Neonatal Hypoglycemia

Neonatal Hypoglycemia - Neonatal Hypoglycemia: Neonatal...

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Unformatted text preview: Neonatal Hypoglycemia: Neonatal Hypoglycemia: Evidences and Practice Evidences and Practice Prof. Pushpa Raj Sharma Department of Child Health Inability to breast feed and weight <2500 g were independently associated with hypoglycaemia. Mortality was 45.2% compared to 19.6% in normoglycaemic neonates (p < 0.001). Osier FH, Berkley JA, Ross A, Sanderson F, Mohammed S, Newton CR. Abnormal blood glucose concentrations on admission to a rural Kenyan district hospital: prevalence and outcome. Arch Dis Child. 2003 Jul;88(7):621-5. 41% newborn infants had mild (less than 2.6 mmol/l) and 11% had moderate hypoglycaemia: Hospital based study. Pal DK, Manandhar DS, Rajbhandari S, Land JM, Patel N, de L Costello AM. Arch Dis Child Fetal Neonatal Ed. 2000 Jan;82(1):F46-51. Why This Topic is Important? Why This Topic is Important? Koivisto M, Blaco-Sequeiros M, Krause U. Neonatal Koivisto M, Blaco-Sequeiros M, Krause U. Neonatal symptomatic hypoglycaemia: a follow-up study of 151 symptomatic hypoglycaemia: a follow-up study of 151 children. Dev Med. Child Neurol 1972; 14:603-14 children. Dev Med. Child Neurol 1972; 14:603-14 Their conclusions? TIME is most important factor affecting onset of sx and SYMPTOMATIC hypoglycemia with convulsions has poor prognosis for permanent CNS damage, while asymptomatic hypoglycemia without convulsions appears to have no influence on CNS pathology Long term neurological outcomes Lucus A, Morley R, Cole TJ. Adverse neurodevelopmental outcome of moderate neonatal hypoglycemia. British Medical Journal 1988; 297:1304-1308 661 preterm infants (BW <1850 g) surviving >48hrs Weekly glucose level taken; reagent strips q6h for first 48-72 hours (if <1.5 or 2 low values below 2.5 blood test) Treated by feeds/iv or bolus if less than 1 mmol/l or sx At 18 months 92% assessed with Bayley motor and development scale Results examined by statistical adjustment for differences between infants with and without hypoglycemia Lucus A, Morley R, Cole TJ. Lucus A, Morley R, Cole TJ. Their findings? <2.6 on 3 to 30 separate days associated with reductions in Bayley motor ad mental development scores even after adjusting for confounding factors <2.6 on 5 or more consecutive days increased risk (3.5 fold) of CP Kinnala et al. Cerebral magnetic resonance Kinnala et al. Cerebral magnetic resonance imaging and ultrasonography findings after imaging and ultrasonography findings after neonatal hypoglycemia. Pediatrics 103; 1999 neonatal hypoglycemia. Pediatrics 103; 1999 Investigated neuroradiologic changes in the brains of infants after transient neonatal hypoglycemia via MRI and U/S Defn of hypoglycemia: <2.5 mM WITH symptoms Treatment included feeds, IV, hydrocortisone MRI and US at fullterm and at 2m in 18 symptomatic fullterms (6 babies with SGA, 2 infants of diabetic mom) without any other pathology and 19 term controls Kinnala et al. Cerebral magnetic resonance Kinnala et al. Cerebral magnetic resonance Kinnala et al....
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Neonatal Hypoglycemia - Neonatal Hypoglycemia: Neonatal...

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