Transitional neonatal hypoglycemia

Abstract

The blood sugar levels of all newborn infants fall after birth from fetal levels and can stay low for several days. The critical level for an intervention to increase the blood sugar remains most contentious, as does the selection of infants for screening and the frequency of screening. Further, quite low blood sugars are relatively common and symptomatic hypoglycemia is uncommon. In this issue of The Journal, a committee of the Pediatric Endocrine Society reports a scholarly analysis of mechanisms causing this normal transitional neonatal hypoglycemia in infants. The low blood sugars are not associated with ketosis, and there is a low glucose threshold for suppression of insulin secondary to an immature pattern of pancreatic beta cell function. The resulting low blood sugar values can confound the identification of infants with persistent and genetic causes of low blood sugars over the first days after birth. Further, the newer technology of measuring continuous subcutaneous glucose with implanted electrodes demonstrates rapid changes in glucose in high-risk preterm or growth-restricted infants in asymptomatic infants for weeks. It seems that the more we know, the less secure the clinician is about how to approach the detection and treatment of hypoglycemia in asymptomatic newborns. This analysis by Stanley et al is a valuable contribution toward further understanding the problem.Article page 1520▶ The blood sugar levels of all newborn infants fall after birth from fetal levels and can stay low for several days. The critical level for an intervention to increase the blood sugar remains most contentious, as does the selection of infants for screening and the frequency of screening. Further, quite low blood sugars are relatively common and symptomatic hypoglycemia is uncommon. In this issue of The Journal, a committee of the Pediatric Endocrine Society reports a scholarly analysis of mechanisms causing this normal transitional neonatal hypoglycemia in infants. The low blood sugars are not associated with ketosis, and there is a low glucose threshold for suppression of insulin secondary to an immature pattern of pancreatic beta cell function. The resulting low blood sugar values can confound the identification of infants with persistent and genetic causes of low blood sugars over the first days after birth. Further, the newer technology of measuring continuous subcutaneous glucose with implanted electrodes demonstrates rapid changes in glucose in high-risk preterm or growth-restricted infants in asymptomatic infants for weeks. It seems that the more we know, the less secure the clinician is about how to approach the detection and treatment of hypoglycemia in asymptomatic newborns. This analysis by Stanley et al is a valuable contribution toward further understanding the problem. Article page 1520▶ Re-Evaluating “Transitional Neonatal Hypoglycemia”: Mechanism and Implications for ManagementThe Journal of PediatricsVol. 166Issue 6PreviewA Committee of the Pediatric Endocrine Society was recently formed to develop guidelines for evaluation and management of hypoglycemia in neonates, infants, and children. To aid in formulating recommendations for neonates, in this review, we analyzed available data on the brief period of hypoglycemia, which commonly is observed in normal newborns during the transition from fetal to extrauterine life, hereafter referred to as transitional neonatal hypoglycemia in normal newborns. The goal was to better understand the mechanism underlying this phenomenon in order to formulate recommendations for recognizing neonates requiring diagnosis and treatment during the first days of life for disorders causing severe and persistent hypoglycemia. Full-Text PDF