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31 - Hypo- and hyperglycemia and other carbohydrate metabolism disorders

Published online by Cambridge University Press:  10 December 2009

Patti J. Thureen
By
Jane E. McGowan
Edited by
William W. Hay
Patti J. Thureen
Affiliation:
University of Colorado at Denver and Health Sciences Center
Jane E. McGowan
Affiliation:
Division of Neonatology, The Johns Hopkins Hospital, Baltimore, MD
William W. Hay
Affiliation:
University of Colorado at Denver and Health Sciences Center
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Summary

Disorders of glucose homeostasis

The presence of neonatal hypoglycemia or hyperglycemia signals a failure of the normal transition from fetal to postnatal patterns of glucose homeostasis. Under normal conditions, glucose from maternal circulation is transported across the placenta via specific glucose transporters to be used by the fetus. The high fetal insulin : glucagon ratio suppresses glycogenolysis and gluconeogenesis and stimulates hepatic glycogen deposition during late gestation.

At delivery, glucose delivery to the infant stops abruptly. Until an exogenous supply of substrate is provided, the infant must rely on hepatic glucose production to meet metabolic needs. Both glycogenolysis and gluconeogenesis contribute to glucose homeostasis during the first few days of extrauterine life. However, hepatic glucose production via these two pathways requires availability of glycogen and gluconeogenic precursors, appropriate levels and activity of hepatic enzymes necessary for glycogenolysis and gluconeogenesis, and a normal endocrine response. The absence of any of these components may result in neonatal hypoglycemia or hyperglycemia.

Hypoglycemia

Incidence and clinical presentation

The reported incidence of neonatal hypoglycemia varies depending on the population studied, the method used for glucose measurement, and the definition of hypoglycemia used. In appropriate-for-gestational-age (AGA) term infants the incidence ranges from 5%–30%, but may be as high as 50% in preterm infants, and 70% in small-for-gestational-age (SGA) infants. Clinical signs of hypoglycemia are nonspecific and may include lethargy, jitteriness, poor feeding, seizures, and temperature disturbances. The frequency of observation of the most common findings is listed in Table 31.1.

Type
Chapter
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Neonatal Nutrition and Metabolism , pp. 454 - 465
Publisher: Cambridge University Press
Print publication year: 2006

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