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Hormonal and metabolic response to hypoglycaemia in small for gestational age infants
J M Hawdon1, A Weddell, A Aynsley-Green
1Department of Child Health, University of Newcastle upon Tyne.
Insights
Hypoglycaemic infants who are small for gestational age (SGA) exhibit a poorly coordinated hormonal response to low blood glucose. This impaired counterregulation hinders their ability to mobilize alternative fuels, necessitating careful monitoring and energy support.
Area of Science:
- Neonatal Medicine
- Endocrinology
- Metabolic Disorders
Background:
- Hypoglycaemia in small for gestational age (SGA) infants is common.
- The counterregulatory hormonal and metabolic response to low blood glucose in SGA infants is not well understood.
Purpose of the Study:
- To investigate the hormonal and metabolic counterregulatory response to hypoglycaemia in SGA infants.
- To identify factors contributing to persistent hypoglycaemia in this population.
Main Methods:
- Studied 22 SGA infants with low birth weight (< 10th centile).
- Measured blood glucose, intermediary metabolites, and glucoregulatory hormones (insulin, glucagon, noradrenaline, cortisol, adrenaline).
Main Results:
- Low concentrations of non-esterified fatty acids and ketone bodies despite low blood glucose.
- Wide variations in plasma insulin and glucagon levels.
- Elevated noradrenaline and glucagon, but lower cortisol and adrenaline compared to hypoglycaemic adults.
- No correlation found between hormone concentrations and blood glucose levels.
Conclusions:
- SGA infants may experience hypoglycaemia due to a poorly coordinated counterregulatory hormone response.
- Peripheral insensitivity to hormonal actions might also contribute.
- Accurate blood glucose monitoring and adequate energy supplementation are crucial for affected infants.
Abstract:
Little is known of the ability of hypoglycaemic infants who are small for gestational age (SGA) to mount the coordinated hormonal and metabolic counterregulatory response that is seen in healthy older subjects during glycopenia. This response was studied in 22 SGA infants (birth weight < 10th centile) by measuring the blood concentrations of glucose, intermediary metabolites, and glucoregulatory hormones. Plasma non-esterified fatty acid and blood ketone body concentrations were low, even when blood glucose concentrations were low. Plasma insulin and glucagon varied widely (< 1.0-53.1 mU/l and 16.6-87.1 pmol/l, respectively). Concentrations of noradrenaline and glucagon were raised, but cortisol and adrenaline were lower than those found in hypoglycaemic adults. There was no relationship between the concentration of any hormone and blood glucose concentration. We postulate that hypoglycaemia and the failure to mobilise alternative fuels in some SGA infants is secondary both to a poorly coordinated counterregulatory hormone response and to a peripheral insensitivity to the actions of the hormones. Those infants, who fail to mount a counterregulatory response, should be identified by accurate and reliable blood glucose monitoring, and an adequate exogenous supply of energy, either enteral or parenteral, should be ensured.