Neonatal Hypoglycemia and the Importance of Gluconeogenesis

The infant s Apgar scores (scale 0-10, with 10 being best) of 2 at 1 minute and 6 at 5 minutes suggested depression of neurological and cardiopulmonary function. The physicians 

When the infant was aged 30 minutes, the hematocrit was 0.63 (normal is 0.45-0.62), and the serum glucose was 2.5 mmol/L (normal is 2.8-3-3 mmol/L). An intravenous line was established. The initial intravenous fluid was 10% dextrose in water and was administered at a rate of 10 mL/hour or a total of 60 mL/kg/day (4 mg/kg/minute of glucose). Several minutes later, the infant s blood glucose concentration was 1.2 mmol/L, and 10 mL of 25% dextrose in water was given via intravenously over a 5-minute period (125 mg/kg/minute). 

By 5 hours of age, this infant was receiving glucose at a rate of 13 5 mg/kg/min. The blood glucose concentration continued to be less than 1.1 mmol/L, and the infant was given 15 mg of hydrocortisone every 6 hours. Echocardiography showed decreased left ventricular contractility and hypertrophy of the ventricular septum but no other structural abnormalities. These findings were consistent with the cardiomyopathy often seen in infants of diabetic mothers. 

By 12 hours of age, the infant had seizure activity that included rhythmic movement of both upper extremities, hiccupping, and repetitive chewing movements. An electroencephalogram was grossly abnormal, showing paroxysmal bursts of activity (seizures) and periods of suppression. Phenobarbital was given to alleviate the seizure activity. 

Eventually, the infant s need for hydrocortisone began to decrease so that by the ninth day of life she no longer required steroids, and she maintained serum glucose concentrations above 2.8 mmol/L with a glucose infusion of less than 7 mg/kg per minute. Subsequently, glucose control was no longer difficult, and no further medications were given for this problem. 

---