes (eg, sepsis) and possibly an endocrine evaluation for persistent hyperinsulinism and disorders of defective gluconeogenesis or glycogenolysis should be considered. 