Recurrent neonatal hypoglycaemia — escalation and investigation station

Escalation and investigation station: recurrent critical neonatal hypoglycaemia in an infant of a diabetic mother. Tests recognition of the dosing ceiling, intravenous and glucagon escalation, the glucose infusion rate trigger for hyperinsulinism, and diagnostic sampling. Includes assessor key and marking domains.

Prompt

A 38-week infant of a mother with type 1 diabetes has had four consecutive blood glucose readings under 2.6 mmol/L despite buccal dextrose gel and feeds, the latest 1.9 mmol/L. He is now on the postnatal ward. The neonatal team is on the way. You are the registrar who must escalate and decide what to investigate.

Station brief

Format. Escalation and investigation station, approximately 12 minutes. You are the registrar on the postnatal ward with a baby who has now breached the gel ceiling. The assessor feeds the glucose trend and the intravenous response.^[1]

Candidate instruction. Escalate from gel to intravenous therapy, recognise the recurrent critical pattern, draw diagnostic samples, and decide when hyperinsulinism is the diagnosis. Verbalise the doses, the escalation principles and the investigation plan.^[1]^[2]

References6Show

[1]Adamkin DH Postnatal glucose homeostasis in late-preterm and term infants Pediatrics, 2011.PMID 21357346
[2]Thornton PS, Stanley CA, De Leon DD, et al. Recommendations from the Pediatric Endocrine Society for Evaluation and Management of Persistent Hypoglycemia in Neonates, Infants, and Children J Pediatr, 2015.PMID 25957977
[3]Harris DL, Weston PJ, Signal M, et al. Dextrose gel for neonatal hypoglycaemia (the Sugar Babies Study): a randomised, double-blind, placebo-controlled trial Lancet, 2013.PMID 24075361
[4]Edwards T, Liu G, Battin M, et al. Oral dextrose gel for the treatment of hypoglycaemia in newborn infants Cochrane Database Syst Rev, 2022.PMID 35302645
[5]McKinlay CJ, Alsweiler JM, Ansell JM, et al. Neonatal Glycemia and Neurodevelopmental Outcomes at 2 Years N Engl J Med, 2015.PMID 26465984
[6]Queensland Clinical Guidelines Hypoglycaemia–newborn (MN23.8-V13-R28, November 2023) and NeoMedQ Glucose gel 40% monograph Queensland Health guideline PDF, 2023.Source

Recurrent neonatal hypoglycaemia — escalation and investigation station

Station brief

References6Show

[1]Adamkin DH Postnatal glucose homeostasis in late-preterm and term infants Pediatrics, 2011.PMID 21357346
[2]Thornton PS, Stanley CA, De Leon DD, et al. Recommendations from the Pediatric Endocrine Society for Evaluation and Management of Persistent Hypoglycemia in Neonates, Infants, and Children J Pediatr, 2015.PMID 25957977
[3]Harris DL, Weston PJ, Signal M, et al. Dextrose gel for neonatal hypoglycaemia (the Sugar Babies Study): a randomised, double-blind, placebo-controlled trial Lancet, 2013.PMID 24075361
[4]Edwards T, Liu G, Battin M, et al. Oral dextrose gel for the treatment of hypoglycaemia in newborn infants Cochrane Database Syst Rev, 2022.PMID 35302645
[5]McKinlay CJ, Alsweiler JM, Ansell JM, et al. Neonatal Glycemia and Neurodevelopmental Outcomes at 2 Years N Engl J Med, 2015.PMID 26465984
[6]Queensland Clinical Guidelines Hypoglycaemia–newborn (MN23.8-V13-R28, November 2023) and NeoMedQ Glucose gel 40% monograph Queensland Health guideline PDF, 2023.Source