What Are Common Causes of Low Blood Sugar In Newborns?

Neonatal hypoglycemia is when the blood glucose of a newborn is below the required blood glucose concentration. It often occurs in premature infants, term infants, and infants with diabetic mothers. It is more common in neonatal hypoxia, asphyxia, scleredema, and infection with sepsis. Severe hypoglycemia persists or recurrent attacks can cause damage to the central nervous system. Neonatal hypoglycemia can be an independent disease or a clinical manifestation of other diseases.

Basic Information

English name: hypoglycemia of newborn
Visiting department: Neonatal, Pediatric Endocrinology
Multiple groups: Premature infants, term infants, infants with diabetic mothers

Common causes: Increased use of glucose, decreased production or reserves, or both
Common symptoms: Poor response, sweating, paleness, etc.

Causes of neonatal hypoglycemia

Temporary hypoglycemia

(1) Insufficient glucose storage It is mainly found in : Premature babies and infants less than gestational age Liver glycogen storage occurs mainly in the last 3 months of pregnancy. Therefore, the younger the gestational age, the less glycogen storage and the enzymes in gluconeogenesis Low vitality; Stress response during perinatal period. Hypoxia and acidosis increase catecholamine secretion, increase liver glycogen decomposition, and increase glucose utilization by anaerobic fermentation. Others such as hypothermia, sepsis, congenital heart Disease, etc., often due to insufficient calorie intake, increased glucose utilization.

(2) Increased glucose utilization (temporary hyperinsulinemia) is mainly seen in: infants with diabetic mothers due to excessive intrauterine blood glucose, which causes temporary hyperinsulinemia, and the mother's blood glucose supply is suddenly interrupted after birth; Rh hemolytic disease Destruction of red blood cells results in the release of glutathione and stimulates an increase in insulin concentration.

2. Persistent hypoglycemia

(1) Hyperinsulinemia is mainly seen in islet cell hyperplasia, Beckwith syndrome, and islet cell adenoma.

(2) Endocrine defects such as congenital pituitary insufficiency, cortisol deficiency, glucagon deficiency, growth hormone deficiency, etc.

(3) Genetic metabolic diseases Abnormal glucose metabolism, such as glycogen storage disease type , type ; Fatty acid metabolic diseases, such as lack of medium chain acyl-CoA dehydrogenase; Defects in amino acid metabolism, such as dysfunction of branched chain amino acid metabolism, bright Defects in amino acid metabolism.

Clinical manifestations of neonatal hypoglycemia

Most people with hypoglycemia lack typical clinical symptoms, and children with hypoglycemia have different clinical manifestations depending on the degree of hypoglycemia. The clinical manifestations of the same hypoglycemia level are also significantly different. A few symptomatic patients can be clinically manifested as low response, hyperhidrosis, paleness, cyanosis, difficulty feeding, drowsiness, apnea, bruising, abnormal crying, tremors, tremors, and even convulsions.

Newborn hypoglycemia

Blood glucose measurement

High-risk children should monitor blood glucose within 1 hour after birth, and then check again every 1 to 2 hours until the blood glucose concentration is stable.

2. Persistent hypoglycemia

Blood insulin, glucagon, T ₄ , TSH, growth hormone, cortisol, blood, urine amino acids, and organic acids should be selected as appropriate.

3. Hyperinsulinemia

Can be used for B-ultrasound or CT examination of the pancreas. Corresponding examination can be done when suspected glycogen accumulation disease.

Neonatal hypoglycemia diagnosis

Medical history

Maternal diabetes, pregnancy-induced hypertension, neonatal erythrocytosis, neonatal blood group incompatibility hemolysis, perinatal asphyxia, severe infection, scleredema, neonatal respiratory distress syndrome, etc., especially premature infants, infants younger than gestational age, and Neonatal hypoglycemia may occur in newborns who are underfed early in life.

2. Clinical manifestations

Patients with atypical clinical manifestations, symptoms improving after glucose infusion, or neurological symptoms and signs that are difficult to explain, should consider neonatal hypoglycemia.

3. Blood glucose measurement

Postnatal blood glucose monitoring is the main method for early detection of hypoglycemia in newborns. In particular, children at risk for hypoglycemia in the newborn should monitor blood glucose within 1 hour after birth.

Neonatal hypoglycemia treatment

Because the threshold of hypoglycemia that causes brain damage cannot be determined, those with or without symptoms should be treated promptly.

1. Asymptomatic hypoglycemia and able to eat

It can be eaten first, and blood glucose is closely monitored. If the hypoglycemia cannot be corrected, glucose can be infused intravenously.

2. Symptomatic hypoglycemia

Intravenous glucose is needed, and blood glucose is closely monitored. Those with persistent refractory hypoglycemia can add hydrocortisone or oral prednisone (prednisone). Gradually decrease after normal blood sugar. Very low weight premature infants have poor tolerance to glucose, and care should be taken when infusion of glucose.

3. Persistent hypoglycemia

Increase glucose infusion rate. Glucagon can also be injected intravenously. Diazoxide can be used for hyperinsulinemia. Insulin hyperplasia requires subtotal resection of the pancreas. Children with congenital metabolic defects are given special diet therapy.