During fetal life, the placenta and the maternal circulation closely regulate metabolic homeostasis. In healthy full-term neonates, homeostasis is maintained by the infant's autoregulatory mechanisms. Unfortunately, these mechanisms often fail during acute illness or after preterm birth. The result is increasing dependence on caretakers for normal metabolic function.
The most common metabolic abnormality in newborns is hypoglycemia. At birth, blood glucose in the neonate is approximately 60 to 70 percent of the maternal level. Within 1 to 2 h, the level falls to approximately 40 mg/dL. This decline may be accentuated in premature infants, acutely ill infants of any gestational age, and certain other high-risk infants (e.g., infants of diabetic mothers).
Because of the risk of hypoglycemia, all neonates should receive glucose containing fluids in preparation for and during transport. Ten-percent dextrose infused at a rate of 80 mL/kg/d should be used in infants with birth weight greater than 1000 g. Five-percent dextrose should be used in smaller infants because they are likely to develop hyperglycemia with high glucose intake. In these infants, the infusion rate should be increased to approximately 100 mL/kg/d because of excessive insensible water loss. In all infants at risk for hypoglycemia, measurement of blood sugar should be repeated at frequent intervals, at least every 2 h. 6
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