26.    A 3-day-old infant was found to have a blood glucose level of 1.6 mmol/L

a)        What is your immediate management?

           1.    To raise the blood glucose above 2.5 mmol/L.

            2.    Give initial IV bolus infusion of 2 - 4 ml/kg of 10% glucose followed by continuous infusion of 8 mg/kg/min of glucose.

            3.    Consider glucagon and hydrocortisone if hypoglycaemia persists.

b)         What are the risk factors for this condition?

            1.    Prematurity: limited glycogen stores.

             2.    Infant of diabetic mother.

             3.    IUGR: limited glycogen and fat stores.

             4.    Hypothermia.

             5.    Asphyxia.

c)         What are the clinical signs?

            1.    Hypotonia.

            2.    Lethargy.

            3.    Poor feeding.

            4.    Jitteriness.

d)         How can this be prevented?

             All asymptomatic infants should be breast fed or given formula within the first few hours of life.