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glucose management in neonates

Eric Ly, Jennifer Alexander, Temi Akinmboni, Hyung Woo, Colleen Driscoll
Point of care glucose (POCG) measurements, used for detecting neonatal hypoglycemia, can have variable accuracy. The appropriate diagnosis of neonatal hypoglycemia in babies with low POCG measurements involves confirmatory serum glucose (CSG) testing. At our institution, no babies with low POCG measurements had CSG testing in their evaluation of neonatal hypoglycemia over a three year period. Our aim was to increase the percentage of CSG testing in babies with a low POCG. A secondary aim was to decrease the percentage of low-risk, asymptomatic babies who received POCG testing...
2016: BMJ Quality Improvement Reports
Giridhara R Babu, Gvs Murthy, R Deepa, Yamuna, Prafulla, H Kiran Kumar, Maithili Karthik, Keerti Deshpande, Sara E Benjamin Neelon, D Prabhakaran, Anura Kurpad, Sanjay Kinra
BACKGROUND: India is experiencing an epidemic of obesity-hyperglycaemia, which coincides with child bearing age for women. The epidemic can be sustained and augmented through transgenerational transmission of adiposity and glucose intolerance in women. This presents an opportunity for exploring a clear strategy for the control of this epidemic in India. We conducted a study between November 2013 and May 2015 to inform the design of a large pregnancy cohort study. Based on the findings of this pilot, we developed the protocol for the proposed birth cohort of 5000 women, the recruitment for which will start in April 2016...
October 14, 2016: BMC Pregnancy and Childbirth
Sadiah Ahsan Pal, Mariam Iqbal Ali
Diabetes mellitus complicates <5% of all pregnancies in Pakistan, but is a major cause of perinatal morbidity and mortality, as well as maternal morbidity. Appropriate glycaemic control is not only important throughout pregnancy but is equally important during the intra-partum period. Increased blood glucose levels 4-6 hours prior to delivery increase the chances of hypoglycaemia in neonates. It is essential to optimize blood glucose levels during the intra-partum period as avoiding maternal hyperglycaemia will prevent foetal hyperglycaemia, and hence reduce the chances of neonatal hypoglycaemia and foetal acidaemia...
September 2016: JPMA. the Journal of the Pakistan Medical Association
Hend S Saleh, Walid A Abdelsalam, Hala E Mowafy, Azza A Abd ElHameid
Gestational diabetes mellitus (GDM) complicates a significant number of pregnancies. Blood glucose control improves perinatal outcomes. Medical nutrition therapy is the foundation in management. Aim of This Study. To evaluate efficacy of metformin in comparison to insulin for managing GDM. Methods. In prospective randomized comparative study, 150 antenatal women whose pregnancies had been complicated by GDM and did not respond to diet alone were recruited from antenatal clinics at Obstetrics Department in Zagazig University Hospitals from November 2012 to December 2014...
2016: International Journal of Reproductive Medicine
Aisha Sheikh, Abdul Jabbar
Diabetes in pregnancy is associated with adverse maternal and neonatal outcomes. Due to variations in insulin resistance throughout pregnancy there is a continuous need to implement Medical Nutrition Therapy (MNT), exercise and pharmacological treatments which have to be escalated. Self-monitoring of blood glucose (SMBG) is integral to the management of diabetes in pregnancy. Proper implementation of SMBG in pregnant women with diabetes requires patient education and understanding of its applications and limitations...
September 2016: JPMA. the Journal of the Pakistan Medical Association
Aisha Sheikh, Abdul Jabbar
Diabetes in pregnancy is associated with adverse maternal and neonatal outcomes. Due to variations in insulin resistance throughout pregnancy there is a continuous need to implement Medical Nutrition Therapy (MNT), exercise and pharmacological treatments which have to be escalated. Self-monitoring of blood glucose (SMBG) is integral to the management of diabetes in pregnancy. Proper implementation of SMBG in pregnant women with diabetes requires patient education and understanding of its applications and limitations...
September 2016: JPMA. the Journal of the Pakistan Medical Association
Aisha Salim Said, Karim Premji Manji
BACKGROUND: Fetal macrosomia is defined as birth weight ≥4000 g. Several risk factors have been shown to be associated with fetal macrosomia. There has been an increased incidence of macrosomic babies delivered and the antecedent complications. This study assessed the risk factors, maternal and neonatal complications of fetal macrosomia in comparison with normal birth weight neonates. METHODS: A case-control study was conducted at the Muhimbili National Hospital (MNH) maternity and neonatal wards...
2016: BMC Pregnancy and Childbirth
Stephen F Quevedo, Marit L Bovbjerg, Randi L Kington
OBJECTIVE: To evaluate the effectiveness of fetal abdominal circumference-guided therapy for gestational diabetes (GDM) in an outpatient population characterized by highly-prevalent maternal obesity. METHODS: Data for this translational retrospective cohort study come from medical records. Fetal abdominal circumference was assessed by ultrasound in late second trimester, and sex- and gestational age-specific percentiles assigned. Taking fetal abdominal circumference percentile as a marker for adequacy of fetal growth, maternal glucose targets were set accordingly: loose, moderate or tight...
August 23, 2016: Journal of Maternal-fetal & Neonatal Medicine
Rhonda D Szczesniak, Dan Li, Leo L Duan, Mekibib Altaye, Menachem Miodovnik, Jane C Khoury
Objective To identify phenotypes of type 1 diabetes control and associations with maternal/neonatal characteristics based on blood pressure (BP), glucose, and insulin curves during gestation, using a novel functional data analysis approach that accounts for sparse longitudinal patterns of medical monitoring during pregnancy. Methods We performed a retrospective longitudinal cohort study of women with type 1 diabetes whose BP, glucose, and insulin requirements were monitored throughout gestation as part of a program-project grant...
August 4, 2016: American Journal of Perinatology
Orhideja Stomnaroska-Damcevski, Elizabeta Petkovska, Snezana Jancevska, Dragan Danilovski
Neonatal hypoglycemia (NH) is one of the most common abnormalities encountered in the newborn. Maintaining glucose homeostasis is one of the important physiological events during fetal-to-neonatal transition. Transient low blood glucose concentrations are frequently encountered in the majority of healthy newborns and are the reflections of normal metabolic adaptation processes. Nevertheless, there is a great concern that prolonged or recurrent low blood glucose levels may result in long-term neurological and developmental consequences...
2015: Prilozi (Makedonska Akademija Na Naukite i Umetnostite. Oddelenie za Medicinski Nauki)
D Ogunyemi, P Friedman, K Betcher, A Whitten, N Sugiyama, L Qu, Amitai Kohn, Paul Holtrop
OBJECTIVE: To determine independent perinatal and intrapartum factors associated with neonatal hypoglycemia Method: Of singleton pregnancies delivered at term in 2013; 318 (3.8%) neonates diagnosed with hypoglycemia were compared to 7955 (96.2%) neonate controls with regression analysis Results: Regression analysis showed that independent prenatal factors were multiparity (odds-ratio [OR] =1.61), gestational age (OR = 0.68), gestational diabetes (OR = 0.22), macrosomia (OR = 4...
July 17, 2016: Journal of Maternal-fetal & Neonatal Medicine
Amanda L da Silva, Augusto R do Amaral, Daniela S de Oliveira, Lisiane Martins, Mariana R E Silva, Jean Carl Silva
OBJECTIVES: To compare different neonatal outcomes according to the different types of treatments used in the management of gestational diabetes mellitus (GDM). METHODS: This was a retrospective cohort study. The study population comprised pregnant women with GDM treated at a public maternity hospital from July 2010 to August 2014. The study included women aged at least 18 years, with a singleton pregnancy, who met the criteria for GDM. Blood glucose levels, fetal abdominal circumference, body mass index and gestational age were considered for treatment decision-making...
June 28, 2016: Jornal de Pediatria
Walid Fazeli, Mert Karakaya, Peter Herkenrath, Anne Vierzig, Jörg Dötsch, Jürgen-Christoph von Kleist-Retzow, Sebahattin Cirak
BACKGROUND: Neonatal lactic acidosis can be associated to severe inborn errors of metabolism. Rapid identification of the underlying disorder may improve the clinical management through reliable counseling of the parents and adaptation of the treatment. METHODS: We present the case of a term newborn with persistent hypoglycemia on postnatal day 1, who developed severe lactic acidosis, aggravating under intravenous glucose administration. Routine metabolic investigations revealed elevated pyruvate and lactate levels in urine, and magnetic resonance spectroscopy showed a lactic acid peak and decreased N-acetylaspartate levels...
December 2016: Molecular and Cellular Pediatrics
Robert L Goldenberg, Elizabeth M McClure, Margo S Harrison, Menachem Miodovnik
Objective Our objective was to review the literature in relationship to diabetes in pregnancy in low and middle income countries. Study Design We reviewed the English language literature related to diabetes and obesity during pregnancy in low and middle income countries published over the last 20 years. Results The global prevalence of diabetes mellitus is an estimated 8% with approximately 380 million adults with this condition worldwide. Ninety percent of diabetes in adults occurs in low- and middle-income countries (LMIC)...
May 16, 2016: American Journal of Perinatology
Sevim Ünal, Deniz Gönülal, Ahmet Uçaktürk, Betül Siyah Bilgin, Sarah E Flanagan, Fatih Gürbüz, Meltem Tayfun, Selin Elmaoğulları, Aslıhan Araslı, Fatma Demirel, Sian Ellard, Khalid Hussain
BACKGROUND: Congenital hyperinsulinism (CHI) is the most common cause of neonatal persistent hypoglycemia caused by mutations in nine known genes. Early diagnosis and treatment are important to prevent brain injury. The clinical presentation and response to pharmacological therapy may vary depending on the underlying pathology. Genetic analysis is important in the diagnosis, treatment, patient follow-up and prediction of recurrence risk within families. CASE PRESENTATION: Our patient had severe hypoglycemia and seizure following birth...
May 16, 2016: Journal of Clinical Research in Pediatric Endocrinology
Paul J Rozance, William W Hay
Despite being a very common problem after birth, consensus on how to manage low glucose concentrations in the first 48 h of life has been difficult to establish and remains a debated issue. One of the reasons for this is that few studies have provided the type of data needed to establish a definitive approach agreed upon by all. However, some recent publications have provided much needed primary data to inform this debate. These publications have focused on aspects of managing low blood glucose concentrations in the patients most at-risk for asymptomatic hypoglycemia-those born late-preterm, large for gestational age, small for gestational age, or growth restricted, and those born following a pregnancy complicated by diabetes mellitus...
2016: Maternal Health, Neonatology and Perinatology
Rana Malek, Stephen N Davis
INTRODUCTION: Gestational diabetes mellitus (GDM) complicates 10% of all pregnancies and is defined as hyperglycemia first noted during pregnancy. Rates of GDM are rising and untreated GDM results in complications for both mother and fetus. GDM is often managed by diet and exercise but 30-40% of women will require pharmacological intervention. Insulin has traditionally been the treatment of choice but since 2007, glyburide, a second generation sulfonylurea has become the most prescribed medication for GDM...
June 2016: Expert Opinion on Drug Metabolism & Toxicology
Philip J Weston, Deborah L Harris, Malcolm Battin, Julie Brown, Joanne E Hegarty, Jane E Harding
BACKGROUND: Neonatal hypoglycaemia, a common condition, can be associated with brain injury. It is frequently managed by providing infants with an alternative source of glucose, given enterally with formula or intravenously with dextrose solution. This often requires that mother and baby are cared for in separate environments and may inhibit breast feeding. Dextrose gel is simple and inexpensive and can be administered directly to the buccal mucosa for rapid correction of hypoglycaemia, in association with continued breast feeding and maternal care...
2016: Cochrane Database of Systematic Reviews
Alexandra Kautzky-Willer, Jürgen Harreiter, Dagmar Bancher-Todesca, Angelika Berger, Andreas Repa, Monika Lechleitner, Raimund Weitgasser
Gestational diabetes (GDM) is defined as any degree of glucose intolerance with onset during pregnancy and is associated with increased feto-maternal morbidity as well as long-term complications in mothers and offspring. Women detected to have diabetes early in pregnancy receive the diagnosis of overt, non-gestational, diabetes (glucose: fasting > 126 mg/dl, spontaneous > 200 mg/dl or HbA1c > 6.5 % before 20 weeks of gestation). GDM is diagnosed by an oral glucose tolerance test (OGTT) or fasting glucose concentrations (> 92 mg/dl)...
April 2016: Wiener Klinische Wochenschrift
Marion Grimaud, Pascale de Lonlay, Laurent Dupic, Jean-Baptiste Arnoux, Anais Brassier, Philippe Hubert, Fabrice Lesage, Mehdi Oualha
UNLABELLED: To investigate glycaemic levels in critically ill neonates with inherited metabolic disorders of intoxication. Thirty-nine neonates with a median age of 7 days (0-24) were retrospectively included (urea cycle disorders (n = 18), maple syrup disease (n = 13), organic acidemias (n = 8)). Twenty-seven neonates were intubated, 21 were haemodialysed and 6 died. During the first 3 days, median total and peak blood glucose (BG) levels were 7.1 mmol/L (0.9-50) and 10 mmol/L (5...
June 2016: European Journal of Pediatrics
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