Low blood sugar levels in the newborn infant: Do changing goal posts matter? Glucose supply and metabolism are essential for growth and normal brain development in both the fetus and newborn. Disorders of glucose availability and metabolism can result in either hypoglycemia or hyperglycemia. This article reviews the current definitions of neonatal hypoglycemia from the American Academy of Pediatrics and the Pediatric Endocrine Society. The authors also discuss the evidence-based guidelines, other definitions, pathogenesis, outcomes and management options in this field. The current variations in practices and possibilities of future trials are also addressed.
Brain death in pregnancy: a systematic review focusing on perinatal outcomes. In selected cases, maternal brain death during pregnancy might justify maternal somatic support to maximize fetal viability and perinatal outcome. The authors reviewed the literature for any case report(s) of maternal brain death to evaluate perinatal outcomes. The diagnosis of brain death occurred at a mean gestational age of 20.2 ±5.3 weeks, usually associated with intracranial hemorrhage. The most common complications were infections (69%), circulatory instability (63%), diabetes insipidus (DI) (56%), temperature variability (41%), and hypopituitarism (34%). The most common indications for delivery were maternal circulatory instability (38%) and non-reassuring fetal testing (35%). The gestational age at delivery was 27.2 ±4.7 weeks. Delivery occurred mostly (89%) by cesarean section. There were 8 (23%) IUFDs in the second trimester (14-25 weeks’ gestation), and 27 babies (77%) born alive. Eight (23%) babies were described as 'healthy' at birth, 15 (43%) had normal longer-term follow-up (>1 month to 8 years, mean 20.3 months), 2 (6%) had neurologic sequelae (born at 23 and 24 weeks), and 2 (6%) were neonatal deaths (born at 25 and 27 weeks). Mean birth weight was 1,229 grams, and small for gestational age was present in 17% of neonates. Live birth rate differed by gestational age at the time of diagnosis of maternal brain death: 55%, at 20-23 weeks; 92% at 24-27 weeks; and 100% at >28 weeks. To conclude, maternal somatic support to maximize perinatal outcome lasted a mean of 7 weeks, with 77% of babies born alive, and 85% of these having normal outcome at a mean of 20 months of life. These data are helpful in counseling families.
Neonatal NIRS monitoring: recommendations for data capture and review of analytics. Brain injury is an important problem in neonates. This article reviews the use of near-infrared spectroscopy (NIRS), which can safely and non-invasively estimate cerebral oxygenation, a correlate of cerebral perfusion, and offer insights into brain injury-related mechanisms. There is a need for standardization in device application, recording methods, and error/artifact correction.