School of Medicine, University of Buenos Aires, Buenos Aires, Argentina,
Department of Paediatrics and Newborn Medicine, Hospitals Sanatorio Trinidad Palermo, San Isidro and Ramos Mejía, Buenos Aires, Argentina,
Neonatology. 2021;118(5):522-529. doi: 10.1159/000514711. Epub 2021 Mar 22.
Neonatal hypoglycaemia is a common metabolic disorder presenting in the first days of life and one potentially preventable cause of brain injury. However, a universal approach to diagnosis and management is still lacking. The rapid decrease in blood glucose (BG) after birth triggers homeostatic mechanisms. Most episodes of hypoglycaemia are asymptomatic, and symptoms, when they occur, are nonspecific. Therefore, neonatologists are presented with the challenge of identifying infants at risk who might benefit from a rapid and effective therapy while sparing others unnecessary sampling and overtreatment. There is much controversy regarding the definition of hypoglycaemia, and one level does not fit all infants since postnatal age and clinical situations trigger different accepted thresholds for therapy. The concentration and duration of BG which cause neurological damage are unclear. Recognizing which newborn infants are at risk of hypoglycaemia and establishing protocols for treatment are essential to avoid possible deleterious effects on neurodevelopment. Early breastfeeding may reduce the risk of hypoglycaemia, but in some cases, the amount of breast milk available immediately after birth is insufficient or non-existent. In these situations, other therapeutic alternatives such as oral dextrose gel may lower the risk for NICU admissions. Current guidelines continue to be based on expert opinion and weak evidence. However, malpractice litigation related to neurodevelopmental disorders is frequent in children who suffered hypoglycaemia in the neonatal period even if they had other important factors contributing to the poor outcome. This review is aimed to help the practicing paediatricians and neonatologists to comprehend neonatal hypoglycaemia from physiology to therapy, hoping it will result in a rational decision-making process in an area not sufficiently supported by evidence.
新生儿低血糖症是一种常见的代谢紊乱，在生命的头几天出现，是潜在可预防的脑损伤原因之一。然而，目前仍然缺乏一种普遍适用的诊断和管理方法。出生后血糖（BG）的快速下降会引发体内平衡机制。大多数低血糖症发作无症状，而出现症状时也无特异性。因此，新生儿科医生面临着挑战，需要识别出有风险的婴儿，这些婴儿可能需要快速有效的治疗，同时避免对其他婴儿进行不必要的采样和过度治疗。关于低血糖症的定义存在很多争议，因为不同的新生儿需要不同的治疗阈值，因为出生后年龄和临床情况会触发不同的可接受阈值。导致神经损伤的 BG 浓度和持续时间尚不清楚。认识到哪些新生儿有发生低血糖症的风险，并制定治疗方案是至关重要的，以避免对神经发育产生可能的有害影响。早期母乳喂养可能会降低低血糖症的风险，但在某些情况下，新生儿出生后立即提供的母乳量不足或不存在。在这些情况下，其他治疗选择，如口服葡萄糖凝胶，可能会降低 NICU 入院的风险。目前的指南仍然基于专家意见和薄弱的证据。然而，与新生儿期低血糖症相关的神经发育障碍的医疗事故诉讼非常频繁，即使这些儿童有其他导致不良预后的重要因素。本综述旨在帮助儿科医生和新生儿科医生从生理学到治疗学全面理解新生儿低血糖症，希望这将有助于在证据不足的情况下，在这一领域做出合理的决策。
