What Is Neonatal Hypoglycemia
Neonatal hypoglycemia is a condition when the babys blood sugar levels drop very low within a few days of birth. It is a kind of metabolic problem in newborns. Glucose is a crucial source of energy for the development of the brain in newborn babies. The babys brain does not receive a sufficient amount of glucose when a newborn develops hypoglycemia which does not get treatment on time. It causes the brain cells to die and leads to permanent brain damage.
Low Blood Sugars In Newborns Linked To Later Difficulties
A newborn condition affecting one in six babies has been linked to impairment in some high-level brain functions that shows up by age 4.5 years.
Researchers found that children who had experienced low bloodsugar levels as newborns were two to three times more likely to have difficulties with executive function and visual-motor co-ordination at age 4.5 years than children who had normal blood sugar levels.
Overall, the lower the blood sugar levels, or the more often they dropped, the greater the impairment was. Strikingly, children who had experienced a drop in blood sugar that was not detected using routine blood sugar monitoring were four times more likely to have difficulties with these skills the first time this has been shown.
There was no link with lowered intelligence as measured by IQ.
The findings, published in top-ranking journal JAMA Pediatrics, are the latest from a major long-term study, dubbed the “CHYLD” study , by an international research team led by Distinguished Professor Jane Harding at the University of Auckland-based Liggins Institute.
The team includes researchers from the Liggins Institute, the University of Auckland, Waikato Hospital, the University of Canterbury and the University of Waterloo. They are following 614 New Zealand babies born at risk of low blood sugar levels into childhood to see if the condition affects their later growth and development.
Why Do Some Babies Have Low Blood Glucose
- In healthy full-term babies , blood glucose levels are at their lowest 1 to 2 hours after birth. After this, the levels usually start to rise as your babys body starts to use healthy sugar and fat stores.
- Small and preterm babies may not have enough stores to keep the level up without extra feedings. These babies are most at risk for low blood glucose in the first 24 hours of life.
- Babies whose mothers have diabetes may have trouble using their glucose stores. The normal rise in blood sugar that takes place after birth may not happen right away.
- Babies who are large for their gestational age may have the same kind of problem during the first 12 hours of life.
Usually, low blood glucose levels will only last for a few hours, but can last up to 24-72 hours. Once your babys levels become normal, he shouldnt have further problems with hypoglycemia .
In very rare cases, low blood sugar can be severe or last a long time. If this happens, your doctor will do special tests to look for other causes.
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What Treatment Will My Baby Have If It Is Diagnosed With Low Blood Glucose
The baby needs to be checked that there is no underlying illness and that the cause of the low glucose level is not serious. The standard treatment for low blood sugar is giving the baby extra feedings or an increased frequency of feedings if the blood glucose continues to stay low.
If the supplemental feedings do not raise the blood glucose level, the medical team may advise using an IV to deliver additional sugar. A normal blood glucose level should stabilize within 12 to 72 hours after delivery, and the baby is at the highest risk of dropping glucose levels during this time.
What Causes Neonatal Hypoglycemia
During pregnancy, the fetus is supplied with glucose and other essential nutrients through the placenta. The placenta stores some of the glucose in the form of glycogen. During the delivery, the infants brain uses up these glycogen stores. A part of glucose is also stored in the liver, and some other parts of the body. These are used up after the baby is born. After delivery, the child gets the needed nourishment through mothers milk. In the first few days after birth, the childs immune system is strengthened with the antibodies present in the milky secretion called colostrum.
The composition of breast milk changes in the weeks that follow. While water forms a substantial part of the mature milk, other components of milk include carbohydrates, fats, proteins and other essential nutrients. Since the baby is dependent on milk for all the essential nutrients, the chances of child suffering from neonatal hypoglycemia would be high if the baby is not being breastfed well. If a child is not breastfed well, it will most likely lead to drop in blood sugar levels that might make the child irritable.
The child will lose more energy from episodes of crying that follow. It is therefore, extremely important that nursing mothers find out all about the ways to breastfeed the infant properly.
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Is Low Blood Sugar In Newborns Common
Approximately about 15% of newborns are suffering from low blood sugar levels called neonatal hypoglycemia in medical terms. And this is the only condition that can be prevented to stop the brain damage in infants. Let us have a look at what causes low blood sugar levels in newborns and how low blood sugar in newborns can be addressed.
How Can I Prevent Low Blood Glucose In My Baby
The most natural way to feed your baby and to keep a normal blood glucose level is early and frequent breastfeeding. Talk to your health care provider before you start using breast milk substitutes .
Its also important to know if your baby is at risk for low blood glucose .
Do not smoke during pregnancy. Babies who are exposed to tobacco dont grow well.
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What Are The Risk Factors That Lead To Low Blood Sugar Levels In Infants
A baby may acquire a low blood sugar level if he/she has signs of one or more below-mentioned factors
- Is born early and has a grave infection
- The need for oxygen as soon as delivery
- The mother is a diabetic and in such conditions, infants are larger
- A slow growth rate than normalcy when in the womb
- Are larger or smaller in size than usual for their gestational age
Newborn With Persistent Hypoglycemia
A full-term male infant was born to a 33-year-old gravida 3, para 3 mother. The prenatal course was uncomplicated, without gestational diabetes the mother received prenatal care at an out-of-state institution. At the delivery, however, the baby was notably macrosomic, with shoulder dystocia and perinatal distress requiring positive pressure ventilation.
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Regular Blood Sugar Check For Newborns
Generally, healthy full-term babies do not need to blood sugar checks. Their bodies have enough glucose stored in their liver for energy. It lasts until the newborn starts break feeding well. Some babies who need routine blood sugar checks are:
- Babies who are small or large for their gestational age
- Babies with rare medical conditions
- Premature babies born more than three weeks before their expected due date
- Babies whose mothers have either pre-existing diabetes or develop gestational diabetes
- Monitoring blood sugar levels in those levels helps in the diagnosis of hypoglycemia and immediate treatment.
Blood sugar levels of less than 30 mg/dL in the first 24-hours of birth and less than 45 mg/dL after that for the next three to four days show that your baby has hypoglycemia. Checking Plasma glucose also helps in diagnosing neonatal hypoglycemia. There is a need to do the estimation based on the underlying cause:
- Preterm and a lesser gestational age infant: 1, 6, 12, 24, 36, 48 hours and third and fourth day.
- Infant of a diabetic mother: 1, 2, 4, and 6 hours of life.
- Infants with erythroblastosis fetalis: after the exchange of transfusion with blood intermixed with citrate phosphate dextrose.
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How To Tell If Your Newborn Has Low Blood Sugar
Low blood sugar in newborns does not usually come with visible signs and symptoms. However, by keenly watching your baby, you should be able to infer the lack of sufficient levels of blood sugar. It is also important to note that these signs will vary from child to child. If you note any of these symptoms in your child, then you need to go see a doctor immediately.
- Blue coloring of the skin
- Poor feeding of the newborn
- Seizure attacks
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Treatment Of Hypoglycemia In Newborns
Early diagnosis of hypoglycemia can help to treat hypoglycemia in newborn babies. The treatment includes feeding the breast milk and drug treatment. Breast milk is a boon for newborn babies. It contains many enzymes and nutrients that help the babies to fight several diseases like hypoglycemia. If the baby is unable to drink breast milk, drug treatments help treat hypoglycemia.
Hypoglycemia is treatable in newborns through following ways:
How Long Will Blood Glucose Checks Or Additional Treatments Be Needed
Blood glucose levels usually get back to normal within 12 hours to 72 hours of birth, especially once your baby is feeding regularly.
Its rare for full-term babies to continue having trouble with their blood glucose levels. If this happens beyond 24 hours, your babys doctor may want to do more tests.
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Do All Newborn Babies Need Blood Glucose Checks
Healthy full-term babies do not need blood glucose checks. They have enough stored energy to last them until breastfeeding is going well. Babies who are not well will need blood glucose checks and other tests.
Some babies are more at risk for low blood glucose. Babies who need routine glucose checks include:
- Preterm babies born more than 3 weeks before they are due .
- Babies who are small for their gestational age , particularly if their growth was poor in the last few weeks of pregnancy.
- Babies whose mothers had diabetes during or before pregnancy.
- Babies who are large for their gestational age.
- Babies with rare medical conditions that cause low blood glucose.
Signs Of Low Blood Sugar In Newborns
Newborns with low blood sugar will usually not show any symptoms or signs. If the baby is born with one of the above risk factors then nurses will check the babys blood glucose levels even if symptoms do not persist.
Usually below are the signs to check for
- Pale or blue-colored skin
- Breathing issues like paused breathing , grunting sound while breathing and fast breathing
- Listlessness or irritability
- Issues in keeping the warmth of the body
- Shakiness, tremors, seizures, and sweating
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Help Your Baby And/or Prevent Low Blood Sugar In Newborns
- Breastfeed as often as you can. Breast milk will help stabilize a babys blood sugar levels.
- Keep your baby warm and prevent your baby from crying for long periods at a time after birth. Skin to skin contact and kangaroo care is recommended.
- Its best to breastfeed your baby as quickly after birth as possible, even in the delivery room if you can.
- If your baby is not sucking properly, you can pump the colostrum and cup feed your baby. Even a small amount of colostrum can help regulate your babys sugar levels.
- Breast compressions can increase the flow of milk and the amount of milk/colostrum that is transferred to a baby.
- If the mother is diabetic, she should eat well and control her diabetes properly during her pregnancy.
- If supplements or donated breast milk are given to a baby, make sure that they are given without using artificial nipples, which can cause nipple confusion. There are many alternative ways to feed a baby, including using an SNS this allows a baby to stay on the breast while being supplemented.
Once feeding is established, newborn low blood sugar is usually not a problem anymore.
What Are The Treatment Options For Hypoglycemia
Children with hypoglycemia have different symptoms, and these vary from one child to another. But no matter what your childs symptoms, the overriding goal is the same to bring the blood sugar back up to normal as rapidly as possible and return your child to good health.
Most often, your childs blood sugar can be brought back up to normal by eating or drinking something that has sugar in it, such as fruit juice, regular soda, table sugar, maple syrup, candy, glucose tablets, glucose gel, or cake frosting. Consider encouraging your child to:
- eat regular meals throughout the day
- eat frequent snacks
For children with diabetes, the goal is to consistently maintain a blood sugar level that is in a healthy range. This involves testing blood sugar often, learning to recognize the earliest symptoms of low blood sugar, and treating the condition quickly, based on instructions given by your child’s healthcare providers.
If your child has recurrent or severe hypoglycemia, the first thing is to determine the cause, because different causes have different treatments. While the cause is determined, some children will receive glucose intravenously in the hospital to make sure their blood-sugar level stays normal.
Some causes of hypoglycemia can be treated with changes in your childs diet or medication. For some rare cases of severe hypoglycemia that dont respond to medical treatment, the doctor may recommend surgery to remove most of the pancreas.
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What To Do If An Infant Has Hypoglycemia
It is common for infants to temporarily have hypoglycemia immediately after birth. If this happens, a doctor will monitor their blood glucose to see if it returns to normal. If it does, treatment may not be necessary.
However, if an infant is showing signs of hypoglycemia in the days, weeks, or months after birth, call a doctor right away.
The doctor may advise giving breast milk, formula, or a mixture of glucose and water, if a person has any, to try to raise the infants blood sugar levels. They may also recommend visiting a health center to get a blood glucose test.
The symptoms of hypoglycemia in newborns are similar to those of many other conditions, so it is important to get help from a healthcare professional.
Prompt feeding at birth and ongoing, on-demand feeding can reduce the risk of hypoglycemia by ensuring that an infant gets adequate nutrition. If someone is nursing, frequent feeding also
There are several reasons that a newborn might develop hypoglycemia. These include the following.
Where Do Babies Get Glucose
Babies get glucose through the placenta and umbilical cord while in their mothers uterus . Some of that glucose is used right away as energy and some is stored for after birth. This stored glucose helps keep your babys levels normal for the first few days of life until she is feeding well.
Once moms breast milk is established , it becomes the main source of sugar for your baby. The sugar in milk changes to glucose in the body. When this happens, your baby will also start to store glucose for use between feeds.
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Some Truths About Hypoglycmia Of The Newborn
1. The best way to prevent low blood sugar is to feed the baby with milk.However, formula and breastmilk are not equivalent and colostrum is far better to prevent and treat low blood sugar than formula . A little bit of colostrum maintains the blood sugar better than a lot of formula.
2. Having the baby skin to skin with the mother immediately after birth maintains the babys blood sugar higher than if the baby is separated from her..
3. There is no lowest level of blood sugar that is universally accepted as meaning the baby has low blood sugar.Because of this atmosphere of hyper-concern about low blood sugar, the level of sugar keeps being raised to absurd levels. In many hospitals now, 3.4 mmol/L is now considered the lowest acceptable blood sugar. Even 30 mmol/L has been used, without proof, as the lower limit of normal. This is patently aberrant and there is no evidence to back up such a level as the lowest acceptable blood sugar concentration.
4. There is no reliable method of measuring the blood sugar outside the laboratory. The use of paper strips to measure the blood sugar is not reliable. Paper strips tend to underestimate the true value. Only the laboratory gives a reliable measure of plasma glucose or sugar .
9. A baby who is born small for the length of the pregnancy maintains his blood sugar just as well if breastfed or formula fed. Of course, its important the baby is breastfeeding.
Also see the video clips of young babies breastfeeding.
Symptoms And Treatment Of Neonatal Hypoglycemia
The symptoms of hypoglycemia may or may not be conspicuous. Moreover, the severity of the symptoms would depend on how low the blood glucose levels are. In severe cases, a child may exhibit symptoms such as pale skin, nausea, vomiting, irritability, restlessness, low body temperature, bluish-colored skin, breathing problems, tremors, sweating or decreased muscle tone. If a newborn is exhibiting any of the symptoms of hypoglycemia, the wise thing to do would be to consult a doctor. Blood tests and other screening tests can be conducted in order to ascertain the underlying problem.
Very low levels of blood sugar can adversely affect the nervous system, which in turn, can even lead to developmental delays. It is therefore, extremely important that steps are taken to bring the blood sugar levels within the normal range. The child must be breastfed or given formula milk soon after birth. Mild cases of hypoglycemia can be treated by feeding the child effectively. If the baby is unable to feed, then sugar solution can be administered intravenously. Maintaining skin-to-skin contact will also help. If the blood sugar levels are still low, the affected child may also be given medication so as to stabilize the blood sugar levels.
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