HYPOGLYCEMIA/ HYPERGLYCEMIA IN THE NEONATE What is the definition of a neonate? The first 30 days of an infants life or A premature infant that has not been discharged since being born

Hypoglycemia: What is it? Blood sugar <40-50 mg/dl Depends on reference Bedside testing Fairly accurate F/U with serum glucose Higher than bedside test Not accurate if not run quickly Delete text and place photo here. Click on “speaker” to hear more information on each slide.

HYPOGLYCEMIA Who is at risk? And why? o Infant of diabetic mother o Hyperinsulinemia o Premature infant o Decreased glycogen stores o SGA/LGA infant o Hyperinsulinemia o Stressed or Sick infant o Using their glucose quickly Signs & Symptoms: Jitteriness, Irritability, Hypotonia, Lethargy, Hypothermia, Respiratory distress, Seizures.. Or there may be NONE. Click on “speaker” to hear more information on each slide.

Management of Low Blood Sugar For the term baby in no sign of distress: Early feeding – usually with formula or breastfeeding Follow-up blood sugar 30 min to 1 hour after feeding Continue to monitor blood sugar according to hospital policy For a term baby in distress: Management will be with IV fluids or gavage feeding depending on symptoms For a preterm baby: IVF – D 10 W (initial fluids) IV Bolus of 2 ml/kg of D 10 W Click on “speaker” to hear more information on each slide.

Hyperglycemia: Blood sugar < 200 mg/dl Causes:  Stress  Will usually resolve with time  Prematurity  May need lower sugar concentration in IVF  May need insulin Click on “speaker” to hear more information on each slide.

Things to remember: HYPOGLYCEMIA: Blood sugar < 45 mg/dl At risk: IDM, SGA, LGA, Prematurity, Stress TX: early feedings, IVF, monitor closely HYPERGLYCEMIA: Blood sugar > 200 mg/dl Causes: stress, severe prematurity TX: usually self resolves; except in severe preemie DIABETES in the NEONATE is RARE EDUCATION/ PREVENTION: Identify at risk patients – type I, type II, and gestational diabetic moms Educate mom about potential risks to fetus/ newborn Educate mom on importance of maintaining good glucose control during pregnancy Early recognition of at risk infants Early feedings for at risk infants Ongoing communication with the family regarding infants status here.Delete text and place photo here. Click on “speaker” to hear more information on each slide.

One last important note: PAIN MANAGEMENT Heel stick = HURTS IV insertion = HURTS Babies feel pain! Babies remember pain! Baby a patient advocate and provide appropriate pain management! Swaddling, decreased light, sucrose pacifier, holding – to name a few. Click on “speaker” to hear more information on each slide. PAIN MANAGEMENT: Sucrose Pacifier Dim the lights Swaddle the baby