Published online by Cambridge University Press: 15 February 2010
Hypoglycaemia in infants of diabetic mothers should be anticipated and all infants should have early and regular glucose measurements until these are stable.
Hypoglycaemia may be asymptomatic or symptomatic.
Approach to the problem
Expectant management in all infants of diabetic mothers.
Early enteral feeds.
Regular (1–2 hourly) blood sugar measurements for first 12 h.
Other causes of hypoglycaemia (see Chapter 2).
Blood glucose level.
Other investigations for hypoglycaemia are not usually required unless hypoglycaemia is persistent.
Calcium and magnesium levels are required in symptomatic babies as symptoms overlap.
Haematocrit should be assessed if the baby appears plethoric or blood sugar is difficult to control (dilutional exchange transfusion may be required if the baby is polycythaemic).
If able to tolerate enteral feeds, increase the volume and frequency of the feeds.
If unable to tolerate feeds, commence an intravenous (IV) infusion and titrate the quantity of glucose to maintain the blood glucose concentration >2.6 mmol/L. Use a higher concentration of glucose via a central line (silastic long-line or umbilical venous catheter) rather than excess volumes of 10% dextrose as the latter is likely to result in fluid overload and hyponatraemia.
If IV access is difficult, intramuscular glucagon (100–200 µg/kg/dose) or buccal hypostop (40% glucose polymer, 1 mL/kg) may restore euglycaemia and buy time to achieve vascular access.