Neonatal Hypoglycaemia

18 November, 2010 by: colinparker

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To bolus, or Not to bolus… that is the question.  Actually, there are a few more questions too… How low is too low? What are the causes of neonatal hypoglycaemia? Any advances in research?

Some neonatologists believe that a bolus of intravenous dextrose when treating hypoglycaemia is to be avoided at all costs.  Others say a bolus is OK, provided that an ongoing infusion at an adequate rate to maintain euglycaemia is instituted without delay.


Outline of this PEMcast

Controversies in Neonatal Hypoglycaemia

Including:

  • definition
  • when to treat asymptomatic hypoglycaemia
  • how to treat

…with reference to a few papers and clinical practice guidelines.

Background:

[KB] 1999 Stanley (NEJM) – causes of hypoglycaemia
[CP] 2000 Cornblath (Pediatrics) – controversies with definition
[SF] 2004 McGowan (NeoReviews.org) – how low is too low?

Current Guidelines:

[CP] RCH Melbourne
[SF] Starship Children’s Hospital
[KB] KEMH

Last few years:

[SF ]2006 Rozance (Biology of the Neonate) – predicting adverse outcomes
[CP] 2008 Burns (Pediatrics) – patterns of brain injury
[SR] 2010 Straussman – current state of play

Discussion:

[al] Is our (local) guideline reflective of current evidence / knowledge?

[CP / SR] Summary & Conclusions

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