Hipoglikemija u novorođenčadi

master's thesis

• Title (english): Neonatal hypoglycemia
• Author: Ana Šimek
• Mentor: Ruža Grizelj (mentor)
• Committee member: Mario Ćuk (predsjednik povjerenstva)
• Committee member: Marija Jelušić (član povjerenstva)
• Committee member: Ruža Grizelj (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Pediatrics); Zagreb
• Defense date and country: 2020-07-17, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Pediatrics

Abstract

Glukoza potrebna za rast fetusa prolazi transplacentarno olakšanom difuzijom te koncentracija GUK-a u fetusa iznosi oko 3 mmol/L tj. 70% koncentracije GUK-a majke. Nakon rođenja, presijecanjem pupčane vrpce, prestaje kontinuirana opskrba novorođenčeta glukozom te ono prolazi kroz razdoblje metaboličke prilagodbe s ciljem uspostave vlastite homeostaze glukoze. U neke novorođenčadi ova prilagodba može biti otežana te se u njih razvija rana adaptacijsko-tranzicijska hipoglikemija. Hipoglikemija može nastati i kao posljedica poremećene sekrecije inzulina, kortizola i/ili hormona rasta ili poremećaja metaboličkih puteva glukoze, glikogena i masnih kiselina. Klinička slika hipoglikemije je nespecifična, varijabilna te karakterizirana simptomima koji nastaju kao odgovor na nedostatnu opskrbu tkiva i organa (ponajprije mozga) glukozom. Hipoglikemija u novorođenačkoj dobi je hitno stanje koje zahtijeva brzu intervenciju s ciljem što brže uspostave euglikemije kako bi se minimalizirala vjerojatnost pojave dugoročnih neuroloških oštećenja. Do danas nije postignut konsenzus oko definicije hipoglikemije tj. hipoglikemiju nije moguće definirati kao jedinstvenu koncentraciju ili raspon koncentracija GUK-a. U nedostatku precizne definicije, Odbor za fetus i novorođenčad američke akademije za pedijatriju (Commitee on the Fetus and Newborn – American Academy of Pediatrics) izdao je praktičan vodič za probir i liječenje hipoglikemije u novorođenčadi tijekom prvog dana života. Liječenje hipoglikemije zasniva se na koncentraciji i trendu kretanja glukoze, kliničkim simptomima i odgovoru na hranjenje. Rezultati istraživanja dugoročnog ishoda novorođenčadi koja je imala hipoglikemiju pokazuju da je trajno neurološko oštećenje češće prisutno u onih s teškom, simptomatskom hipoglikemijom praćenom konvulzijama, dok se u novorođenčadi s blagom, asimptomatskom hipoglikemijom ne nalazi trajnih neuroloških oštećenja.

Abstract (english)

Glucose used by fetus is supplied from maternal circulation via facilitated diffusion across placenta. Fetal blood glucose concentration is approximately 70% of the maternal value. After birth, by clamping the umbilical cord, newborn’s continuous glucose supply stops, and the newborn goes through a period of metabolic adjustment in order to establish its own glucose homeostasis. In some newborns, metabolic adjustment may be inadequate, and those children develop transient hypoglycemia. Hypoglycemia can also be caused by disrupted secretion of insulin, cortisol and/or growth hormone, or by disorders of glucose, glycogen or fatty acid metabolism. Clinical presentation of hypoglycemia is often unspecific and variable. Clinical signs and symptoms of hypoglycemia develop due to inadequate glucose supply of tissue and organs (primarily brain). Neonatal hypoglycemia is pediatric emergency which requires prompt intervention in order to quickly achieve euglycemia and avoid neurodevelopmental impairment. Studies did not show any unified definition of hypoglycemia yet i.e. neonatal hypoglycemia cannot be defined as single concentration or range of concentrations of blood glucose. In the absence of unified definition, Commitee on the Fetus and Newborn – American Academy of Pediatrics published guidelines for screening and treatment of hypoglycemia in newborns during the first day of life. Treatment of hypoglycemia is based on values of blood glucose concentration, clinical symptoms and newborn’s response to feeding. Studies of long-term neonatal hypoglycemia outcome have shown that neurodevelopmental impairment is more often present in children who experienced severe, symptomatic hypoglycemia followed by convulsions whereas those who experienced mild, asymptomatic hypoglycemia do not develop neurodevelopmental impairment.

• Keywords: hipoglikemija; novorođenče; neurološko oštećenje
• Keywords (english): hypoglycemia; newborn; neurodevelopmental impairment
• Language: croatian
• URN:NBN: urn:nbn:hr:105:372535
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2021-08-25 10:35:46