From the Guidelines
Pediatric hypoglycemia is primarily caused by an imbalance between glucose utilization and production, with common etiologies including prematurity, small for gestational age (SGA), large for gestational age (LGA), and infants of mothers with diabetes (IDM) 1. The most recent and highest quality study, published in 2023 in JAMA Pediatrics, highlights that multiple maternal and infant factors are associated with neonatal hypoglycemia due to impaired metabolic transition following birth 1. Some key factors that contribute to pediatric hypoglycemia include:
- Prematurity
- Small for gestational age (SGA)
- Large for gestational age (LGA)
- Infants of mothers with diabetes (IDM) These factors can lead to impaired metabolic transition, resulting in hypoglycemia, which can have significant effects on neurodevelopmental outcomes, including an increased risk of neurodevelopmental impairments in childhood 1. It is essential to recognize these causes promptly, as severe and prolonged hypoglycemia can lead to neurologic injury and long-term neurodevelopmental sequelae 1. In clinical practice, it is crucial to consider these factors when assessing infants at risk for hypoglycemia, and to follow clinical practice guidelines for early identification and screening of at-risk infants 1.
From the Research
Causes of Pediatric Hypoglycemia
The causes of pediatric hypoglycemia are diverse and can be attributed to various factors, including:
- Metabolic and/or endocrine disorders 2, 3
- Congenital disorders, such as Congenital Adrenal Hyperplasia and Adrenal Hypoplasia 4
- Hormone deficiencies, including adrenal insufficiency 4
- Systemic diseases or syndromes 5
- Metabolic disorders, such as ketotic hypoglycemia and congenital hyperinsulinemic hypoglycemia 5
- Transient hyperinsulinemic hypoglycemia 5
Age-Related Etiological Variations
The etiology of hypoglycemia in children varies by age, with different causes being more prevalent in different age groups 5. For example:
- Neonates are at risk of hypoglycemia due to defects in glucose homeostasis and counter-regulatory mechanisms 4
- Infants and young children may experience hypoglycemia due to metabolic and endocrine disorders, such as congenital hyperinsulinemic hypoglycemia 5
- Older children and adolescents may be at risk of hypoglycemia due to systemic diseases or syndromes, such as adrenal insufficiency 4
Diagnostic Challenges
Diagnosing hypoglycemia in children can be challenging due to non-specific symptoms and the need for laboratory investigations during a hypoglycemic event 3, 5. A comprehensive diagnostic approach, including biochemical tests, dynamic endocrine tests, and molecular genetics, may be necessary to determine the underlying cause of hypoglycemia 3, 5.