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Abstract
Glucose is essential for energy metabolism in human, especially in brain, and is a source of energy storage in the form of glycogen, fat and protein. During fetal life, the predominant source of energy is also glucose, which crosses the placenta by facilitated diffusion. There is very little endogenous glucose production under normal circumstances during fetal life. During labor, the fetus is exposed to physiological challenges that require metabolic adaptation. A healthy infant successfully manages the postnatal transition by mobilizing and using alternative. After birth, there is a rapid surge in catecholamine and glucagon levels, and a steady decrease in insulin, as blood glucose levels decline. These hormonal changes induce enzyme activities that lead to glycogenolysis and gluconeogenesis. During the first 24-48 hours of life, plasma glucose concentrations of neonates are typically lower than later in life. Distinguishing between transitional neonatal glucose regulation in normal neonates and hypoglycemia that persists or occurs for the first time beyond the first 72 hours of life is important for prompt diagnosis and treatment to avoid serious consequences.
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Fig. 1
Screening for and management of postnatal glucose homeostasis in late-preterm (gestational age 34 –36+6 weeks) and term smallfor-gestational age infants and infants who were born to mothers with diabetes, large-for-gestational age infants. Modified from Pediatrics 2011;127:575-9.8
Table 1.
Metabolic Transition from Fetus and Neonate
Table 2.
Neonates at Increased Risk for a Persistent Hypoglycemia Disorder
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