Glucose disappearance in infants of diabetic mothers. III. Relationship of spontaneous glucose disappearance to glucose tolerance,neonatal hypoglycemia and lowest blood glucose

Spontaneous glucose disappearance in the first 90 min of life and glucose disappearance following an intravenous injection of 1 g/kg dextrose were measured in 23 infants of insulin-dependent diabetic mothers. Spontaneous disappearance was log-linear in 12/23 infants, providing for calculation of an endogenous K_t which correlated significantly (P < 0.01) with the exogenous Kt determined after the dextrose injection, r = 0.74.Hypoglycemia <20 mg/dl occurred in 4/23 infants, and was identified during the spontaneous glucose disappearance (3 infants) and/or predicted by an endogenous K_t > 3.0%/min (2 infants). There was also a significant inverse correlation (P < 0.01) of the lowest blood glucose obtained within the first 24 h of life with the endogenous K_t, r = 0.61. There was no correlation of the endogenous or exogenous Kt, lowest blood glucose or hypoglycemia with White's classification of the maternal diabetes, diabetic control during pregnancy, the maternal blood glucose at delivery or the cord blood glucose.These data indicate that determination of spontaneous glucose disappearance within the first 90 min of life is useful in identifying infants of diabetic mothers with hypoglycemia or those who will subsequently develop hypoglycemia.     

Prediction of neonatal hypoglycemia in infants of diabetic mothers by glucose disappearance in the first hour of life

Whole blood glucose determinations were obtained in the first hour of life in 44 infants of diabetic mothers in order to predict the occurrence of subsequent hypoglycemia by means of the calculated glucose disappearance rate. Hypoglycemia (whole blood glucose < 20 mg/dl) occurred in 10 infants with linear glucose disappearance of whom 9 had a glucose disappearance rate ? 3.0% per min (90% sensitivity). Nine of 11 infants with glucose disappearance rates ? 3.0% per min had hypoglycemia (82% specificity). This relatively simple procedure offers an accurate method for prediction of neonatal hypoglycemia due to reactive hyperinsulinemia in infants of diabetic mothers.     

NEONATAL HYPOGLYCEMIA II. A Clinical Study of 44 Idiopathic Cases with Special Reference to Corticosteroid Treatment

Forty-four newborn infants with significant hypoglycemia, i. e. with two or more true blood glucose values of 20 mg/100 ml or less, have been studied. Two thirds of the patients were males, and a similar proportion had low birth weight for gestation, mostly associated with maternal toxemia. Hypoglycemia was diagnosed during the first day of life in 34 cases. Only three infants were asymptomatic, whereas the others exhibited various nonspecific symptoms, which generally were more severe in patients aged two or three days. A therapeutic test with glucose was positive in only 20 infants, and mostly negative before 24 hours of age. The hypoglycemia was transient in all cases. Mental retardation with spasticity and infantile spasms has developed in four infants by the age of six months, and one of them died at the age of eight months. The others appear normal after 4–26 months of observation. A significant effect of hydrocortisone in shortening the duration of hypoglycemia was demonstrated. On the basis of experience with the patients reported, it is suggested that all infants with significant hypoglycemia should be efficiently treated, regardless of symptomatology.     

METABOLIC OBSERVATIONS IN INFANTS OF STRICTLY CONTROLLED DIABETIC MOTHERS

Abstract. Thirty-five infants of strictly controlled diabetic mothers (IDM), 12 infants of gestational diabetic mothers (IGDM) and 29 control infants were studied to assess the influence of maternal blood glucose level during pregnancy on infant metabolic measurements. At 2 hours after birth the disapperance rate k_t of intravenously injected glucose was determined. Plasma concentration of glucose, insulin, FFA, glycerol and β-hydroxybutyrate were followed in umbilical arterial blood. The 2 hour mean k_t value of IDMs (1.27) was higher (p<0.05) than in IGDMs (1.14) and controls (0.80), but the group mean values were no different at 3 to 5 days although the k_t values were higher. In 10 IDms, k_t values were determined both at 2 hours (1.24) and at 3 days (1.39) without significant differences. Pretest FFA but not glycerol values correlated inversely to k_t values in IDMs and IGDMs. A late insulin peak at 60 min was found in both controls and IGDMs. Insulin responses were unrelated to k_t values. No relation was found between pregnancy glucose value (5 daily determinations during 4 and 2 weeks prior to delivery in DM and GDM respectively) or maternal glucose at delivery and k_t values of IDMs and IGDMs. According to the FFA and glycerol values at 2 hours after birth, 3 sub-groups of IDMs and IGDMs were arbitrarily formed. IDMs and IGDMs of group 1 had glucose, k_ts, FFA, glycerol and β-hydroxybutyrate values no different from controls, whereas sub-groups 2 and 3 showed increasing metabolic deviations. Clinical data and pregnancy glucose levels could not separate the 3 sub-groups. However, the day-to-day variation in maternal glucose was greater in sub-group 3. Mean values of daily maternal blood glucose differences at 10 o'clock correlated to 2-hour k_ts in IDMs. We conclude that strict metabolic control during pregnancy will normalize metabolic adjustment of the infant, thus supporting the maternal hyperglycemia-fetal hyper-insulinism theory.     

Natural progress of blood glucose in full-term low-grade low-birthweight infants

BACKGROUND: Although various authors have suggested the risk of hypoglycemia in practical medicine for low-birthweight infants is exaggerated, convincing evidence using recent definitions of hypoglycemia is not documented. METHODS: To evaluate the risk of hypoglycemia in low grade low-birthweight infants (LGLBWI) (2100 g < birthweight < 2500 g) whose only abnormality is low-birthweight, whole blood glucose (BGw) was measured five times (0, 0.5, 1, and 4 h after birth and just before the first bottle feeding) in 49 LGLBWI and 38 normal birthweight infants. RESULTS: Whole blood glucose was not lower in LGLBWI with a gestational age of 38-40 weeks (GT38LGLBWI) than in normal birthweight individuals with a gestational age of 38-40 weeks at each of the five measuring times. No case of GT38LGLBWI, not even in small for gestational age infants, required treatment for hypoglycemia. The BGw was significantly lower in 37-week gestational age LGLBWI than in GT38LGLBWI at 0.5 h and 1 h after birth (P < 0.05). However, in all cases with low BGw value (below 30 mg/dL at 1 h after birth), BGw value increased naturally to the normal level 1.5 h after birth. No symptoms of hypoglycemia were observed. CONCLUSIONS: In the care of hypoglycemia in LGLBWI, attention should be paid first to gestational age, namely, tendency to prematurity. In this study, however, no hypoglycemia that required treatment was found among full-term normal LGLBWI, even those who were small for gestational age. Frequent blood glucose measurement for those infants is therefore unnecessary.     

Incidence of hypoglycemia in newborns at risk and an audit of the 2011 American academy of pediatrics guideline for hypoglycemia

Background

Hypoglycemia is low blood glucose level that may negatively affect neurological and developmental prognosis. The American Academy of Pediatrics (AAP), Committee on Fetus and Newborn defined the safe glucose concentrations in the 2011 guideline for newborns at risk for hypoglycemia. This study aimed to investigate the incidence and associated risk factors for hypoglycemia in newborn infants having risk and to assess compliance with the AAP guideline.

NEONATAL HYPOGLYCEMIA I. Occurrence of Hypoglycemia in Patients with Various Neonatal Disorders

Two or more serial blood glucose determinations were performed before the age of five days in 964 neonates treated in the Children's Hospital. Two or more values of 20 mg/100 ml or less, considered to indicate significant hypoglycemia, were observed in 55 infants, or 5.7% of those studied. The incidence of significant hypoglycemia was 20% in dysmature infants, 16% in infants of diabetic mothers and 15% in critically ill infants dying within ten days of birth. No other important predisposing factors were detected. A screening procedure for the early diagnosis of neonatal hypoglycemia is described.     

Glycemic variability in preterm infants receiving intermittent gastric tube feeding: Report of three cases

Late‐onset hypoglycemia (day 12–16, blood glucose <50 mg/dL) was detected in three preterm infants (birthweight 998–1780 g; gestational age 27–30 weeks) by routine screening. All infants showed high serum insulin levels and extremely low ketone levels at the time of hypoglycemia. Continuous glucose monitoring was conducted at 31–34 weeks' postconceptual age when the infants were receiving intermittent gastric tube feeding with no intravenous glucose infusion. The continuous glucose monitoring results showed characteristic postprandial glucose increases and subsequent sharp deceases along with many hyper‐ and hypoglycemic events. This fluctuating pattern disappeared at 38–40 weeks' postconceptual age. These observations suggest that prolonged insulin oversecretion may be associated with early aggressive intravenous nutrition, and that large glycemic variability is a common feature of tube‐fed preterm infants that can be explained by immature glucose homeostasis.     

低血糖症患儿胰高血糖素水平的研究

目的 分析不同病因低血糖症患儿胰高血糖素的分泌能力及低血糖发生时的反应能力.方法 收集首都儿科研究所附属儿童医院内分泌科2020年3月至2021年3月收治的低血糖症患儿资料,对其数据进行分析.其中先天性高胰岛素血症11例,特发性酮症性低血糖30例,对照组30例(行胰岛素诱发低血糖试验的特发性矮小患儿);测定其低血糖发作...     

新生儿低血糖的诊断与治疗

新生儿低血糖是一种常见的临床代谢问题。对新生儿低血糖的定义和临床管理一直存在较多争议。主要有三方面的原因:出生后新生儿血糖水平存在生理性下降和恢复的过程;存在无症状性低血糖新生儿;以及血糖水平与神经系统远期预后的关系尚未明了。文章就有关新生儿低血糖的病因、定义和临床管理等内容做一介绍。     

新生儿糖代谢紊乱的临床研究

目的分析新生儿糖代谢紊乱的相关因素,探讨其预防和治疗措施。方法住院新生儿1783例进行血糖监测。所有息儿监测至2次空腹血糖正常为止。计数资料采用X2检验。结果发生糖代谢紊乱295例,其中低血糖症176例,高血糖症52例,二者兼有67例。血糖异常与胎龄呈显著负相关(P=0.001);与出生体质量呈显著负相关(P<0.01);小于胎龄儿(SGA)易发生糖代谢紊乱;轻度窒息组血糖紊乱以低血糖症为主,重度窒息组血糖紊乱以高血糖症居多(P<0.01);血糖恢复时间与窒息程度呈显著正相关(P<0.01);血糖异常与感染程度星显著正相关(P=0.019);糖尿病母亲婴儿易患低血糖症。结论对高危儿应尽早进行血糖监测,对血糖异常者及时处理,以减少或避免后遗症发生。     

Newborn hypoglycemia.

Neonatal hypoglycemia is a common problem encountered by both term and preterm infants. It can be either symptomatic or asymptomatic. Prolonged hypoglycemia may result in permanent neurologic impairment and death. Definitions of hypoglycemia vary and remain controversial. Underlying causes of hypoglycemia include (a) inadequate glucose production; (b) increased glucose utilization; (c) abnormalities of endocrine regulation; and (d) other causes. Nurse practitioners must be aware of infants at risk for hypoglycemia so they can provide appropriate interventions. In this article the clinical characteristics of hypoglycemia are reviewed, various causes for hypoglycemia are identified, and an infant with prolonged hypoglycemia is described. In addition, the role of the nurse practitioner in the care and management of these infants is addressed.     

METABOLIC EVENTS IN INFANTS OF DIABETIC MOTHERS DURING FIRST 24 HOURS AFTER BIRTH I.

ABSTRACT. Changes in plasma glucose, nonantibody-bound insulin and glucagon concentrations were studied in 32 newborn infants of diabetic mothers (IDM) during the first 24 hours after birth. Ten infants were born to White class A mothers and 22 to class B-F mothers. The infants were kept fasting during the investigative period and blood was sampled from an umbilical artery catheter. At birth, plasma glucose and glucagon levels were similar in the class A and B-F infants, whereas nonantibody-bound insulin levels were approximately 15-fold higher in the class B-F infants than in the class A infants (p<0.001). After birth, plasma glucose fell in all infants, the nadir being reached at two hours (p<0.01). Plasma glucose fell by approximately 35 % in the class A infants and 63 % in the class B-F infants (p<0.01). Eight IDM had asymptomatic hypoglycemia (plasma glucose <1.9 mmol/l) and four of these infants had glucose levels below 1.7 mmol/l and were withdrawn from further study. In the remaining four hypoglycemic IDM, plasma glucose was about 1.6-fold higher (p<0.01) and insulin about 11-fold higher (p<0.001) at birth compared to the 24 normoglycemic IDM. The hypoglycemia was attended by unchanged insulin levels in the class A infants, whereas insulin fell in the class B-F infant (p<0.01). However, during the whole investigative period, plasma insulin of the class B-F infants was higher than that of the class A infants (p<0.01). After birth, plasma glucagon increased slowly in all IDM and peak values were reached after 12 hours in the class A infants (p<0.05) and 24 hours in the class B-F infants (p<0.01). Only those infants who became hypoglycemic after birth exhibited a significant increment in plasma glucagon from 0-2 hours (p<0.05). These results suggest that neonatal hypoglycemia of IDM results from high plasma levels of nonantibody-bound insulin together with a very retarded increment in plasma glucagon levels. The degree of neonatal hypoglycemia and hyperinsulinemia of an individual IDM seems to be positively correlated to the severity of the diabetes of the mother.     

EFFECT OF GLUCAGON ON BLOOD GLUCOSE HOMEOSTASIS IN INFANTS OF DIABETIC MOTHERS

ABSTRACT: Wu, P. Y. K., Modanlou, H. and Karelitz, M. (Department of Pediatrics, University of Southern California School of Medicine, Los Angeles County-University of Southern California Medical Center, Los Angeles, USA). Effect of glucagon on blood glucose homeostasis in infants of diabetic mothers. Acta Paediatr Scand, 64:441, 1975.–Thirty infants of diabetic mothers (IDM) were randomly selected and divided into 3 groups of 10 babies each. Group A were used as controls. Group B received glucagon 300Uµg/kg i.m. and Group C received glucagon 300µg/kg i.v. at birth. Hypoglycemia developed in 6 infants in Group A and 4 infants in Group B. None of the infants in Group C had hypoglycemia. Mean blood glucose was higher in Group C in the first 3 hours than Group A, and higher in Group B in the first 1/2-1 hour. I.v. glucagon, 300µg/kg when given in the first IS minutes after birth prevented hypoglycemia in IDM in the first hours of life.     

糖尿病母亲婴儿低血糖发生情况及其与脑损伤的关系

目的探讨糖尿病母亲婴儿（IDMS）低血糖的发生情况及其与脑损伤的关系。方法分析86例IDMS低血糖的发生情况、母亲孕期血糖控制与低血糖持续时间的关系。分析其脑损伤发生及严重程度与低血糖持续时间、并其他疾病和症状性低血糖的关系。结果短暂性低血糖75例（87.2%）,反复发作性低血糖11例（12.8%）。母亲孕期血糖反复发作性低血糖发生率控制不满意组为19.4%,满意组为8%。反复发作性低血糖组脑损伤总发生率及重度脑损伤发生率高于短暂性低血糖组,并其他疾病组48.5%和无临床症状组57.4%,均有显著性差异（Pa〈0.05）。结论低血糖的持续时间与母亲妊娠期血糖控制情况及脑损伤发生、严重程度有关;低血糖并其他疾病会加重脑损伤,症状性低血糖时常存在严重脑损伤。     

新生儿低血糖脑损伤临床特征与脑电图监测

目的探讨新生儿低血糖脑损伤(HBD)时的脑电图(EEG)改变与临床预后关系,为HBD的诊断及预防提供依据。方法监测住院新生儿血糖并描记入院后24～72 h的EEG,低血糖新生儿于入院后2周再次EEG检查。分析比较低血糖新生儿与正常血糖新生儿,以及无症状性与症状性低血糖患儿EEG的异常率以及预后。结果入组100例新生儿,其中低血糖组52例,正常血糖组48例;低血糖组新生儿中症状性低血糖25例,无症状性低血糖27例。EEG异常率低血糖组新生儿73.1%(38/52),正常血糖组12.5%(6/48),两者差异有统计学意义(χ2=37.17,P<0.05)。低血糖组新生儿中,症状性低血糖组EEG异常率96%(24/25),无症状性低血糖组51.9%(14/27),两者差异有统计学意义(χ2=10.7,P<0.05)。新生儿血糖越低、持续时间越长,则EEG异常越严重。EEG中重度异常新生儿,大多遗留认知障碍、癫疒间、脑瘫等后遗症。结论新生儿HBD与低血糖的严重程度及持续时间密切相关。EEG能客观、直接地反映脑细胞的功能状态及损害程度,有助于早期评估脑损伤的程度及预后。     

Preventive management of hypoglycemia in very low-birthweight infants following indomethacin therapy for patent ductus arteriosus

BACKGROUND: To evaluate the effects of an increase in glucose infusion rate of 2 mg/kg per min from the basal infusion rate on the prevention of hypoglycemia in very low-birthweight (VLBW) infants, following indomethacin therapy for patent ductus arteriosus (PDA). METHODS: Forty VLBW infants with PDA were given indomethacin 0.2 mg/kg intravenously up to three doses. In 15 of the 40 infants (supplemented group: between April 1995 and March 1996) the glucose infusion rate was increased in 2 mg/kg per min increments from the basal rate just before the initial indomethacin administration, compared with 25 historical control infants who received a fixed glucose infusion rate during the first 12 h after the initial dose. We evaluated the changes in blood glucose levels and glucose infusion rates in both groups. RESULTS: In the control group 11 of 25 (44%) infants had a blood glucose value below 40 mg/dL between 12 and 60 h (mean 32.7 h). In contrast only two out of 15 infants in the supplemented group reached the glucose level below 40 mg/dL between 72 and 96 h but both two were light-for-dates infants (defined as birthweight below the 10th percentile for gestational age on the standard intrauterine growth curve). Blood glucose values in the supplemented group were significantly higher than those in the control group between 12 and 96 h. However, glucose infusion rates were similar before and between 72 and 96 h. CONCLUSIONS: This retrospective study shows that an increase in glucose infusion rate of 2 mg/kg per min, in addition to the pre-existing stable maintenance glucose intake, might prevent against the occurrence of unexpected hypoglycemia in VLBW infants following indomethacin therapy.     

GROWTH HORMONE SECRETION IN PROTEIN ENERGY MALNUTRITION

ABSTRACT. Günöz, H., Neyzi, O., Sencer, E., Molvalilar, S. and Argun, A. (Departments of Pediatrics and Internal Medicine, Istanbul Faculty of Medicine, University of Istanbul, Turkey). Growth hormone secretion in protein energy malnutrition. Acta Paediatr Scand, 70: 521,.–Plasma hGH levels were assessed in 15 infants with protein energy malnutrition following insulin induced hypoglycemia, arginine and L-Dopa provocation tests and intravenous glucose tolerance test. Fasting hGH levels were high in 85.7 % of the cases. An adequate hGH response to stimulation was obtained in only 42.8 % of the cases with insulin induced hypoglycemia; in 52.5 % with arginine; in 30.8 % with L-Dopa. Response to at least one type of provocation was obtained in all 5 cases to which all three tests were applied. Exaggerated or delayed response to provocative stimuli was also encountered in a number of the cases. Intravenous glucose tolerance test did not lead to suppression in hGH secretion or to increase in insulin secretion in these subjects. The results indicate that marasmic protein energy malnutrition may lead to defects in the hGH secretory function of the hypothalamopituitary axis.     

Glucose metabolism disorder in obese children assessed by continuous glucose monitoring system

Background  Continuous glucose monitoring system (CGMS) can measure glucose levels at 5-minute intervals over a few days, and may be used to detect hypoglycemia, guide insulin therapy, and control glucose levels. This study was undertaken to assess the glucose metabolism disorder by CGMS in obese children. Methods  Eighty-four obese children were studied. Interstitial fluid (ISF) glucose levels were measured by CGMS for 24 hours covering the time for oral glucose tolerance test (OGTT). Impaired glucose tolerance (IGT), impaired fasting glucose (IFG), type 2 diabetic mellitus (T2DM) and hypoglycemia were assessed by CGMS. Results  Five children failed to complete CGMS test. The glucose levels in ISF measured by CGMS were highly correlated with those in capillary samples (r=0.775, P<0.001). However, the correlation between ISF and capillary glucose levels was lower during the first hour than that in the later time period (r=0.722 vs r=0.830), and the ISF glucose levels in 69.62% of children were higher than baseline levels in the initial 1–3 hours. In 79 obese children who finished the CGMS, 2 children had IFG, 2 had IGT, 3 had IFG + IGT, and 2 had T2DM. Nocturnal hypoglycemia was noted during the overnight fasting in 11 children (13.92%). Conclusions  Our data suggest that glucose metabolism disorder including hyperglycemia and hypoglycemia is very common in obese children. Further studies are required to improve the precision of the CGMS in children.     

Glucose disappearance in infants of diabetic mothers I. Relationship to maternal glucose tolerance and insulin production

Glucose disappearance and insulin response were determined in mother--infant pairs of normal, gestational diabetic and diabetic pregnancies following an intravenous glucose load. Mothers were studied in the third trimester of pregnancy and at least 6 wk postpartum. Significant differences were present in glucose disappearance and insulin response in both gestational diabetic and diabetic mothers during pregnancy compared with the control group. Infants were studied within 4 h of birth while fasting, and glucose and insulin levels followed through the first 3 days of life. Neonatal hypoglycemia did not occur and glucose disappearance (KT) was not different among the three groups. There was no correlation between maternal glucose tolerance or insulin production and that of their infants. The only distinguishing factor among the infants was higher insulin production in infants of diabetic mothers during the 60-min intravenous glucose tolerance test which persisted up to 4 h following the infusion. It is concluded that factors other than the degree of maternal glucose tolerance are responsible for the development of neonatal hypoglycemia in infants of diabetic mothers, most notably control of maternal diabetes, the amount of glucose infused immediately before delivery and neonatal glucose production.