In particular, children at risk of neonatal hypoglycaemia should have their blood glucose monitored within one hour of birth. Management
Some infants are treated with 40% dextrose (a form of sugar) gel applied directly to the infants mouth. There are two main ways that neonatal hypoglycemia is treated. The first way includes intravenous infusion of glucose. For less severe, borderline, asymptomatic hypoglycemic neonates early introduction of breast milk can be effective for raising glucose levels to a healthy level. Any infant at risk of hypoglycemia should have their blood sugar taken again one hour after birth. Oral glucose is another option to restore normal glucose levels if the newborn is having difficulty latching to the breast or breastfeeding is not an option, however, breast milk is proven to be a better source as it includes glucose and carbohydrates. It is recommended by The American Academy of Pediatrics that infants feed within the first hour of life with the glucose reading being 30 minutes after this feeding for an accurate result. If the initial feeding does not raise the newborns blood glucose above 40 mg/dL then the newborn must receive an IV infusion of 10% dextrose in water as a mini bolus as 2 mL/kg over 1 minute. Following the mini bolus a continuous infusion of 10% dextrose in water at 80-100 mL/kg/day in order to maintain a healthy serum glucose level between 40 and 50 mg/dL. Maintaining newborn thermoregulation is a large part in preventing further hypoglycemia as well.
A patient with high grade spondylolisthesis may present with a posterior pelvic tilt causing a loss in the normal contour of the buttocks. An antalgic gait, rounded back and decreased hip extension, can result from severe pain. While standing, the patient should be observed from the front, back, and sides. Increased and decreased lumbar lordosis, inward curvature of the lower spine, has been seen. Palpation
Detection of spondylolisthesis by palpation is most often done by palpating for the spinous process. Each level of the lumbar spine should be palpated. Spinous process palpation by itself is not a definitive method for the detection of spondylolisthesis. Maneuvers
Spinal range of motion testing – Range of motion limitations may be seen. Lumbar hyperextension – Extension often elicits pain. This can be assessed by having the patient hyperextend the lumbar spine, provide resistance against back extensions, or undergo repeated lumbar extensions. Sport-specific motion – Patient can be asked to repeat aggravating movements that they experience during their activity. During the movement, ask patient to point to any places with focal pain. Straight leg raise – Maneuver used to assess for hamstring tightness. The straight leg raise has been found to be positive in only 10% of patients with spondylolisthesis. Muscle strength exercises – Lower abdominal, gluteal, and lumbar extensors should be assessed for weakness. Weakness in these muscles can increase lordosis and contribute to sacroiliac instability. Abdominal flexor strength can be assessed with the abdominal flexor endurance test.