Neonatal hypoglycemia and hyperglycemia
Introduction
Introduction to neonatal hypoglycemia and hyperglycemia Neonatal hypoglycemia and hyperglycemia: disorders of glucose metabolism are extremely common in the neonatal period. Due to the difference between the method of collecting blood samples and detecting blood glucose, the definition of neonatal hypoglycemia is confusing. The hypoglycemia index determined by most scholars is: full blood glucose <1.67mmol/L (30mg/) within 3 days of full-term birth. Dl), <2.2 mmol/L (40 mg/dl) after 3 days; <1.1 mmol/L (20 mg/dl) within 3 days after birth, <2.2 mmol/L (40 mg/dl) after 1 week; current trend Whole blood glucose <2.2 mmol>7.0 mmol/L (125 mg/dl), or plasma sugar >8.12 to 8.40 mmol/L (145-150 mg/dl). basic knowledge The proportion of sickness: 0.00652% Susceptible population: newborn Mode of infection: non-infectious Complications: coma, children with cerebral palsy, mental retardation
Cause
Neonatal hypoglycemia and the cause of hyperglycemia
Insufficient storage of glycogen and fat (30%):
The storage of fetal liver glycogen mainly occurs in the last 4 to 8 weeks of gestational age. The differentiation of fetal brown fat begins from 26 to 30 weeks of gestational age and continues until 2 to 3 weeks after birth. On the one hand, low birth weight infants, including premature infants and small for gestational age (SGA) children, have less glycogen and fat storage, and on the other hand, the energy required for postnatal metabolism is relatively high, which is prone to hypoglycemia. There is data to confirm that the glycogen synthase activity of SGA children is low, so glycogen synthesis is less, and the amount of sugar required for metabolism of some important organs is relatively large. The brain needs to increase the glucose requirement and utilization rate of SGA children. The ratio of brain weight to liver weight increased from normal 3:1 to 7:1, and brain utilization of sugar was twice as high as that of liver.
Excessive consumption of sugar (25%):
Newborns with serious diseases such as asphyxia, RDS, and scleredema are prone to hypoglycemia. These stress states are often accompanied by increased metabolic rate, hypoxia, hypothermia, and reduced intake. Hypoxia can cause hypoglycemia. Hypoxia has different effects on glucose metabolism in term infants and premature infants. Hypoglycemia occurs in neonates with Apgar scores of 1-3, because full-term children use glucose in stress. Premature infants have poor ability to use glucose. Domestic scholars have confirmed that the incidence of hypoglycemia in neonates with cold or hypothermia is high, which is related to the ability of hypothermia to meet the need for thermoregulation. The rate of glucose metabolism increases during neonatal infection, and the average glucose consumption rate is about 3 times higher than that of normal children. The neonatal gluconeogenesis enzyme activity is low, and the infection aggravates the deficiency of the gluconeogenesis function, and the amino acid is not easily converted into glucose. Neonatal gluconeogenesis mainly relies on the release of glycerol from brown fat. When the infection is severe, the brown fat is depleted, and the source of gluconeogenesis is interrupted, thus lowering blood sugar. In addition, when the infection is reduced, the patient's intake is reduced, the digestion and absorption function is weakened, and hypoglycemia is also likely to occur.
Hyperinsulinemia (30%):
Temporary hyperinsulinemia is common in infants with diabetes in their mothers. Due to high blood sugar in pregnant women, fetal blood sugar also increases, and hypoglycemia occurs after the birth of glucose from the mother. Due to the destruction of red blood cells in the hemolytic disease of the fetus, the glutathione in the red blood cells can inhibit the action of insulin in the plasma, and can also cause hyperinsulinemia in the islet hyperplasia of the islet B cells of the fetus. Children with polycythemia can have hypoglycemia after transfusion of blood with citrate and glucose as maintenance fluid. Because of the high glucose concentration in the maintenance solution, insulin secretion is stimulated, and the insulin level is still high in the short time after transfusion. Persistent hyperinsulinemia includes islet cell adenomas, islet cell proliferative disorders, and Beckwith syndrome (characterized by large body, large tongue, umbilical hernia, and certain malformations with hyperinsulinemia).
Endocrine and metabolic diseases (5%):
In neonates with galactosemia, the amount of galactose in the blood increases and the glucose decreases accordingly. In children with glycogen storage disease, the glycogen decomposition is reduced, and the amount of glucose in the blood is low. In neonates with leucine allergy, leucine in breast milk increases insulin secretion. Other congenital dysfunctions such as the pituitary gland, thyroid gland or adrenal gland can also affect blood sugar levels.
Prevention
Neonatal hypoglycemia and hyperglycemia prevention
How to improve the monitoring of blood sugar should be paid attention to by clinicians, and prevention should be the main. Early diagnosis and timely treatment can reduce the incidence and reduce brain damage.
1. For neonates prone to hypoglycemia, blood glucose should be monitored at 3, 6, 9, 12, 24 hours after birth, and hypoglycemia or hyperglycemia should be discovered sooner or later.
2, for low birth weight infants, high-risk children can eat as soon as possible after birth, start feeding syrup or milk 2 to 4 hours after birth, can not be fed by oral or nasal feeding, intravenous infusion of glucose to maintain nutrition.
3, gastrointestinal nutrition, pay attention to supplement amino acids and fat milk when supplementing calories, glucose should not be too high.
4, for high-risk children, premature infants should control the rate of glucose infusion, not 8mg / (kg · min), and do blood glucose monitoring, such as increased should immediately reduce the input concentration and speed, can not stop infusion, to prevent reactive hypoglycemia .
5. The concentration of glucose used in neonatal asphyxia resuscitation is 5%.
Complication
Neonatal hypoglycemia and hyperglycemia complications Complications, coma, cerebral palsy, mental retardation
1, hypoglycemia can be accompanied by mental retardation, cerebral palsy, tremor, convulsions, coma and other neurological sequelae.
2, severe hyperglycemia can be complicated by intracranial hemorrhage, causing brain damage.
Symptom
Neonatal hypoglycemia and hyperglycemia symptoms Common symptoms Hypoglycemia erythrocytosis Diabetes coma convulsions Intracranial hemorrhage Defibrillation Sclerotic sclered hypoglycemic coma
History: history of maternal diabetes, history of pregnancy-induced hypertension, neonatal asphyxia, premature delivery, full-term small sample, severe infection, scleredema, history of hemolysis, polycythemia; parenteral nutrition or history of aminophylline Monitor blood sugar regularly.
1. Hypoglycemia: neonatal hypoglycemia symptoms are atypical or asymptomatic, a few symptoms appear, manifested as low response, weak crying, refusing milk and sucking, muscle tension is low, pale, hypothermia, irregular breathing, pause, Cyanosis, etc., severe cases of tremors, convulsions, coma, etc., the incidence of most of the 1-2 days after birth, combined with blood glucose monitoring can be used for diagnosis.
2. Hyperglycemia: early and mild can be asymptomatic, severe symptoms can be expressed as polydipsia, polyuria, weight loss, eye socket depression, dehydration, and even shock symptoms, and can present convulsions, intracranial hemorrhage.
Examine
Examination of neonatal hypoglycemia and hyperglycemia
Mainly do blood sugar testing to understand the changes in blood sugar.
Blood glucose monitoring method: clinically used paper method, micro blood glucose meter for heel capillary blood test for blood glucose and venous blood monitoring, requiring early monitoring, early admission, 1, 3, 6, 9, 12, 24h after birth At that time and regular monitoring, but the majority of grassroots hospitals unconditionally carry out blood glucose monitoring, Tianjin Children's Hospital proposed the use of electronic computers to discriminate the risk factors (day age, body weight, gestational age, infection and hypoxia) of internal hypoglycemia, establish discriminant Y=-0.18295X1-0.90382X2-0.0519X3+5.6895X4+5.10437X5. Using this formula, the newborns scored Y-33.80474 and were judged to be high-risk children with hypoglycemia. Precautions should be taken to reduce the incidence of blood glucose from 310. In the case of neonatal determination, the accuracy is high, and the false positive rate is 2.42%, which can be used for trial.
Diagnosis
Diagnosis of neonatal hypoglycemia and hyperglycemia
Diagnostic criteria
(1) Hypoglycemia: According to the diagnostic value of traditional hypoglycemia (for whole blood standard).
Ogata ES proposed plasma glucose <40mg/dl for hypoglycemia, plasma glucose should be 10% to 15% higher than whole blood (Avery GB. Neonatology 4ed. 1994: 572), which is more consistent in China, whole blood glucose < 2.22mmol / L (40mg / dl) is the diagnostic criteria for hypoglycemia.
(2) Whole blood glucose 7mmol / L (135mg / dl) diagnosed as hyperglycemia.
(3) When serum insulin level (U/L)/blood glucose (mmol/L)>0.3, it is an unsuitable increase in insulin levels.
Mainly between the high blood sugar and low blood sugar, blood glucose measurement can be identified.
