HYPOGLYCAEMIA

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 HYPOGLYCAEMIA

This is a metabolic disorder in which the blood glucose level falls below 2.6 mmol/L. At term, the baby’s glucose level is almost equal to that of the mother but gradually drops within 3-4 hrs after birth. This is why the baby has to be fed within four hours of life. The baby’s maintain their energy requirements as long as they are kept warm.

This condition is common in infants of diabetic mothers. Due to excess glucose, the large babies (macrosomia). At birth the glucose level falls rapidly while insulin levels remain relatively high so the baby is at risk of hypoglycemia .this is why such babies are admitted to the NBU.

Prolonged hypoglycaemia can lead to mental retardation, permanent neurological damage anddeath due to respiratory and metabolic acidosis.

PREDISPOSING FACTORS

Ø Low birth weight

Ø Prematurity

Ø  Birth injuries

Ø Maternal diabetes mellitus

Ø  Asphyxia

Ø  Septicaemia

Ø  Respiratory distress syndrome

CLINICAL FEATURES

v Low blood glucose less than 2.6 mmol/L

v  Poor feeding

v High pitched cry

v Lethargy

v  Irritability

v  Hypotonic muscle activity

v  Hypothermia

v  Apnoea

 NURSING MAMAGEMENT

ü Give 10% dextrose infusion until normal glucose levels are achieved.

ü Encourage the mother to breastfeed the baby

ü  Feed through NGtube or cup and spoon expressed breast milk.

ü  If the hypoglycemia is severe, put up 10% dextrose infusion and give 65-85 mls/kg of body weight in 24hrs.

ü  Give bolus dose of 25% dextrose 2wmls/kg body weightiv slowly for 30 min.

ü  Closely monitor the glucose levels 1 hourly until the general condition is stable or normal levels have been achieved.

ü  Once the normal levels have been achieved, wean off the dextrose and observe closely for changes in the condition.

 PREVENTION

² Taking blood glucose levels at birth and introducing glucose feeds e.g. dextrose or breastfeeding within 1hr of life.

²  Prevent hypothermia.

²  Monitoring glucose level 2hrly for the first 6-8 hours.

²  Infants of diabetic mothers should be admitted into NBU and blood glucose level regularly checked.

COMPLICATION

l Hypothermia

l  Convulsions

l  Brain damage

l  Neonatal death as an outcome.

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