Neonatal Hypoglycemia: A Diagnostic and Therapeutic Emergency - Current Status and a Clinical Case Report

Abstract

Background: Neonatal hypoglycemia is a common metabolic condition associated with a risk of significant neurological morbidity. Its definition remains controversial due to the lack of a universally accepted glycemic threshold. Transient forms related to perinatal stress are increasingly recognized but may present with severe and recurrent episodes.

Case Observation: We report the case of a term newborn presenting with early-onset recurrent hypoglycemia. The perinatal period was marked by moderate asphyxia, hypothermia, and secondary neonatal sepsis due to Escherichia coli. Despite early nutritional management, severe hypoglycemia (0.16 mmol/L) occurred within the first 24 hours of life. Biological evaluation revealed inappropriate hyperinsulinemia associated with hypoglycemia, elevated growth hormone levels, and transiently low cortisol with a normal Synacthen response. The diagnosis of transient hyperinsulinism in the context of perinatal stress was retained. Glycemic control was achieved through optimized glucose intake without the need for specific pharmacological treatment.

Discussion: This case highlights the multifactorial nature of neonatal hypoglycemia and the central role of transient hyperinsulinism in stress conditions such as perinatal asphyxia and infection. The absence of neurological symptoms despite severe hypoglycemia raises questions about individual cerebral tolerance and compensatory metabolic mechanisms. However, the risk of delayed neurodevelopmental impairment remains significant.

 Conclusion: Neonatal hypoglycemia requires early recognition, prompt management, and thorough etiological investigation. Transient hyperinsulinism should be considered in cases of persistent or recurrent hypoglycemia, particularly in the context of perinatal stress. Long-term neurological follow-up is essential.