Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- Acknowledgments
- List of abbreviations
- 1 Fetal nutrition
- 2 Determinants of intrauterine growth
- 3 Aspects of fetoplacental nutrition in intrauterine growth restriction and macrosomia
- 4 Postnatal growth in preterm infants
- 5 Thermal regulation and effects on nutrient substrate metabolism
- 6 Development and physiology of the gastrointestinal tract
- 7 Metabolic programming as a consequence of the nutritional environment during fetal and the immediate postnatal periods
- 8 Nutrient regulation in brain development: glucose and alternate fuels
- 9 Water and electrolyte balance in newborn infants
- 10 Amino acid metabolism and protein accretion
- 11 Carbohydrate metabolism and glycogen accretion
- 12 Energy requirements and protein-energy metabolism and balance in preterm and term infants
- 13 The role of essential fatty acids in development
- 14 Vitamins
- 15 Normal bone and mineral physiology and metabolism
- 16 Disorders of mineral, vitamin D and bone homeostasis
- 17 Trace minerals
- 18 Iron
- 19 Conditionally essential nutrients: choline, inositol, taurine, arginine, glutamine and nucleotides
- 20 Intravenous feeding
- 21 Enteral amino acid and protein digestion, absorption, and metabolism
- 22 Enteral carbohydrate assimilation
- 23 Enteral lipid digestion and absorption
- 24 Minimal enteral nutrition
- 25 Milk secretion and composition
- 26 Rationale for breastfeeding
- 27 Fortified human milk for premature infants
- 28 Formulas for preterm and term infants
- 29 Differences between metabolism and feeding of preterm and term infants
- 30 Gastrointestinal reflux
- 31 Hypo- and hyperglycemia and other carbohydrate metabolism disorders
- 32 The infant of the diabetic mother
- 33 Neonatal necrotizing enterocolitis: clinical observations and pathophysiology
- 34 Neonatal short bowel syndrome
- 35 Acute respiratory failure
- 36 Nutrition for premature infants with bronchopulmonary dysplasia
- 37 Nutrition in infants with congenital heart disease
- 38 Nutrition therapies for inborn errors of metabolism
- 39 Nutrition in the neonatal surgical patient
- 40 Nutritional assessment of the neonate
- 41 Methods of measuring body composition
- 42 Methods of measuring energy balance: calorimetry and doubly labelled water
- 43 Methods of measuring nutrient substrate utilization using stable isotopes
- 44 Postnatal nutritional influences on subsequent health
- 45 Growth outcomes of preterm and very low birth weight infants
- 46 Post-hospital nutrition of the preterm infant
- Index
- References
31 - Hypo- and hyperglycemia and other carbohydrate metabolism disorders
Published online by Cambridge University Press: 10 December 2009
- Frontmatter
- Contents
- List of contributors
- Preface
- Acknowledgments
- List of abbreviations
- 1 Fetal nutrition
- 2 Determinants of intrauterine growth
- 3 Aspects of fetoplacental nutrition in intrauterine growth restriction and macrosomia
- 4 Postnatal growth in preterm infants
- 5 Thermal regulation and effects on nutrient substrate metabolism
- 6 Development and physiology of the gastrointestinal tract
- 7 Metabolic programming as a consequence of the nutritional environment during fetal and the immediate postnatal periods
- 8 Nutrient regulation in brain development: glucose and alternate fuels
- 9 Water and electrolyte balance in newborn infants
- 10 Amino acid metabolism and protein accretion
- 11 Carbohydrate metabolism and glycogen accretion
- 12 Energy requirements and protein-energy metabolism and balance in preterm and term infants
- 13 The role of essential fatty acids in development
- 14 Vitamins
- 15 Normal bone and mineral physiology and metabolism
- 16 Disorders of mineral, vitamin D and bone homeostasis
- 17 Trace minerals
- 18 Iron
- 19 Conditionally essential nutrients: choline, inositol, taurine, arginine, glutamine and nucleotides
- 20 Intravenous feeding
- 21 Enteral amino acid and protein digestion, absorption, and metabolism
- 22 Enteral carbohydrate assimilation
- 23 Enteral lipid digestion and absorption
- 24 Minimal enteral nutrition
- 25 Milk secretion and composition
- 26 Rationale for breastfeeding
- 27 Fortified human milk for premature infants
- 28 Formulas for preterm and term infants
- 29 Differences between metabolism and feeding of preterm and term infants
- 30 Gastrointestinal reflux
- 31 Hypo- and hyperglycemia and other carbohydrate metabolism disorders
- 32 The infant of the diabetic mother
- 33 Neonatal necrotizing enterocolitis: clinical observations and pathophysiology
- 34 Neonatal short bowel syndrome
- 35 Acute respiratory failure
- 36 Nutrition for premature infants with bronchopulmonary dysplasia
- 37 Nutrition in infants with congenital heart disease
- 38 Nutrition therapies for inborn errors of metabolism
- 39 Nutrition in the neonatal surgical patient
- 40 Nutritional assessment of the neonate
- 41 Methods of measuring body composition
- 42 Methods of measuring energy balance: calorimetry and doubly labelled water
- 43 Methods of measuring nutrient substrate utilization using stable isotopes
- 44 Postnatal nutritional influences on subsequent health
- 45 Growth outcomes of preterm and very low birth weight infants
- 46 Post-hospital nutrition of the preterm infant
- Index
- References
Summary
Disorders of glucose homeostasis
The presence of neonatal hypoglycemia or hyperglycemia signals a failure of the normal transition from fetal to postnatal patterns of glucose homeostasis. Under normal conditions, glucose from maternal circulation is transported across the placenta via specific glucose transporters to be used by the fetus. The high fetal insulin : glucagon ratio suppresses glycogenolysis and gluconeogenesis and stimulates hepatic glycogen deposition during late gestation.
At delivery, glucose delivery to the infant stops abruptly. Until an exogenous supply of substrate is provided, the infant must rely on hepatic glucose production to meet metabolic needs. Both glycogenolysis and gluconeogenesis contribute to glucose homeostasis during the first few days of extrauterine life. However, hepatic glucose production via these two pathways requires availability of glycogen and gluconeogenic precursors, appropriate levels and activity of hepatic enzymes necessary for glycogenolysis and gluconeogenesis, and a normal endocrine response. The absence of any of these components may result in neonatal hypoglycemia or hyperglycemia.
Hypoglycemia
Incidence and clinical presentation
The reported incidence of neonatal hypoglycemia varies depending on the population studied, the method used for glucose measurement, and the definition of hypoglycemia used. In appropriate-for-gestational-age (AGA) term infants the incidence ranges from 5%–30%, but may be as high as 50% in preterm infants, and 70% in small-for-gestational-age (SGA) infants. Clinical signs of hypoglycemia are nonspecific and may include lethargy, jitteriness, poor feeding, seizures, and temperature disturbances. The frequency of observation of the most common findings is listed in Table 31.1.
- Type
- Chapter
- Information
- Neonatal Nutrition and Metabolism , pp. 454 - 465Publisher: Cambridge University PressPrint publication year: 2006
References
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