Posted January 27Jan 27 Good time for all! Dear colleagues, we are talking about preterm, late preterm, early term babies, and it’s very important for everybody. But the babies with gestational age about 42+ weeks are without our attention. We observed two babies with serious hypoglycemia (0,1 mmol/l) with seizures at 3 days of life, which we explained by transient hyperinsulinism associated with post term age. Seizures rapidly stopped by intravenous glucose infusion without any complications. Intravenous glucose 10% 12-8- 6 mg/kg/min infusion was 3 h, oral 20% 2 ml/kg hourly 6 h, and didn’t use after 9 hours of start with normal glucose blood tests. Both babies were on breastfeeding, 3500&3880 g weighted, and haven’t complications in pregnancy and mother’s diabetes before or during pregnancy. I couldn’t find any studies dedicated hypoglycemia and other metabolism problems in post term group of neonates, and with to ask your thoughts and your help. We haven’t any hormonal and genetics tests now. Many thanks for attention.
January 29Jan 29 Interesting observation, did you measure serum levels of insulin?I have always thought that the higher risk of post.term infants to develop hypoglycemia (like doubled even in "low-risk" post-term deliveries https://fn.bmj.com/content/102/4/F286.long) was related to less good energy storages but interestingly, the MSD manual mentions that post-term infants may have higher levels of insulin (https://www.msdmanuals.com/professional/pediatrics/perinatal-problems/postterm-infants) I tried but failed to find levels on s-insulin in post-term infants on Pubmed, anyone else with input?
January 29Jan 29 Author Many thanks, Stefan, for your answer and links! Unfortunately we haven’t the opportunity of insulin level measurement. We many discussed our cases about, and hypothesized the next: babies were with normal trophic and haven’t problem with breastfeeding, haven’t serious weight loss, on hypoglycemia day they were 42+2, 42+3 postconceptual weeks, that poor glycogen store and transient hyperinsulinism are the reason. It’s only our hypothesis, unfortunately.
January 29Jan 29 Interesting discussion here! I would also think that depleted energy storages (fat and glycogen) due to post- term pregnancy plus some perinatal stress or increased metabolic demand could be responsible: "Infants experiencing perinatal stress (e.g., fetal distress, perinatal ischemia, maternal preeclampsia/eclampsia, sepsis, hypothermia) or those with congenital heart disease have increased metabolic energy requirements, which puts them at risk for hypoglycemia. Perinatal stress causes a state of 'hypoglycemic hyperinsulinism' that can persist for days to weeks, resulting in persistently low glucose concentrations requiring ongoing interventions to maintain euglycemia." https://www.ncbi.nlm.nih.gov/books/NBK537105/#:~:text=Infants are at risk for,excessive insulin production or increased Were there any difficulties with feeding? Do you know what was the interval between feeding and the occurrence of seizures? What was the mode of birth?
January 30Jan 30 Author We discussed many time about hypoglycemia. And because both babies were with normal weight, normal nutrition, the energy store isn’t so important in hypoglycemia origin. Probably transient hyperinsulinemia is the main reason of. If we extrapolate the case on term infant, we know that in 2 weeks age the nutrition is 200 ml/kg per day and more, but in post term group the volume of nutrition is 70-90 ml/kg per day, and energy intake is restricted too. But, probably, the pancreas stimulation accordingly postconceptual age can be transient excessive, but appropriate the term infant of 2 weeks. It may the key point of hypoglycemia in post term group infant. Sorry my poor English. 13 hours ago, piatkat said: Interesting discussion here! I would also think that depleted energy storages (fat and glycogen) due to post- term pregnancy plus some perinatal stress or increased metabolic demand could be responsible: "Infants experiencing perinatal stress (e.g., fetal distress, perinatal ischemia, maternal preeclampsia/eclampsia, sepsis, hypothermia) or those with congenital heart disease have increased metabolic energy requirements, which puts them at risk for hypoglycemia. Perinatal stress causes a state of 'hypoglycemic hyperinsulinism' that can persist for days to weeks, resulting in persistently low glucose concentrations requiring ongoing interventions to maintain euglycemia." https://www.ncbi.nlm.nih.gov/books/NBK537105/#:~:text=Infants are at risk for,excessive insulin production or increased Were there any difficulties with feeding? Do you know what was the interval between feeding and the occurrence of seizures? What was the mode of birth? The both infants were clinically before and after hypoglycemic episodes absolutely normally. They haven’t breastfeeding difficulties, the frequencies of feeding were 10-12 times per day, without the night pause. We can’t image so low level of glucose only with low energy store. May be we are wrong.
Create an account or sign in to comment