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Diagnosis and treatment of 46 cases of neonatal hypoglycemia_1826

By Kristen Lawson,2014-10-30 17:59
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Diagnosis and treatment of 46 cases of neonatal hypoglycemia_1826

Diagnosis and treatment of 46 cases of neonatal hypoglycemia

     Abstract Objective To investigate the diagnosis and treatment of neonatal hypoglycemia experience. Methods 46 cases of neonatal hypoglycemia were retrospectively analyzed clinical data and statistics. Results of 46 cases in 42 patients treated within 48 h, accounting for 91.3%, 3 cases of the use of hormones returned to normal after treatment, accounting for 6.5%, and 1 case due to primary disease increased automatically discharged. Conclusion closely observed changes in condition, regular monitoring of blood glucose is the early detection and treatment of an important means to guide low blood sugar; appropriate concentration and the rate of intravenous glucose is the treatment of neonatal hypoglycemia, the most effective

    measures.

     Key words Brain injuries / therapy; infant, newborn; blood sugar is too small / therapy

     Neonatal hypoglycemia can cause varying degrees of brain cell injury, the longer the duration of severe that can lead to serious complications such as mental stunting, severe may cause death, such as early diagnosis and treatment can prevent the occurrence of permanent sequelae of central nervous system, to reduce morbidity. This article aims to sum up our hospital treated 46 cases of neonatal hypoglycemia clinical information on the diagnosis and treatment of low blood sugar and prevention to explore in order to improve the diagnosis and treatment of this disease.

     A clinical data

     1.1 General infor

    139 cases of blood glucose monitoring high-risk newborns, including 46 cases diagnosed

    as neonatal hypoglycemia, male 24 cases, female 22 cases; onset age: 1 ~ 96 h, an average of 1.2 d. 1 tire 36 cases, the first two births in 10 cases; 42 cases of singleton pregnancies, twin 4 cases. 30 ~ 42 weeks gestational age, full-term births and 26 cases,

    19 cases of premature infants, expired products in 1 case. Birth weight 1 350 ~ 4 400 g, an average of 2 410 g, including ? 2 500 g 28 Li,> 2 500 g 18 Li. Time of occurrence of hypoglycemia after birth, 1 h to 4 d, where <2 h 4 Li, 2 ~ 10 h 19 Li, 11 ~ 24 h 15 Li, 25 ~ 48 h 5 Li, 49 ~ 96 h 3 Li. Primary disease as follows: asphyxia, 20 cases (43.5%), premature and small for gestational age in 14 cases (30.5%), feeding disorder in 6 cases (13.0%), infection in 3 cases (6.5%), mothers suffering from diabetes 2 cases (4.3%), hemorrhage in 1 case (2.2%).

     1.2 when the diagnostic criteria for admissions that the heel of the 139 cases of

    neonatal blood samples, using Advantage Blood Glucose Meter and the corresponding

    blood collection needles and test strips; this group of "Zhu Futang Practical Pediatrics," to begin treatment of newborns with low blood sugar standards ( <2.24

    mmol / L) for the diagnostic criteria of neonatal hypoglycemia [1].

     1.3 clinical symptoms in 21 cases (45.6%), lethargy in 6 cases (13.0%), poor sucking power of 5 cases (10.9%), low body temperature in 3 cases (6.5%), apnea, or shortness

    of breath in 3 cases (6.5% ), tremor in 3 cases (6.5%), cyanosis in 2 cases (4.4%), bowel in 2 cases (4.4%), convulsion in 1 case (2.2%).

     1.4 Treatment and prognosis of the newborn, in general, warmth and reasonable feed. Pairs of children diagnosed with low blood sugar: (1) Whether there are

    symptoms, immediately give 10% glucose 2 mL / kg bolus, then to 6 ~ 8 mg / (kg * min) infusion to maintain, if not correct dosage increase to 10 ~ 12 mg / (kg * min), while those still not back to normal I prednisone or hydrocortisone with 2 mg / (kg * d) or 5 mg / (kg * d) adjuvant therapy until the blood sugar a normal, stable 48 ~ 72 h after cessation of treatment [2]. At the same time oxygen, correct acidosis and maintain water and electrolyte balance. (2) strengthening of primary diseases. Following the above treatment of 28 cases at 24 h, blood glucose returned to normal (60.9%), 14 cases returned to normal after 48 h (30.4%), 3 cases returned to normal after the use of hormone therapy (6.5%), 1 case of primary disease due to illness Critical automatically discharged. Reposted elsewhere in the paper for free download http://

     2 Discussion

     Because newborns lack of liver glycogen and fat storage, blood sugar after birth and 2 h began to decline, if not promptly added, 12 h or so has been basically run out of blood glucose [3]. In the stress state (such as hypoxia, low body temperature, suffering from disease, etc.) a greater energy consumption, easy to hypoglycemia. Hypoxia-

    induced glucose oxidase and gluconeogenesis enzyme activity decreased, so that decomposition of glucagon in liver glycogen to glucose and released from muscle storage of glucose in the process can not be successfully carried out; newborn affected by cold stimulation, the temperature drops to mobilize the body's brown fat, a chemical reaction producing heat, oxygen consumption in this process the need for adequate glucose for energy and improve the nervous system of regulation, blood sugar consumed more, so prone to cause low blood sugar. Prematurity, low birth weight

    infants less storage of sugar the body break down glycogen enzymes also immature, coupled with body surface area, need more calories; macrosomia metabolism fast, consuming more calories, are prone to low - glucose. Therefore, low birth weight,

    prematurity, macrosomia, and hypoxia, cold stimulation, there are primary diseases are a major risk of neonatal hypoglycemia risk factors [3,4], the need for timely and proactive and preventive. Low blood sugar in children with clinical manifestations of

    the lack of specificity, and some even asymptomatic (21 cases in this group, accounting for 45.6%), so regular monitoring of blood glucose changes and guidance for early detection of low blood sugar low blood sugar is one important means of treatment.

    Another closely watched changes in condition, regular measurement of body temperature, respiration, heart rate, closely observed the spirit of the newborn state, crying, color, muscle tension, sleep, feeding and other changes. If abnormal situation

    should in time measure of blood sugar, which is the early detection of the primary means of low blood sugar. In particular, there is a risk factors of hypoglycemia in children at high risk should be closely observed.

     Neonatal hypoglycemia can occur any time in the neonatal period. It was reported that newborns 2 ~ 6 h after birth, the lowest blood glucose high insulin levels, so 1 ~ 24 h after birth are more hypoglycemia [4]. In this group within 10 h after birth,

    hypoglycemia in 19 cases accounted for 41.3%, so at this time segment observation and treatment should be strengthened as soon as possible to the glucose-water and breast-

    feeding should not eat in time to the 10% glucose infusion, which for the prevention and treatment the incidence of neonatal hypoglycemia have a very positive meaning.

     Because glucose is the neonatal central nervous system, the only source of energy, low blood sugar can lead to brain cell damage caused by permanent damage may be a long time, and can lead to death and serious complications [5,6]. According to clinical observations indicate that there are symptoms of low blood sugar low blood sugar than the asymptomatic performance of poor prognosis, especially in small for gestational age, there are symptoms of low blood sugar treatment in children if they have not survived the central nervous system occurred after dysfunction by 30% to 60% [7]. Therefore, once hypoglycemia, regardless of whether the symptoms should be treated immediately, or after 10% glucose solution intravenously, and 10% ~ 12.5% glucose solution to maintain and promptly correct the low blood sugar, reduce brain tissue damage. Must be taken when using glucose concentration, trickle-down speed and

    specificity of the individual. At the same time monitoring of blood glucose, and

    promptly correct the low blood sugar and the avoidance of high blood sugar.

     References

     [1] Wu Ruiping, Ya-Mei, JIANG Zai-fang. Zhu Fu-tong Practical Pediatrics [M] .6

     [2] Shanghai Municipal Health Bureau, the Chinese Medical Association Shanghai Branch. Health care routine - routine pediatric clinic [M]. Shanghai: Shanghai Science

    and Technology Press, 1999:18,67.

     [3] Kim Han-Zhen, Huang Min, official shiggi. Practical neonatology [M] .2 version.

     [4] Feng Qi, Jiang Yi. Less than the gestational age of the systematic monitoring of

     [5] Xu Qi new. Newborns with low blood sugar risk factors and prevention [J]. Practical Clinical Journal of Pediatrics, 20

     [6] MAO Jian, Li-Ying Chen, Fu Jianhua, et al. Hypoglycemic brain injury in neonatal

     [7] Yu-Kun Han, Fan Shao Zeng, Fu Wenfang. Practical Guide to Diagnosis and

    Treatment of Neonatal & E [M]. Shenyang: Liaoning Science and Technology Press, 1991:326.

     Reposted elsewhere in the paper for free download http://

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