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PE19.10 | Neonatal Hypoglycemia — SDL Guide (Part 3)

Self-Assessment

Use the following questions to consolidate your understanding. Cover your notes, attempt each question, then review the explanation.

Q1. A 3.8 kg IDM is born by caesarean section. At 1 hour of life, pre-feed glucose is 41 mg/dL; the baby is awake and rooting actively. What is the most appropriate immediate management?
Answer: Initiate early breastfeeding and recheck glucose 30–60 min after the feed. An asymptomatic IDM with glucose 41 mg/dL (just below the 45 mg/dL threshold) who can feed should receive enteral glucose first. IV dextrose is not the first step for an asymptomatic, feeding-capable neonate at this level.

Q2. What is the correct dose and concentration of dextrose for emergency IV treatment of a 2.5 kg neonate with symptomatic hypoglycemia (glucose 28 mg/dL, seizure)?
Answer: 10% dextrose 2 mL/kg = 5 mL IV over 5 minutes (200 mg/kg glucose), followed immediately by a continuous infusion at GIR 6–8 mg/kg/min. This delivers a precise, safe osmotic load without rebound risk.

Q3. A 3-day-old neonate remains hypoglycemic on GIR 10 mg/kg/min. A critical sample shows insulin 18 mIU/L with plasma glucose 32 mg/dL. What does this confirm and what drug is used first?
Answer: Hyperinsulinism (insulin inappropriately elevated in the context of hypoglycemia). Diazoxide (5–15 mg/kg/day) is first-line medical therapy — it opens pancreatic KATP channels to suppress insulin secretion.

Q4. Why should neonates in cold environments have their blood glucose monitored more closely?
Answer: Cold stress activates non-shivering thermogenesis in brown adipose tissue, greatly increasing glucose consumption. Neonates cannot shiver and have limited glycogen reserves, so hypothermia rapidly accelerates glucose depletion — making glucose monitoring essential in all hypothermic neonates.