Neonatal hypoglycemia (Draft of clinical guidelines)

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Abstract

Neonatal hypoglycemia is one of the most common metabolic disorders in newborns, characterized by a high risk of developing neurological complications, including long-term ones, and, as a consequence, leading to a decrease in the quality of life of patients. As a rule, neonatal hypoglycemia is transient and is caused by the physiological characteristics of the infant’s body. The mechanism of development of transient neonatal hypoglycemia is based on transient hyperinsulinism and deficiency of alternative glucose sources in the neonatal period. In some cases, hypoglycemia can be caused by congenital metabolic disorders, enzymopathies and endocrine diseases. The frequency of neonatal hypoglycemia varies depending on the diagnostic threshold, the screening protocol used, the method of measuring blood glucose levels, and the population studied. According to the latest meta-analyses and systematic reviews, neonatal hypoglycemia is observed in 5–15% of healthy newborns and in 50% of children from the risk group. Despite the large number of clinical protocols for the management of patients with neonatal hypoglycemia, there is no single algorithm. This draft clinical guidelines for the diagnosis and treatment of neonatal hypoglycemia in children were prepared by a group of authors, leading domestic specialists in the field of neonatology, pediatrics and pediatric endocrinology. The information on the epidemiology, modern classification of neonatal hypoglycemia, methods of their diagnosis, screening and treatment, based on the principles of evidence-based medicine, is presented.

About the authors

Dmitry O. Ivanov

Saint Petersburg State Pediatric Medical University

Author for correspondence.
Email: spb@gpma.ru
ORCID iD: 0000-0002-0060-4168
SPIN-code: 4437-9626

MD, PhD, Dr. Sci. (Medicine), Professor, Head of the Department of Neonatology with Courses in Neurology and Obstetrics-Gynecology of the Faculty of Postgraduate and Additional Professional Education, Rector

Russian Federation, Saint Petersburg, 194100

Yuriy V. Petrenko

Saint Petersburg State Pediatric Medical University

Email: Klinika.spb@gpmu.org
ORCID iD: 0000-0002-8623-4574
SPIN-code: 1644-1394

MD, PhD, Associate Professor of the Department of Neonatology with Courses in Neurology and Obstetrics-Gynecology of the Faculty of Postgraduate and Additional Professional Education, Chief freelance neonatologist of the Northwestern Federal District of the Russian Federation, Vice-Rector for National Projects and therapeutic work

Russian Federation, Saint Petersburg, 194100

Ludmila V. Tyrtova

Saint Petersburg State Pediatric Medical University

Email: dr-tyrtova@yandex.ru
ORCID iD: 0000-0003-4417-1373
SPIN-code: 2869-0568

MD, PhD, Dr. Sci. (Medicine), Professor, Department of faculty pediatrics, Honored Doctor of the Russian Federation

Russian Federation, Saint Petersburg, 194100

Liliya V. Ditkovskaya

Saint Petersburg State Pediatric Medical University

Email: Liliya-ditkovskaya@yandex.ru
ORCID iD: 0000-0002-9407-817X
SPIN-code: 5771-0580

MD, PhD, Associate Professor, Professor I.M. Voronsov Department of Childhood Diseases of the Faculty of Postgraduate and Additional Professional Education

Russian Federation, Saint Petersburg, 194100

Galina N. Chumakova

Saint Petersburg State Pediatric Medical University

Email: zelchum-neo@yandex.ru
ORCID iD: 0000-0001-5353-4610
SPIN-code: 1821-0198

Gynecology of the Faculty of Postgraduate and Additional Professional Education

Russian Federation, Saint Petersburg, 194100

Aleksei S. Olenev

Saint Petersburg State Pediatric Medical University

Email: olenev.alse@yandex.ru
ORCID iD: 0000-0003-3289-4400
SPIN-code: 6348-3466

MD, PhD, Associate Professor, Department of faculty pediatrics

Russian Federation, Saint Petersburg, 194100

Natalia V. Parshina

Saint Petersburg State Pediatric Medical University

Email: dr-parshinanv@yandex.ru
ORCID iD: 0009-0007-4212-1571
SPIN-code: 9530-9348

MD, PhD, Associate Professor, Department of faculty pediatrics

Russian Federation, Saint Petersburg, 194100

Irina V. Solodkova

Saint Petersburg State Pediatric Medical University

Email: isolodkova@mail.ru
ORCID iD: 0000-0003-3559-6003
SPIN-code: 7295-1721

MD, PhD, Assistant Professor, Department of hospital pediatrics

Russian Federation, Saint Petersburg, 194100

Olga I. Maryina

Saint Petersburg State Pediatric Medical University

Email: olga210697@yandex.ru
ORCID iD: 0000-0001-5399-828X
SPIN-code: 2329-6271

Postgraduate Student, Professor I.M. Voronsov Department of Childhood Diseases, Faculty of Postgraduate and Additional Professional Education

Russian Federation, Saint Petersburg, 194100

References

  1. Ponomaryova LP, Shabalov NP. Early neonatal adaptation and transient (borderline with norm) physiologic states. In: Neonatology: national guidelines. Volodin NN, editor. Moscow: GEOTAR-Media; 2014. P. 73–77. (In Russ.)
  2. Narvey MR, Marks SD. The screening and management of newborns at risk for low blood glucose. Paediatr Child Health. 2019;24(8):536–544. doi: 10.1093/pch/pxz134
  3. Wackernagel D, Gustafsson A, Edstedt Bonamy A-K, et al. Swedish national guideline for prevention and treatment of neonatal hypoglycaemia in newborn infants with gestational age ≥35 weeks. Acta Paediatr. 2020;109(1):31–44. doi: 10.1111/apa.14955
  4. Taranushenko TE, Kiseleva NG, Lazareva OV, Kalygnaja II. Hypoglycemia in neonates: a review of the literature and a case report. Problems of Endocrinology. 2019;65(4):251–262. doi: 10.14341/probl8336 EDN: DWZCDO
  5. de Angelis LC, Brigati G, Polleri G, et al. Neonatal hypoglycemia and brain vulnerability. Front Endocrinol. 2021;12:634305. doi: 10.3389/fendo.2021.634305
  6. W ight NE. ABM clinical protocol #1: Guidelines for glucose monitoring and treatment of hypoglycemia in term and late preterm neonates, revised 2021. Breastfeed Med. 2021;16(5):353–365. doi: 10.1089/bfm.2021.29178.new EDN: YDCZIQ
  7. Zhou Y, Bai S, Bornhorst JA, et al. The effect of early feeding on initial glucose concentrations in term newborns. J Pediatr. 2017;181:112–115. doi: 10.1016/j.jpeds.2016.10.032
  8. Ivanov DO. Glucose metabolism disorders. In: Manual of perinatology. In 2 vol. Vol. 2. 2nd edit. Saint Petersburg: Inform-Navigator; 2019. P. 173–194. EDN: PKODQR (In Russ.)
  9. Raykina E N, Bolmasova AV, Pankratova MS, Bezlepkina OB. Neonatal hypoglycemia: analytical review. Archives of Pediatrics and Pediatric Surgery. 2024;2(2):40–46. EDN: PTYCOM doi: 10.31146/2949-4664-apps-2-2-40-46
  10. Kimble К, Lee J, Sutherns S, et al. Hypoglycaemia — newborn. Maternity and neonatal queensland clinical guideline. 2023, 29 p.
  11. Roeper M, Hoermann H, Kummer S, Meissner T. Neonatal hypoglycemia: lack of evidence for a safe management. Front Endocrinol. 2023;14:1179102. doi: 10.3389/fendo.2023.1179102
  12. Edwards T, Harding JE. Clinical aspects of neonatal hypoglycemia: A mini review. Front Pediatr. 2021;8:562251. doi: 10.3389/fped.2020.562251
  13. Harding JE, Harris DL, Hegarty JE, et al. An emerging evidence base for the management of neonatal hypoglycaemia. Early Hum Dev. 2017;104:51–56. doi: 10.1016/j.earlhumdev.2016.12.009
  14. Mitchell NA, Grimbly C, Rosolowsky ET, et al. Incidence and risk factors for hypoglycemia during fetal-to-neonatal transition in premature infants. Front Pediatr. 2020;8:34. doi: 10.3389/fped.2020.00034
  15. Wang D, Zhou X, Ning J, et al. Risk factors for neonatal hypoglycemia: a meta-analysis. BMC Endocr Disord. 2024;24:166. doi: 10.1186/s12902-024-01700-7
  16. Hewitt V, Watts R, Robertson J, Haddow G. Nursing and midwifery management of hypoglycaemia in healthy term neonates. Int J Evid-Based. 2005;3(7):169–205. doi: 10.1097/01258363-200508000-00001
  17. Agarwal R. Hypoglycemia in the newborn screening for hypoglycemia. Evidence-based protocols for neonatal practice. New Delhi: AIIMS; 2012.
  18. Mark A. Sperling pediatric endocrinology. 5 th edit. Philadelphia; 2020. P. 175–183.
  19. Cornblath M, Hawdon JM, Williams AF, et al. Controversies regarding definition of neonatal hypoglycemia: suggested operational thresholds. Pediatrics. 2000;105(5):1145–1145. doi: 10.1542/peds.105.5.1141
  20. Group of Neonatology, Pediatric Society, Chinese Medical Association. Expert consensus on standard clinical management of neonatal hypoglycemia in China (2021). Chinese Journal of Contemporary Pediatrics. 2022;24(1):1–13. doi: 10.7499/j.issn.1008-8830.2108061
  21. Banerjee I, Mohnike K, editors. The problem of childhood hypoglycemia. Frontiers Media SA, 2023. doi: 10.3389/978-2-8325-2623-1
  22. Thornton PS, Stanley CA, De Leon DD, et al. Recommendations from the pediatric endocrine society for evaluation and management of persistent hypoglycemia in neonates, infants, and children. J Pediatr. 2015;167(2):238–245. doi: 1 0.1016/j.jpeds.2015.03.057
  23. O’Brien M, Gilchrist C, Sadler L, et al. Infants eligible for neonatal hypoglycemia screening: a systematic review. JAMA Pediatrics. 2023;177(11):1187–1196. doi: 10.1001/jamapediatrics.2023.3957
  24. Giouleka S, Gkiouleka M, Tsakiridis I, et al. Diagnosis and management of neonatal hypoglycemia: a comprehensive review of guidelines. Children. 2023;10(7):1220. doi: 10.3390/children10071220
  25. Papageorghiou AT, Ohuma EO, Altman DG, et al. International fetal and newborn growth consortium for the 21st century (INTERGROWTH-21st). Project. Lancet. 2014;384(9946):869–879. doi: 10.1016/S0140-6736(14)61490-2
  26. Bamehrez M. Hypoglycemia and associated comorbidities among newborns of mothers with diabetes in an academic tertiary care center. Front Pediatr. 2023;11:1267248. doi: 10.3389/fped.2023.1267248
  27. de Leon DD, Arnoux JB, Baneerje I, et al. International guidelines for the diagnosis and management of hyperinsulinism. Horm Res Paediatr. 2023;97(3):279–298. doi: 10.1159/000531766
  28. Chapter hypoglycaemia. In: Neonatal guidelines 2022 –2024. The bedside clinical guidelines partnership in association with the West midlands neonatal operational delivery network. 2022. P. 174–181.
  29. Aliefendioğlu D, Coban A, Hatipoglu N, et al. Approach to hypoglycemia in the newborn: Turkish neonatal and pediatric endocrinology and diabetes societies consensus report. Turk Pediatri Arsivi. 2018;53(S1):S224–S233. doi: 10.5152/TurkPediatriArs.2018.01820
  30. Melikyan MA. Federal clinical practice guidelines on the diagnostics, treatment, and management of the children and adolescents presenting with congenital hyperinsulinism. Problems of Endocrinology. 2014;60(2):31–41. EDN: TGSJYD doi: 10.14341/probl201460231-41
  31. Shabalov NP. Neonatology: textbook. Moscow : MEDpress-Inform; 2004. (In Russ.)
  32. Salum SS, Kalabamu FS, Fataki MR, et al. Asymptomatic hypoglycemia among preterm newborns: A cross-sectional analysis. PLoS ONE. 2024;19(4):e0301803. doi: 10.1371/journal.pone.0301803
  33. Stanley CA, Thornton PS, de Leon DD. New approaches to screening and management of neonatal hypoglycemia based on improved understanding of the molecular mechanism of hypoglycemia. Front Pediatr. 2023;11:1071206. doi: 10.3389/fped.2023.1071206
  34. Bolisetty S, Osborn D, Shindler T, et al. Standardised neonatal parenteral nutrition formulations — Australasian neonatal parenteral nutrition consensus update 2017. BMC Pediatrics. 2020;20:59. doi: 10.1186/ s12887-020-1958-9
  35. Volodin NN, editor. Parenteral nutrition of newborns. Clinical recommendations. 2015. 32 p. (In Russ.)
  36. Walsh EPG, Alsweiler JM, Ardern J, et al. Glucagon for neonatal hypoglycaemia: systematic review and meta-analysis. Neonatology. 2022;119(3):285–294. doi: 10.1159/000522415
  37. Lord LG, Harding JE, Crowther CA, Lin L. Skin-to-skin contact for the prevention of neonatal hypoglycaemia: a systematic review and meta-analysis. BMC Pregnancy and Childbirth. 2023;23:744. doi: 10.1186/s12884-023-06057-8
  38. FGAU “NMIC Children’s Health Center” of the Ministry of Health of Russia. Program of optimization of infant feeding for the first year of life in the Russian Federation: methodological recommendations. Moscow: [b. i.]; 2019. 112 p. (In Russ.)
  39. Oladimeji OI, Harding JE, Crowther CA, Lin L. Expressed breast milk and maternal expression of breast milk for the prevention and treatment of neonatal hypoglycemia: a systematic review and meta-analysis. Matern Health Neonatol Perinatol. 2023;9:12. doi: 10.1186/s 40748-023-00166-0
  40. Ionov OV, Degtyarev DN, Kirtbay AR, et al. Emergency conditions in newborn children: a guide for physicians. Moscow: GEOTAR-Media; 2020. 416 p. (In Russ.)

Supplementary files

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2. Fig. 1. Scheme of selective screening of newborns from the high-risk group for the development of neonatal hypoglycemia

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3. Fig. 2. Treatment regimen for neonatal hypoglycemia

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