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Metabolic Problems

  1. Hypoglycemia; Blood glucose level < 40 mg %(irrespective of gestation)

Causes of hypoglycemia are given below

Transient Hypoglycemia

  1. Inadequate substrate
    1. Premature and SGA Infants.
    2. Smaller of the twins.
    3. Infants of diabetic mother.
  2. Relative hyperinsulinsim as in infants of diabetic mothers.

Persistent Hypoglycemia

  1. Hyperinsulin states
    1. Beta cell hyperplasia (Nesidioblastosis)Adenoma of beta cells.
    2. Leucine sensitivity.
  2. Deficiency of harmons such as glucagon, Hgh, epinephrine adrenal and ACTH.
  3. Deficiency of substrate such as in ketotic hypoglycemia and maple syrup urine disease.
  4. Disorders of carbohydrate metabolism such as glycogen storage diseases and fructose intolerance.
  1. Hypocalcemia:
    1. Total calcium < 7.0 mg/dl
      Ionized calcium < 4.0 mg/dl
    2. Early - if occurs in first 3 days
    3. Late - Usually at the end of the first week.
    4. Early:
      1. Pre term
      2. IDM (Infants of Diabetic Mothers)
      3. Birth asphyxia
    5. Late: Hypoparathyroidism
      1. Vit D def
      2. Hyperphosphatemia
      3. Phototherapy
  2. Hypercalcemia:
    Total calcium > 11.0 mg/dl
    Ionized calcium > 5 mg /dl
  3. Hemorrhagic Disease Of Newborn: Vitamin K Deficiency.
    1. Early: Onset within 24 his
    2. Maternal illness- warfarin, phenytoin, phenobarbitone
    3. Classical:
      1. 1 -7 days
      2. More common in breast feed babies
    4. Late:
      1. 2nd-16th week
      2. Chronic diarrhea, malabsorption
      3. Prolonged diarrh
    1. Venous hematocrit over 65%
    2. Hypoglycorrachia, hyperbilirubinemia
    3. Hypocalcemia



Plethoric / Poor sucking / Jitteriness / Seizure / Tachypnea

Chest X-ray: Prominent pulmonary vascular marking.






65 – 70%

Hydration and monitoring

70 – 75%




Hydration and monitoring

Partial Exchange Transfusion


Partial Exchange Transfusion

  1. Hypothermia
    1. Normal temperature: 36.5-37.5°C
    2. Cold stress: 36.5-36.0°C
    3. Moderate hypothermia: 36-32°C
    4. Severe hypothermia < 32°C

Neonatal cold injury - presenting feature are apathy, refusal of food, oliguria, and coldness body temperature is usually between 29.5-350C

  1. Edema, redness of the extremity especially of the hands feet and face
  2. Bradycardia and apnea may also occurs
  3. Rhinitis is common
  4. Metabolic disturbances - particularly hypoglycemia and acidosis, hypoxemia
  5. Hemorrhagic manifestations are common, massive pulmonary hemorrhage is a common finding at autopsy
  6. Newborn babies have only non shivering thermogenesis employing brown fat.

Immunological system is depressed leading to

  1. Increased incidence of septicemia
  2. Sclerema
  3. DIC

Most imp. Mechanism of Heat Loss in neonates

  1. At birth- Evaporation
  2. After birth- Radiation
  3. In incubator- Radiation
  4. Under radiant warmer- Convection

Most imp. Mechanism of Heat gain/exchange in neonates

  1. In incubator- Convection
  2. Under radiant warmer- Radiation
  1. Infant of diabetic mother:- Special features
    1. Fetus may suddenly die during the last trimester of pregnancy.
    2. Preterm delivery may have to be included to avoid third trimester fetal ndeath.
    3. Macrosomia or large size of the body and its attending risks during delivery such as birth trauma, asphyxia and increased possibilities of cesarean section. (A few infants may rarely suffer from intrauterine growth retardation.)
    4. Neonatal respiratory distress.
    5. Hypoglycemia
    6. Hyperbillirubinemia.
    7. Polycythemia and increased viscosity of blood.
    8. Higher risk of congenital anomalies. Infants of mothers with gestational diabetes are 20.6 times more at risk to develop cardiovascular defects.
    9. Cardiomyopathy and persistent pulmonary hypertension.
    10. Lazy left colon syndrome.

Long Term Complications

  1. Obesity - up to 50%
  2. Risk of subsequent overt diabetes
  3. Adverse neurodevelopment in 4% of cases (may relate to maternal ketosis)
  1. ROP

Systemic ophthalmologic examination of infants at risk of retinopathy of prematurity (ROP) is recommended. Although the guidelines vary but generally include infants weighing less than 1,500 gm at birth and those born before 32 weeks of gestational age.

Infants born weighing over 1,500 gm and having an unstable clinical course and thought to be at risk should also be examined for ROP.

The initial examination should be performed between 4 and 6 weeks of chronological age or at 34 weeks of postconceptional age. ROP is diagnosed most often at 32-44 week postconceptional.



  1. Retrolental fibroplasia occurs in premature infants treated with oxygen at concentrations above ambient air levels.
  2. The increased arterial oxygen tensions that result may lead to severe arterial vasoconstriction with subsequent hypoxic damage to the immature retina.
  3. The exact level or duration of elevated arterial pO2 that results in injury is not known, but arterial oxygen tension should be kept between 50-80 mmHg. Immaturity and periods of relative retinal HYPEROXIA are considered to be major factors in the development of this disorder.

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