Glucose metabolism is not well developed in the newborn period and the critically ill neonate is liable to develop hypoglycemia at times of acute stress, particularly the preterm infant. This may be as a result of: (1) diminished glycogen stores (inadequate stores in the premature or depletion from catecholamine stimulated glycogen break- down release in perinatal stress); (2) hyperinsulinemia in infants of diabetic mothers; (3) inadequate glucose produc- tion in small for gestational age infants. Failure to recognize and correct neonatal hypoglycemia will result in seizures
and brain damage. In order to prevent this it is recom- mended that a minimum of 10% dextrose with saline be used in all maintenance fluid infusions in the newborn after surgery. In addition the blood sugar should be regularly measured to prevent hypoglycemia (B1.1 mmol/L in the preterm and B1.7 mmol in the term infant). Persistent hypoglycemia may require further boluses and increasing the infusion to 15% dextrose. Where the hypoglycemia is due to delay in glucose release from glycogen stores in the liver, the administration of glucagon 300mg/kg or steroid may result in a rise in blood sugar.152Infants receiving high concentration dextrose infusions have increased blood insulin levels. Abrupt discontinuation of the infusion will result in rebound hypoglycemia and therefore these should be weaned gradually.
Hypocalcemia is common in the newborn period, but measurements of the total serum calcium do not accurately reflect the level of ionized calcium (Ca) in the blood.
Levels of total serum Ca above 1.75 mmol/L rarely cause problems but levels below 1.5 mmol/L may result in seizures, apnea, and low cardiac output. Critically ill infants in the first 2448 hours of life, infants of diabetic mothers, and new- borns who have undergone large volume blood transfusions are all at risk for developing hypocalcemia. Calcium infusions should be given preferentially through central venous lines because of the tendency to cause intense venous irritation and damage to skin.
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