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blood glucose management in neonates

Mona Noureldein, Roxana Mardare, Jack Pickard, Hoi Lun Shing, Michael Eisenhut
BACKGROUND: It has been estimated that paediatric meningitis without elevated CSF white cell count (pleocytosis) accounts for 0.5-12% of all cases of bacterial meningitis. CSF protein and glucose measurements are therefore essential in management but may be neglected in clinical practice. In order to improve recognition of bacterial meningitis in neonates and to enable adequate management and audit, we investigated whether a systemic inflammatory response in the absence of meningitis is associated with elevated CSF protein and reduced CSF glucose levels...
March 14, 2018: Fluids and Barriers of the CNS
Annie Dude, Charlotte M Niznik, Emily D Szmuilowicz, Alan M Peaceman, Lynn M Yee
Achieving maternal euglycemia in women with pregestational and gestational diabetes mellitus is critical to decreasing the risk of neonatal hypoglycemia, as maternal blood glucose levels around the time of delivery are directly related to the risk of hypoglycemia in the neonate. Many institutions use continuous insulin and glucose infusions during the intrapartum period, although practices are widely variable. At Northwestern Memorial Hospital, the "Management of the Perinatal Patient with Diabetes" policy and protocol was developed to improve consistency of management while also allowing individualization appropriate for the patient's specific diabetic needs...
March 13, 2018: American Journal of Perinatology
Sherry LeBlanc, Jamie Haushalter, Carl Seashore, Karen S Wood, Michael J Steiner, Ashley G Sutton
BACKGROUND AND OBJECTIVE: Neonatal hypoglycemia is a common problem, often requiring management in the NICU. Nonpharmacologic interventions, including early breastfeeding and skin-to-skin care (SSC), may prevent hypoglycemia and the need to escalate care. Our objective was to maintain mother-infant dyads in the mother-infant unit by decreasing hypoglycemia resulting in NICU transfer. METHODS: Inborn infants ≥35 weeks' gestation with at least 1 risk factor for hypoglycemia were included...
February 8, 2018: Pediatrics
Rajesh Shah, Christopher J D McKinlay, Jane E Harding
PURPOSE OF REVIEW: Continuous glucose monitoring (CGM) is increasingly used in the management of diabetes in children and adults, but there are few data regarding its use in neonates. The purpose of this article is to discuss the potential benefits and limitations of CGM in neonates. RECENT FINDINGS: Smaller electrodes in new sensors and real-time monitoring have made CGM devices more approachable for neonatal care. CGM is well tolerated in infants including very low birth weight babies, and few if any local complications have been reported...
April 2018: Current Opinion in Pediatrics
Muhammad Saad Yousuf, Mohsin Nazir Butt, Fauzia Anis Khan
Nesidioblastosis is the most common cause of non-transient, recurrent and persistent hypoglycaemia in neonates and infants. It is a disorder of diffuse proliferation of beta cells of the pancreas leading to hyperinsulinemia and hypoglycaemia. The main aim is to prevent the severe episodes of hypoglycaemia which can cause damage to the brain and/or mental retardation. In this case report we present two cases of nesidioblastosis and their perioperative anaesthetic course for near-total pancreatectomy. First case was a 7 months old female who had repeated episodes of convulsions since birth...
October 2017: Journal of Ayub Medical College, Abbottabad: JAMC
Christopher J D McKinlay, J Geoffrey Chase, Jennifer Dickson, Deborah L Harris, Jane M Alsweiler, Jane E Harding
Continuous glucose monitoring (CGM) is well established in the management of diabetes mellitus, but its role in neonatal glycaemic control is less clear. CGM has provided important insights about neonatal glucose metabolism, and there is increasing interest in its clinical use, particularly in preterm neonates and in those in whom glucose control is difficult. Neonatal glucose instability, including hypoglycaemia and hyperglycaemia, has been associated with poorer neurodevelopment, and CGM offers the possibility of adjusting treatment in real time to account for individual metabolic requirements while reducing the number of blood tests required, potentially improving long-term outcomes...
2017: Maternal Health, Neonatology and Perinatology
Evangelia Gole, Stavroula Oikonomou, Sian Ellard, Elisa De Franco, Kyriaki Karavanaki
BACKGROUND: Neonatal diabetes mellitus (NDM) is a rare type of monogenic diabetes that presents in the first 6 months of life. Activating mutations in the KCNJ11 gene encoding for the Kir6.2 subunit of the KATP channel can lead to transient (TNDM) or permanent neonatal diabetes mellitus (PNDM). CASE REPORT: A female infant presented at the 22nd day of life with severe hyperglycemia and ketoacidosis (glucose: 907mg/dl, blood gas pH: 6.84, HCO3: 6mmol/l). She was initially managed with intravenous (IV) fluids and IV insulin...
September 25, 2017: Journal of Clinical Research in Pediatric Endocrinology
Michael S Toce, Margaret A Stefater, David T Breault, Michele M Burns
BACKGROUND: Methadone is a synthetic μ-opioid receptor agonist that is used in the management of pain, neonatal abstinence withdrawal syndrome, and opioid dependence. Overdose can cause miosis, respiratory depression, and central nervous system depression. Rarely, hypoglycemia has been reported. We present the case of an 11-month-old male who developed hypoketotic, hyperinsulinemic, hypoglycemia after an acute, unintentional methadone exposure. CASE DETAILS: The patient was a previously healthy 11-month-old male who presented in respiratory failure...
January 2018: Clinical Toxicology
Matthew R Timlin, Alexander B Black, Heather M Delaney, Renée I Matos, Candace S Percival
Congenital hyperinsulinism (CHI) is the most common cause of persistent hypoglycemia in infancy. The mainstay of medical management for CHI is diazoxide. Diazoxide inhibits insulin release from the pancreas, but also causes smooth muscle relaxation and fluid retention so it is typically given with chlorothiazide. In July 2015, the FDA issued a drug safety communication warning that pulmonary hypertension (PH) had been reported in 11 infants being treated with diazoxide and that the PH resolved with withdrawal of diazoxide...
August 2017: Pediatric Cardiology
Hanna Mila, Aurélien Grellet, Marine Delebarre, Claire Mariani, Alexandre Feugier, Sylvie Chastant-Maillard
Despite the high neonatal mortality rate in puppies, pertinent criteria for health evaluation of the newborns are not defined. This study was thus designed to measure and to characterize factors of variation of six health parameters in dog neonates, and to evaluate their value as predictors of neonatal mortality. A total of 347 purebred puppies under identical conditions of housing and management were examined within the first 8h after birth and then at Day 1. The first health evaluation included Apgar score, weight, blood glucose, lactate and β-hydroxybutyrate concentration, rectal temperature and urine specific gravity (SG)...
August 1, 2017: Preventive Veterinary Medicine
Foong Ming Moy, Amita Ray, Brian S Buckley, Helen M West
BACKGROUND: Self-monitoring of blood glucose (SMBG) is recommended as a key component of the management plan for diabetes therapy during pregnancy. No existing systematic reviews consider the benefits/effectiveness of various techniques of blood glucose monitoring on maternal and infant outcomes among pregnant women with pre-existing diabetes. The effectiveness of the various monitoring techniques is unclear. OBJECTIVES: To compare techniques of blood glucose monitoring and their impact on maternal and infant outcomes among pregnant women with pre-existing diabetes...
June 11, 2017: Cochrane Database of Systematic Reviews
M Van Eetvelde, M M Kamal, L Vandaele, G Opsomer
The aim of the present research was to assess factors associated with first-lactation milk yield in dairy heifers, including maternal and environmental factors, factors related to the development of the heifer and factors related to its offspring such as gender of the calf. In addition, the potential underlying mechanism, in particular metabolic adaptations, was further explored. Data on body growth, reproduction and milk yield of 74 Holstein Friesian heifers on three herds in Flanders (Belgium) were collected...
May 24, 2017: Animal: An International Journal of Animal Bioscience
Ivana Rabbone, Fabrizio Barbetti, Raffaella Gentilella, Gilberto Mossetto, Riccardo Bonfanti, Claudio Maffeis, Dario Iafusco, Elvira Piccinno
AIMS: Neonatal diabetes mellitus (NDM) is a rare disorder, and guidance is limited regarding its optimal management. We reviewed insulin usage in NDM, with a focus on continuous subcutaneous insulin infusion (CSII). METHODS: A PubMed search identified 40 reports of patients with NDM treated with insulin published between 1994 and 2016. RESULTS: Data concerning treatment of NDM are limited. CSII resolves some of the issues associated with insulin therapy in neonates...
July 2017: Diabetes Research and Clinical Practice
Hasan M Isa, Masooma S Mohamed, Afaf M Mohamed, Adel Abdulla, Fuad Abdulla
PURPOSE: This study aimed to determine the prevalence of glucose-6-phosphate dehydrogenase (G6PD) deficiency among infants with neonatal indirect hyperbilirubinemia (NIH); compare G6PD-deficient and G6PD-normal patients regarding hyperbilirubinemia and need for exchange transfusions (ET); and assess risk factors for ET and kernicterus. METHODS: This is a case-control retrospective study. Medical records of NIH patients admitted to the Pediatric Department, Salmaniya Medical Complex, Bahrain, between January 2007 and June 2010 were reviewed...
April 2017: Korean Journal of Pediatrics
A Al-Omran, S Al-Abdi, Z Al-Salam
BACKGROUND: Hyperbilirubinemia is one of the most common causes of neonatal readmission to hospital. AIMS: To assess risk factors for hyperbilirubinemia among neonates readmitted for this condition and the ratio of the mean corpuscular hemoglobin concentration (MCHC) to the mean corpuscular volume (MCV). METHODS: We retrospectively studied the clinical and laboratory findings, management and possible risk factors for hyperbilirubinemia in 301 neonates born at ≥35 weeks gestation and readmitted to hospital owing to hyperbilirubinemia over five years...
2017: Journal of Neonatal-perinatal Medicine
Jane Alsweiler, Kathryn Williamson, Frank Bloomfield, Geoffrey Chase, Jane Harding
INTRODUCTION: Neonatal hyperglycaemia is frequently treated with insulin, which may increase the risk of hypoglycaemia. Computer-determined dosage of insulin (CDD) with the STAR-GRYPHON program uses a computer model to predict an effective dose of insulin to treat hyperglycaemia while minimising the risk of hypoglycaemia. However, CDD models can require more frequent blood glucose testing than common clinical protocols. The aim of this trial is to determine if CDD using STAR-GRYPHON reduces hypoglycaemia in hyperglycaemic preterm babies treated with insulin independent of the frequency of blood glucose testing...
March 6, 2017: BMJ Open
Elles J T M van der Louw, Tanya J Williams, Bobbie J Henry-Barron, Joanne F Olieman, Johannes J Duvekot, Marijn J Vermeulen, Natalja Bannink, Monique Williams, Rinze F Neuteboom, Eric H Kossoff, Coriene E Catsman-Berrevoets, Mackenzie C Cervenka
PURPOSE: Evaluation of ketogenic diet (KD) therapies for seizure control during pregnancy when safety and appropriate management become considerations. Until now, no information has been available on seizure reduction and human pregnancy related outcomes in women treated with KD therapies. METHOD: We describe two cases of pregnant women with epilepsy treated with KD therapy either as monotherapy (Case 1) or as adjunctive therapy (Case 2). RESULTS: Case 1: A 27 year old woman, gravida1, started the classic KD with medium chain triglyceride (MCT) emulsion and 75g carbohydrate-restriction, later reduced to 47g...
February 2017: Seizure: the Journal of the British Epilepsy Association
Ram Uma, Balaji Bhavadharini, Harish Ranjani, Manni Mohanraj Mahalakshmi, Ranjit Mohan Anjana, Ranjit Unnikrishnan, Arivudainambi Kayal, Belma Malanda, Anne Belton, Viswanathan Mohan
AIM: To evaluate the impact of a structured model of care (MOC) prepared for resource-constrained settings, on the pregnancy outcomes of Asian Indian women with gestational diabetes mellitus (GDM). METHODS: Pregnant women were screened under the Women in India with GDM Strategy (WINGS) MOC for GDM using the International Association of Diabetes and Pregnancy Study Groups criteria. Women with GDM went through a structured MOC that included medical nutrition therapy (MNT), regular physical activity (PA); and insulin when indicated...
March 2017: Journal of Obstetrics and Gynaecology Research
H Evren Eker, Oya Yalcin Cok, Bilin Çetinkaya, Anis Aribogan
PURPOSE: Newborns are often sedated during MRI but sedation itself creates adverse events and management is more challenging in this environment. Oral glucose/sucrose administration has been studied in newborns during painful procedures; however, its effectiveness in keeping newborns sleepy and motionlessness during painless procedures has not been demonstrated. The objective of this study was to describe effectiveness of oral 30% glucose administration by comparing with intravenous midazolam sedation for newborns during MRI...
April 2017: Journal of Anesthesia
Marene Ter, Ikhwan Halibullah, Laura Leung, Susan Jacobs
AIM: The aim of this study was to evaluate dextrose gel in the management of neonatal hypoglycaemia in the postnatal wards at an Australian tertiary level perinatal centre. METHODS: An audit was performed before and after implementation of dextrose gel. Pre-implementation, neonatal hypoglycaemia was managed with feed supplementation alone, and dextrose gel was used in addition to feed supplementation in the post-implementation phase. Outcomes included admission to neonatal intensive care unit (NICU) for management of hypoglycaemia, proportion of neonates who achieved normoglycaemia (defined as blood glucose ≥2...
April 2017: Journal of Paediatrics and Child Health
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