PRACTICE PARTNER
Use screening guidelines to detect
significant hypoglycemia in infants
P
ediatric care providers are
reminded of the importance
of recognizing infants at risk
for hypoglycemia and initiating
appropriate screening protocols to
detect significant hypoglycemia.
The recommendation comes from
the Chief Coroner’s Maternal and
Perinatal Death Review Committee in its review of the death of an
eight-day old infant.
The infant was born at term in
good condition after an induction
of labour for decreased fetal growth.
She was discharged home at four
hours of age. An examination by the midwife
at home the next day was considered normal.
Later that evening, however, the infant
became irritable and difficult to settle. By
the next morning, she became lethargic and
off-colour and was taken to hospital for assessment. Upon presentation, she was limp,
cyanotic and unresponsive. After initial
improvement with endotracheal intubation,
she had what appeared to be a cardiorespiratory arrest and required extensive resuscitative
efforts to revive her. Although her cardiorespiratory status subsequently improved, she
had recurrent seizure activity and showed evidence of severe central nervous system injury
that was confirmed by radiologic and electrophysiologic studies at the children’s hospital.
The prognosis was considered very poor and
she died after withdrawal of life-sustaining
medical therapy at eight days of age.
The cause of the infant’s severe CNS injury
is unclear. The pathologist performing the
post mortem examination attributed it to
hypoxia-ischemia from the cardiopulmonary
arrest the infant suffered after arrival at the
hospital. However, the arrest was shortlived,
blood gases taken shortly thereafter failed
to reveal severe metabolic acidosis and there
was little evidence of other end-organ damage. If hypoxia-ischemia from an arrest were
to cause CNS injury of the extent apparent
with this infant, one would expect a much
more deranged blood gas picture shortly after
the event and evidence of collateral organ
damage. The extent of the CNS injury is difficult to explain and the reason for the arrest
remains unclear.
Acute life-threatening events in newborns
are most commonly due to infectious, respiratory, cardiac or metabolic causes. An exhaustive work up performed to identify the cause
in this infant’s case was inconclusive. Sepsis
was ruled out and there was no evidence of
an inborn error of metabolism. Post mortem
examination showed no evidence of congeni-
DIALOGUE • Issue 3, 2014
PRACTICE PA IQ9H()Q