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    PQCNC NHPC LS3 Devente 20200310

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    kcochran
    Perinatal Quality Collaborative of North Carolina Newborn Hypoglycemia Prevention and Care Learning Session 3: Neonatal Hypoglycemia - An Obstetric Perspective

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    PQCNC NHPC LS3 Devente 20200310

    Uploaded by

    kcochran
    624 views8 pages
    Perinatal Quality Collaborative of North Carolina Newborn Hypoglycemia Prevention and Care Learning Session 3: Neonatal Hypoglycemia - An Obstetric Perspective

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    Perinatal Quality Collaborative of North Carolina Newborn Hypoglycemia Prevention and Care Learning Session 3: Neonatal Hypoglycemia - An Obstetric Perspective

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    624 views8 pages

    PQCNC NHPC LS3 Devente 20200310

    Uploaded by

    kcochran
    Perinatal Quality Collaborative of North Carolina Newborn Hypoglycemia Prevention and Care Learning Session 3: Neonatal Hypoglycemia - An Obstetric Perspective

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    The key takeaways are that infants at risk for neonatal hypoglycemia include those that are small for gestational age, large for gestational age (infants of diabetic mothers), and late preterm infants. Poorly controlled maternal diabetes, antenatal corticosteroid use, and antenatal late preterm steroid use can also increase the risk.

    The common risk factors discussed are 1) Intrauterine Growth Restriction/Small for Gestational Age infants, 2) Infant of Diabetic Mothers/Large for Gestational Age infants, and 3) Late Preterm Infants (34 to 36.6 weeks).

    Some acute intrapartum-associated issues include poorly controlled maternal blood sugars (>200 mg/dl) in diabetic mothers adjacent to delivery, antenatal corticosteroid use from 24-34 weeks gestation, and antenatal late preterm steroid use from 34-36 6/7 weeks gestation.

    Neonatal Hypoglycemia:

    An Obstetric Perspective

    James deVente MD/PhD


    East Carolina University Brody School of Medicine
    Department of Obstetrics and Gynecology
    VIDANT Medical Center
    VIDANT Women’s Center
    Disclosures

    u None
    Objectives

    1. Appreciate the obstetric patients at greatest risk for


    delivering infants with neonatal hypoglycemia
    2. Appreciate the obstetric issues associated with “acute”
    neonatal hypoglycemia
    3. Appreciate the obstetric issues associated with “chronic”
    neonatal hypoglycemia
    4. What can obstetric providers do to decrease the chances of
    neonatal hypoglycemia?
    Neonatal hypoglycemia:
    Common Risk factors

    1. Intrauterine Growth Restriction/Small for Gestational Age


    infants
    2. Infant of Diabetic Mothers/Large for Gestational Age infants
    3. Late Preterm Infants (34 to 36.6 weeks)

    Neonatal Hypoglycemia. Abramowski A; Hamdan AH. StatPearls Publishing. 2019 01. UI:30725790
    Neonatal Hypoglycemia:
    “Acute” intrapartum-associated issues

    1. Poorly controlled blood sugars (>200 mg/dl) in diabetic


    mothers adjacent to delivery
    2. Antenatal Corticosteroids (24 23 22? weeks -34 weeks)
    3. Antenatal Late Preterm Steroids (34 weeks – 36 6/7 weeks)

    ALPS trail:
    Please use Caution
    and select your
    patients carefully
    Neonatal Hypoglycemia. Abramowski A; Hamdan AH. StatPearls Publishing. 2019 01. UI:30725790
    Maternal Diabetes:
    Intrapartum glucose control
    Fact: Marked increase in neonatal hyperglycemia in mothers with intrapartum
    blood sugars >200 mg/dl Critical
    Thinking is
    1. Mothers with poorly controlled or difficult to control (brittle) glucose levels Key
    should be managed with insulin infusion (insulin ggt, endotool, glucomander)
    early during labor so that blood sugars are normalized (goal:110 mg/dl) many
    hours prior to delivery.

    2. Mothers with well controlled diabetes but have received antenatal steroids will
    be difficult to control over next five days… may need insulin ggt

    3. During “active phase” of labor blood sugars should be monitored hourly!!!!


    You can’t find
    what you do
    Mitanchez D, Yzydorczyk C, Siddeek B, Boubred F, Benahmed M, Simeoni U. The offspring of the diabetic mother--short- and not look for
    long-term implications. Best Pract Res Clin Obstet Gynaecol. 2015 Feb;29(2):256–69.
    ACOG Practice Bulletin, Pregestational DM, Number 201: 2018
    Neonatal Hypoglycemia:
    “Chronic” antepartum-associated issues
    1. Infants of diabetic mothers can demonstrate increased insulin “Trifecta of
    production/secretion (fetal hyperinsulinemia) in addition to increased Neonatal
    peripheral glucose utilization Hypoglycemia”
    2. Infants of diabetic mothers can demonstrate defects in their ability to
    mobilize glycogen after birth
    3. Infants of diabetic mothers can demonstrate a relative adrenal insufficiency
    with decreased levels of catecholamines

    u Infants of diabetic mothers and Large for gestational age infants are at a
    higher risk for prolonged increased insulin production
    u Well controlled antenatal blood sugars during gestation marked decrease the
    chance of significate neonatal hypoglycemia

    Sharma A, Davis A, Shekhawat PS. Hypoglycemia in the preterm neonate: etiopathogenesis, diagnosis, management and long-term
    outcomes. Transl Pediatr. 2017 Oct;6(4):335-348.

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