Recurrent Hypoglycemia in Infants

What Is Hypoglycemia?

Hypoglycemia is a clinical condition characterized by lower-than-normal blood sugar levels. Since sugar or glucose is the body's primary energy source, low blood sugar levels can cause several health issues. A fasting blood sugar level of 70 mg/dL, or lower should be regarded as a warning sign for hypoglycemia in many people. Severe hypoglycemia is a medical emergency and should be treated immediately. Some of the common causes of hypoglycemia include oral hypoglycemic drugs (diabetes medicines), the side effects of other drugs, alcoholism, critical systemic illness, insulin overproduction in the body, etc. Patients suffering from hypoglycemia may exhibit symptoms like tremors, shakiness, hunger, nausea, headache, fatigue, dizziness, numbness, etc.

What Is Recurrent Hypoglycemia in Infants?

Recurrent hypoglycemia in infants is a metabolic disorder seen in newborn babies. The condition is characterized by a plasma glucose level of less than 30 mg/dL during the first 24 hours of the baby’s life and less than 45 mg/dL afterward. Recurrent hypoglycemia can have severe long-term complications in the newborn’s life; therefore, it requires immediate medical treatment. In addition, recurrent hypoglycemia in infants can cause cardiovascular dysfunction, mental retardation, impaired development, delayed development, recurrent seizures, and personality disorders.

What Causes Recurrent Hypoglycemia in Infants?

Common causes of recurrent hypoglycemia in infants are:

• Poor maternal nutrition during pregnancy.

• Excessive insulin production due to uncontrolled diabetes in the mother.

• Hemolytic disease of the newborn may cause incompatibility in the mother and baby’s blood types.

• Congenital disabilities (birth defects).

• Birth asphyxia (lack of oxygen during birth).

• Hepatic (liver) diseases.

• Infections.

• Congenital hormonal deficiencies.

• Persistent hyperinsulinemia hypoglycemia of infancy (PHHI).

• Limited glycogen stores in the body.

• Asphyxia-perinatal stress (asphyxia means the inability to breathe that can cause unconsciousness or death).

What Are the Symptoms of Recurrent Hypoglycemia in Infants?

Symptoms of recurrent hypoglycemia in infants are:

• Weak muscle tone (hypotonia).

• Cyanosis (bluish skin discoloration due to low oxygen levels in the blood).

• Weakness and lethargy.

• Poor or impaired feeding.

• Seizures.

• Apnea (a sleep disorder characterized by difficulty in breathing).

• Hypothermia (severely low body temperature).

• Seizures.

• Lack of movement.

• Nausea and vomiting.

• Tachycardia (increased heart rate).

• Paleness of the skin.

• Stroke.

• Visual disturbances.

• Confusion.

• Coma (prolonged unconsciousness).

Is Recurrent Hypoglycemia in Infants a Common Condition?

• Recurrent hypoglycemia in infants occurs in 1.3 to three cases per 1000 live childbirths.

• In a Japanese study, babies born around 35 to 36 weeks of gestation were admitted to the neonatal intensive care unit more than 80 percent of the time because of apnea (a sleep disorder characterized by difficulty in breathing) or recurrent hypoglycemia.

• Babies born to diabetic mothers are prone to developing recurrent hypoglycemia.

• Babies born with low birth weight, born under stress, or born before full term can also develop recurrent hypoglycemia.

How Is Recurrent Hypoglycemia in Infants Diagnosed?

Recurrent hypoglycemia in infants can be diagnosed in the following ways:

• Signs and Symptoms: Neonatal hypoglycemia signs are non-specific, although they principally involve two systems: sympathetic nervous system adrenergic activation and decreased central nervous system functioning.

• Blood Examinations: Serum glucose or blood glucose levels should be evaluated to check for severe hypoglycemia in infants. This blood examination employs a heel stick to measure a newborn's blood sugar. Blood is taken from the heel of the foot, which is a simple and least invasive method for taking babies' blood samples.

• Urine Examination: Urine samples should be collected and analyzed for the presence of ketone bodies.

How Is Recurrent Hypoglycemia in Infants Treated?

The treatment of recurrent hypoglycemia in infants involves the following:

• The baby's overall health and gestational age will determine the course of treatment. First, the infant is treated with a supply of glucose with a rapid onset. This could be a simple, early formula feeding or a mixture of glucose and water. In some cases, the infant needs intravenous glucose therapy. After the treatment, the baby's blood glucose levels are frequently examined to see if the hypoglycemia recurs.

• When hypoglycemia is recurring, the treatment should be started with a five percent or ten percent Dextrose drip. Life-threatening conditions should be stabilized, and supportive therapy for patients with hypoglycemia and prehospital care should be done. Oral liquids that contain sugar can be given to the patient if they are conscious and still have their airway protective reflexes intact.

• Dextrose, Glucagon, Diazoxide, and Octreotide are glucose-raising medications that can be administered by nasogastric, intramuscular, intraosseous, or intravenous methods for patients who are unable to protect their airways or drink liquids.

• Surgery can be indicated if infants younger than three months old are found to have recurrent hypoglycemia. In addition, surgery is frequently done when critically ill infants who are unresponsive to glucose and hormone therapy are involved. It is advised that 85 percent to 90 percent of the pancreas be removed almost entirely. However, this may increase the risk of developing diabetes in adulthood.

What Are Possible Complications of Hypoglycemia in a Newborn Baby?

The possible complications of recurrent hypoglycemia in infants are:

• A hypoglycemic state can impair brain function. Hypoglycemia that is severe or persistent can lead to seizures and severe brain damage.

• Delayed development.

• Mental retardation and brain damage.

• Personality disorders.

What Can Be Done to Prevent Hypoglycemia in a Newborn Baby?

• In many instances, preventing hypoglycemia in a newborn child might not be possible. However, healthcare professionals should watch closely for the symptoms and administer treatment as soon as feasible for a newborn with risk factors.

• During pregnancy, diabetic mothers should maintain normal blood glucose levels. This could reduce the risk for their unborn child.

Conclusion

When a newborn's blood glucose level is too low and causes symptoms, it is known as neonatal hypoglycemia. One to three newborns out of every 1000 have it. With so many potential etiologies for hypoglycemia, it is best to treat babies and children with this condition using a multidisciplinary approach. In addition, research advancements have helped to better understand the disorder's complex pathogenesis, diagnosis, and treatment. Neonatal hypoglycemia, which is severe and persistent, can have fatal consequences, long-term neurodevelopmental problems, cerebral palsy, and even death.