Clinical presentation

• 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.

Differential diagnosis

Other causes of hypoglycaemia (see Chapter 2).

Investigations

• 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).

Management

Immediate

• 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.

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