PE19.10 | Neonatal Hypoglycemia — Summary & Reflection

KEY TAKEAWAYS

Neonatal hypoglycemia is defined as blood glucose <45 mg/dL and affects at-risk groups including IDMs, preterm, SGA neonates, and those with asphyxia or polycythaemia. The pathophysiology involves decreased substrate (preterm/SGA), hyperinsulinism (IDM, Beckwith-Wiedemann), or counter-regulatory failure (sepsis, asphyxia). Clinically, it ranges from asymptomatic (detected only by screening) to jitteriness, apnoea, seizures, and coma. Management is stepwise: enteral feeds for mild asymptomatic cases, 10% dextrose 2 mL/kg IV bolus (NEVER 50% dextrose) followed by GIR 6–8 mg/kg/min for symptomatic or severe cases, and escalation to diazoxide or octreotide for hyperinsulinism-driven persistent hypoglycemia. Prevention rests on identifying at-risk neonates, early breastfeeding, kangaroo mother care, and maintaining thermal neutrality.

REFLECT

Return to the opening scenario: a preterm IDM, 36 weeks, glucose 32 mg/dL, jittery. The intern reached for 50% dextrose. Now that you understand neonatal glucose physiology, the dangers of hyperosmolar dextrose, and the weight-based mini-bolus regimen, what would you do differently? Reflect on what prior knowledge (adult hypoglycemia management) created the wrong reflex, and how the neonatal physiology (hyperinsulinism from IDM, lack of rebound compensation, vascular fragility) demands a fundamentally different approach. How will you ensure you remember '10% dextrose 2 mL/kg, never 50%' the next time you face a hypoglycemic neonate?