neonatal hypoglycaemia

Source:
http://nnfpublication.org/Uploads/Articles/4c86270b-ac2d-4c04-b55b-abc5add3e623.pdf
Local Hospital protocol

• Make sure baby is warm
• On day 1: In terms of enteral feeding, Basically start at 60ml/kg/day, and go up to 90ml/kg/day - might be difficult to get more than that in at this stage
• If iv fluids are needed on day 1, start at 60ml/kg/day 10% dextrose, which can be increased to 90ml/kg/day; if BMs still low, increase concentration of dextrose rather than volume (max 12.5% dextrose via peripheral line) 

• Persistent or severe hypoglycaemia (requiring more than 10mg/kg/min of glucose or lasting longer than one week) may require further investigation and management e.g. with glucagon, diazoxide, steroids or surgery
• 10mg/kg/min = 144ml/kg/day of 10% dextrose = 115.2 ml/kg/day 12.5% dextrose

 Methods for calculating the glucose infusion rate mg/kg/min:

% of dextrose being infused x rate of infusion (in ml/hr)
 Body weight (in kg) x 6
(b)
Rate of IV fluids (in ml/kg/day) x % of dextrose infused
144
(c) Rate of IV fluids (in ml/kg/day) x % of dextrose infused x 0.007
Calculating the daily

fluid requirement for the desired glucose infusion rate:

infusion rate (mg/kg/min)* 144
% dextrose infused

Calculate GIR in an infant on oral feeds along with simultaneous intravenous infusion of glucose?

Glucose infusion rate while on feeding (mg/kg/min) =

• [IV rate (ml/hr) x Dextrose conc (g/dl) x .0167 / wt (kg)] + [Feed rate(ml/hr) x Dextrose conc* (g/dl) x .0167 / wt (kg)] 
• Amount of dextrose in milk : Breast milk = 7.1 gm/dL ,Term formula = 7.1gm/dL, Preterm formula = 8.5 gm/dL