Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Glucose metabolism and evaluation of hypoglycemia in neonates

신생아에서의 포도당 대사와 저혈당증의 평가

  • Kim, Eun Young (Department of Pediatrics, College of Medicine, Chosun University)
  • 김은영 (조선대학교 의과대학 소아과학교실)
  • Received : 2007.02.20
  • Accepted : 2007.02.20
  • Published : 2007.03.15
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Abstract

The fetus is completely dependent on mother for glucose and other nutrient transfer across the placenta. At birth, when the maternal supply is discontinued, the neonate must adjust to an independent existence. The changes in the neonate's glucose homeostasis during this transition to the extrauterine environment are influenced by the mother's metabolism and intrinsic fetal and placental problems. Maturation of carbohydrate homeostasis results from a balance between substrate availability and coordination of developing hormonal, enzymatic, and neural systems. These mechanisms may not be fully developed in neonates, so the neonate is vulnerable to carbohydrate disequilibrium resulting in damage to the central nervous system. Hypoglycemia is a relatively common metabolic problem seen during newborn care. However its definition, management and long term sequalae remain controversial. Hyporglycemia occurs frequently as a transient disorder with excellent prognosis. It also may persist and recur and cause permanent neurological complications. Although the key to effective treatment of hypoglycemia is diagnostic specific, the maintenance of euglycemia is critical to the preservation of central nervous system function. This article discusses physiology of perinatal glucose homeostasis, focusing on evaluation and treatment of hypoglycemia.

Keywords

References

  1. Bier DM, Leake RD, Haymond MW, Arnold KJ, Gruenke LD, Sperling MA, et al. Measurement of true glucose production rates in infancy and childhood with 6,6-dideuteroglucose. Diabetes 1977;26:1016-23 https://doi.org/10.2337/diabetes.26.11.1016
  2. Sperling MA: Carbohydrate metabolism: Insulin and glucagon. In Tulchinsky D, Little AB(eds): Maternal-Fetal Endocrinology. Philadelphia: WB Saunders 1994:380-400
  3. Cryer PE. Glucose homeostasis and hypoglycemia. In: Larson PR, Kronenberg HM, Melmed S, Polonsky KS, editors. Williams textbook of endocrinology. 10th ed. Philadelphia: WB Saunders Co 2002:1585-618
  4. Girard J. Gluconeogenesis in late fetal and early neonatal life. Biol Neonate 1986;50:237-58 https://doi.org/10.1159/000242605
  5. Bloch CA, Ozbun MA, Khan SA. Gycogen phosphorylase; developmental expression in rat liver. Biol Neonate 1993;63: 113-9 https://doi.org/10.1159/000243919
  6. Granner D, Andreone T, Sasaki K, Beale E. Inhibition of transcription of the phosphoenol pyruvate carboxylase gene by insulin. Nature(Lond) 1983;305:549-51 https://doi.org/10.1038/305549a0
  7. Cahill GF Jr. Starvation in man. N Engl J Med 1970;282: 668-75 https://doi.org/10.1056/NEJM197003192821209
  8. McGarry JD. New perspectives in the regulation of ketogenesis. Diabetes 1979;28:517-23 https://doi.org/10.2337/diab.28.5.517
  9. Stanley CA, Baker L. Hyperinsulinism in infants and children; diagnosis and therapy. Adv Pediatr 1976;23:315-55
  10. Stanley CA, Thornton PS, Finegold DN, Sperling MA. Hypoglycemia in neonates and infants. In Sperling MA, editor. Pediatric endocrinology 2nd ed. Philadelphia: WB Saunders Co 2002:135-59
  11. Whipple AO, Fratz DK. Adenoma of islet cells with hyperinsulinism: a review. Ann Surg 1935;101:1299-310 https://doi.org/10.1097/00000658-193506000-00001
  12. Cornblath M, Hawdon JM, Williams AF, Aynsley-Green A, Ward-Platt MP, Schwartz R, et al. Controversies regarding definition of neonatal hypoglycemia; suggested operational thresholds. Pediatrics 2000;105:1141-5 https://doi.org/10.1542/peds.105.5.1141
  13. Wilker RE. Hypoglycemia and hyperglycemia. In: Cloherty JP, Eichenwald EC, Stark AR, editors. Manual of neonatal care 5th ed. Philadelphia: Lippincott Williams & Wilkins 2004:335-49
  14. Kalhan SC, Parimi PS. Disorders of carbohydrate metabolism. In: Martin RJ, Fanaroff AA, Walsh MC, editors. Fanaroff and Martin's Neonatal-perinatal medicine. Diseases of the fetus and infant. 8th ed. Philadelphia : Mosby 2006:1467-589
  15. Lubchenco LO, Bard H: Incidence of hypoglycemia in newborn infants by birth weight and gestational age. Pediatrics 1971;47:831-8
  16. Embleton ND, Ward-Platt MP. Management of hypoglycemia in the newborn. Curr Paediatr 2003;13:134-9 https://doi.org/10.1054/cupe.2002.0427
  17. Lubchenco LO, Bard H. Incidence of hypoglycemia in newborn infants classified by birth weight and gestational age. Pediatrics 1971;47:831-8
  18. Schultz K, Soltesz G: Transient hyperinsulinism in asphyxiated newborn infants. Acta Paediatr Hung 1991;31:47-52
  19. Creswell JS, Warburton D, Susa JB, Cowett RM, Oh Wl. Hyperviscosity in the newborn lamb produces pertubation in glucose homeostasis. Pediatr Res 1981;15:1348-50 https://doi.org/10.1203/00006450-198110000-00009
  20. Finegold DN, Stanley CA, Baker L. Glycemic response to glucagon during fasting hypoglycemia; an aid in the diagnosis of hyperinsulinism. J Pediatr 1980;96:257-9 https://doi.org/10.1016/S0022-3476(80)80817-1
  21. Levitt Katz LE, Satin-Smith MS, Collett-Solberg P, Thornton PS, Baker L, Stanley CA, et al. Insulin-like growth factor binding protein-1 levels in the diagnosis of hypoglycemia caused by hyperinsulinism [see comments]. J Pediatr 1997; 131:171-3
  22. Glaser B, Thornton P, Otonkoski T, Junien C. Genetics of neonatal hyperinsulinism. Arch Dis Child Fetal Neonatal Ed 2000;82:F79-86 https://doi.org/10.1136/fn.82.2.F79
  23. Shilyansky J, Fisher S, Cutz E, Perlman K, Filler RM. Is 95% pancreatectomy the procedure of chosice for treatment of persistent hyperinsulinemic hypoglycemia of the neonate? J Pediatr Surg 1997;32:342-6 https://doi.org/10.1016/S0022-3468(97)90207-4
  24. Glaser B, Kesavan P, Heyaman M, Davis E, Cuesta A, Buchs A, et al. Familial hyperinsulinism caused by an activating glucokinase mutation N Engl J Med 1998;338:226-30 https://doi.org/10.1056/NEJM199801223380404
  25. Huijmans JG, Duran M, De Klerk JB, Rovers MJ, Scholte HR. Functional hyperactivity of hepatic glutamate dehydrogenase as a cause of the hyperinsulinism/hyperammonemia syndrome: effect of treatment. Pediatrics 2000;106:596-600 https://doi.org/10.1542/peds.106.3.596
  26. de Lonlay-Debeney P, Poggi-Travert F, Fournet JC, Sempoux C, Vici CD, Brunnele F, et al. Clinical features of 52 neonates with hyperinsulinism. N Engl J Med 1999;340: 1169-75 https://doi.org/10.1056/NEJM199904153401505
  27. Pettenati MJ, Haines JL. Higgins RR, Wappner RS, Palmer CG, Weaver DDl. Wiedemann-Beckwith syndrome: presentation of clinical and cytogenic data on 22 new cases and review of the literature. Hum Genet 1986;74:143-54 https://doi.org/10.1007/BF00282078
  28. Lovinger RD, Kaplan SL, Grumbach MM: Congenital hypopitruitarism associated with neonatal hypoglycemia and microphallus: Four cases secondary to hypothalamic hormone deficiencies. J Pediatr 1975;87:1171-81 https://doi.org/10.1016/S0022-3476(75)80132-6
  29. Sperling MA, Menon RK. Differential diagnosis and management of neonatal hypoglycemia. Pediatr Clin North Am 2004;41:703-23
  30. Hay WW Jr. Disorders of Glucose Metabolism. In: Rudolph CD, Rudolph AM, Hostetter MK, Lister G, Siegel NJ, editors. Rudolph's Pediatrics. 21th ed. New York : McGraw- Hill 2002:155-61