Hypoglycemia

Hypoglycemia is relatively common in the newborn infant. In the healthy term newborn, low blood glucose concentrations are often encountered and usually reflect normal metabolic adaptation to extrauterine life. However, with prolonged or recurrent hypoglycemia, the newborn risks neurologic sequelae (Fluge, 1975).

The blood glucose level that defines clinically significant hypoglycemia is controversial. Cornblath and associates (2000) believe that a plasma glucose concentration less than 36 mg/dL warrants close monitoring. If the plasma glucose remains below this level or does not rise after a feeding, intervention is recommended. Liver glycogen stores are rapidly depleted within a few hours after birth. In the newborn, serum glucose levels decline after birth until 1 to 3 hours of age, when levels tend to begin spontaneously rising.

Serum glucose levels are higher than whole-blood glucose levels. Whole-blood measurements of glucose (bedside testing using finger or heel stick) often underestimate the plasma glucose concentration by as much as 10% to 15%.

Infants who are known to be at higher risk for hypogly-cemia should have blood glucose concentrations routinely measured. Infants at high risk for hypoglycemia include infants of diabetic mothers (IDMs), small-for-gestational-age (SGA) newborns, infants with a history of perinatal hypoxia or ischemia, and infants who become hypothermic from cold stress. Infants who become septic are also at higher risk for hypoglycemia. For infants at risk, glucose monitoring should be initiated as soon as possible after birth, and within the first hour of life in IDMs. Healthy term newborns delivered after a normal pregnancy, with no known risk factors for hypogly-cemia and with no clinical signs of low blood sugar, do not need monitoring of blood glucose concentrations (Cornblath et al., 2000). Routine blood glucose monitoring of large-for-gestational-age (LGA) infants who have no additional risk factors is not necessary (de Rooy and Hawdon, 2002).

If the infant is asymptomatic and alert, low blood sugar can be treated by breastfeeding or by giving formula and repeating the serum glucose concentration after the feeding. If the infant is symptomatic, intravenous (IV) glucose is recommended. The exact concentration and amount of IV glucose to deliver depends on the amount of decrease in the serum glucose concentration. Guidelines for management can be found in the Harriet Lane Handbook (Robertson and Shilkofski, 2005).

Getting Back Into Shape After The Pregnancy

Getting Back Into Shape After The Pregnancy

Once your pregnancy is over and done with, your baby is happily in your arms, and youre headed back home from the hospital, youll begin to realize that things have only just begun. Over the next few days, weeks, and months, youre going to increasingly notice that your entire life has changed in more ways than you could ever imagine.

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