Abstract
Introduction: Neonatal hypoglycemia is common and a preventable cause of brain damage. The goal of management is to prevent or minimize brain injury. The purpose of this mini review is to summarize recent advances and current thinking around clinical aspects of transient neonatal hypoglycemia.Results: The groups of babies at highest risk of hypoglycemia are well defined. However, the optimal frequency and duration of screening for hypoglycemia, as well as the threshold at which treatment would prevent brain injury, remains uncertain. Continuous interstitial glucose monitoring in a research setting provides useful information about glycemic control, including the duration, frequency, and severity of hypoglycemia. However, it remains unknown whether continuous monitoring is associated with clinical benefits or harms. Oral dextrose gel is increasingly being recommended as a first-line treatment for neonatal hypoglycemia. There is some evidence that even transient and clinically undetected episodes of neonatal hypoglycemia are associated with adverse sequelae, suggesting that prophylaxis should also be considered. Mild transient hypoglycemia is not associated with neurodevelopmental impairment at preschool ages, but is associated with low visual motor and executive function, and with neurodevelopmental impairment and poor literacy and mathematics achievement in later childhood.Conclusion: Our current management of neonatal hypoglycemia lacks a reliable evidence base. Randomized trials are required to assess the effects of different prophylactic and treatment strategies, but need to be adequately powered to assess outcomes at least to school age.
Highlights
Neonatal hypoglycemia is common and a preventable cause of brain damage
Neonatal hypoglycemia is a preventable cause of brain injury
The purpose of this review is to summarize the recent advances in clinical aspects of transient neonatal hypoglycemia
Summary
The goal of management is to prevent or minimize brain injury The purpose of this mini review is to summarize recent advances and current thinking around clinical aspects of transient neonatal hypoglycemia. Neonatal hypoglycemia is a preventable cause of brain injury It is common, affecting 5–15% of all babies [1] and approximately half of at-risk babies [2] and is associated with a range of adverse sequelae [3, 4]. The purpose of this review is to summarize the recent advances in clinical aspects of transient neonatal hypoglycemia. Glucose is the primary metabolic fuel for the fetus. The fetus receives glucose from its mother through carrier-mediated diffusion down a concentration gradient across the placenta [5, 6]. The function of insulin in the fetus is as a growth hormone rather than to regulate glucose concentrations, and secretion of insulin occurs at a lower glucose concentration in the fetus than in postnatal life [8]
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