HYPOGLYCEMIA IN THE NEONATE - HOW AND WHEN IS IT IMPORTANT

Cerebral metabolism is known to be highly dependent upon glucose utili sation. In the neonate, severe hypoglycaemia is now recognized to be a ssociated with subsequent adverse neurodevelopment and in extremis gli al and neuronal cell death. However, the level at which hypoglycaemia becomes clinically important is not well understood. Clinical methods for assessing effects of hypoglycaemia are at best crude. Noninvasive assessment of neuronal function suggests that cerebral dysfunction occ urs at blood glucose levels well above clinical action levels. Thus, w e appear to ignore apparently asymptomatic hypoglycaemia at our and in deed the patient's peril. Furthermore, glycaemic status invariably is interpreted with scant regard to alternative catabolic substrates. In the neonate, recent evidence suggests this approach is unfounded. This presentation will review evidence that glycaemic status in neonates s hould no longer be considered as an entity in itself, but rather in th e light of compensatory metabolic processes and treated accordingly.