Contents Chapter Topic Page Neonatology Respiratory Cardiology

Key points:
A. Serial blood glucose should be routinely monitored in infants who have risk factors for
hypoglycaemia
B Bolus injections of large volumes of hypertonic glucose solutions should be
avoided - dangerous to neurological function and may be followed by a rebound
hypoglycaemia, cerebral oedema and is caustic to neonatal veins.
C Milk formula provide more energy/ml than 10% dextrose and supply important nonglucose
fuels, which have a glucose sparing role in neurological function.
(Energy content of formula milk is 2750 kJ/l while that of 10% D is 1600 kJ/l). It
promotes ketogenesis and gut maturation.
Breast-feeding should be encouraged as it is more ketogenic.
D. Milk feeds must not be discontinued or reduced when intravenous fluids are given
unless the child develops NEC or other causes of feeding intolerance. The
recommended practice is to feed the baby with as much milk as is tolerated and
to infuse glucose at a rate sufficient to prevent hypoglycaemia. The IV glucose is
then reduced slowly while milk feeds is maintained or increased. May need to
continue over a few days.
E. Ensure volume of intravenous fluid is appropriate for patient, taking into consideration
concomitant problems like cardiac failure, cerebral oedema and renal failure. If unable
to increase volume further, concentration of dextrose to be increased.
Glucose requirement (mg/kg/min) = % of dextrose x rate (ml/hr) x 0.167
------------------------------------------------------wt
(kg)
F. Plasma glucose is 13-18% higher than whole blood glucose. Arterial blood has higher
glucose concentration than venous blood. Capillary sampling can be unreliable in the
presence of poor peripheral circulation.
G. Requirement of >9mg/kg/min suggests hyperinsulinism. Truly hyperinsulinaemic babies
may require 15-20 mg/kg/min
References
Koh G Aynsley-Green A 1988a Neonatal hypoglycaemia- the controversy definition. Arch Dis
Childhood;63:1386-1398
Koh G Aynsley-Green A Tarbit A Etre J 1988b Neural dysfunction during hypoglycaemia. Arch Dis
Childhood;63:1353-1358
DK Pal et al 2000 Neonatal hypoglycaemia in Nepal. Prevalence and risk factors Arch Dis
Childhood;82:F46-52
AA M Moris et al 1996 Evaluation of fast for investigating hypoglycaemia or suspected metabolic disease
Arch Dis Childhood;75:115-119
Gomella, Cunningham ,Eyal and Zenk: Neonatalogy 4 th edition Lange