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Hypoglycaemia (Low blood sugars at birth)

Hypoglycaemia (Low blood sugars at birth)

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‘Hypoglycaemia’ (low blood sugar levels) can be a serious complication after birth.

Often presenting within the first 2-3 hours after birth, hypoglycaemia must be recognised early and managed in order to keep your baby safe.

Signs your baby may be hypoglycaemic:

  • Jittery or noticeable repetitive tremor
  • Not feeding well
  • Cool to the touch and has a low body temperature
  • Rapid breathing
  • Lethargic
  • Weak or high-pitched cry

 

As your newborn baby adapts to the outside world, they burn energy. Now, for babies who are born at term, at a healthy birth weight and no pregnancy or labour complications, this transition can go relatively smoothly. However, for babies who are born small, premature, to mothers who have gestational diabetes or have a difficult delivery – these babies can be at risk for developing hypoglycaemia.

Other risks including:

  • Prematurity (<37 weeks gestation)
  • Babies weighing <2.5kg or >4.5kg
  • Growth restricted babies
  • Stressed baby – required resuscitation at birth
  • Not feeding well after birth
  • Gestational diabetes in pregnancy, particularly if insulin controlled

 

Gestational Diabetes

So, what if you have been diagnosed with Gestational Diabetes?

Diabetes in pregnancy means your hormones have impacted your insulin levels. This means your blood sugar levels can become very high or unstable. If you have gestational diabetes, your baby can receive higher levels of sugar (glucose) during pregnancy.  Extra glucose can cause rapid growth in utero and requires your baby to produce extra insulin themselves.

After birth, your baby no longer has the same, ‘sweet’ environment. And with the glucose source suddenly gone, and their insulin levels still high – their blood sugar level can drop, leading to hypoglycemia.

If you baby is considered at risk for hypoglycemia then your midwife/neonatal nurse will assess your baby’s blood sugar level within the first few hours after birth to make sure their blood sugar level is still within a safe range. They do so with a small pin-prick blood test on your baby’s heel. The blood sugar level (BSL) should be greater than 2.5mmol/L.

If not, the treatment for a low blood sugar is food, and ensuring your baby is kept warm throughout to help conserve their energy. If only mild hypoglycaemia, then breastfeeding can help restore your baby’s blood sugar level to normal. If the hypoglycaemia is severe – your baby may require larger volumes of milk then you have available, as well as oral glucose gel or even intravenous dextrose infusion.

Failure to recognise and treat hypoglycaemia effectively can result in poor growth/wellbeing and damage to your baby’s brain.

How can you help prevent your baby from becoming hypoglycaemic?

  • Skin to skin contact after birth (if they are healthy and don’t require assistance to breathe)
  • Keep your baby warm, ask for warm blankets and towels if you need!
  • Offer you baby a breastfeed or expressed colostrum within the first hour of birth (if able!)

Offer regular breastfeeds (every 3-4 hours) if your baby is at risk of hypoglycaemia.

Written by Keryn Thompson, RM & IBCLC (L-301766)

References

Alissa, R., Dudek, C., Travers, L., Smotherman, C., Hudak, M., & Makker, K. (2018). Glucose Gel in Infants at Risk for Transitional Neonatal Hypoglycemia. American Journal of Perinatology, 35(11), 1050–1056. https://doi.org/10.1055/s-0038-1639338

Alsaleem, M., Saadeh, L., & Kamat, D. (2019). Neonatal Hypoglycemia: A Review. Clinical Pediatrics, 58(13), 1381–1386. https://doi.org/10.1177/0009922819875540

Dani, C., & Corsini, I. (2020). Guidelines for Management of Neonatal Hypoglycemia. JAMA Pediatrics, 174(7), 638. https://doi.org/10.1001/jamapediatrics.2020.0632

Edwards, T., & Harding, J. E. (2021). Clinical Aspects of Neonatal Hypoglycemia: A Mini Review. Frontiers in Pediatrics, 8. https://doi.org/10.3389/fped.2020.562251

Mukhopadhyay, S., Wade, K. C., Dhudasia, M. B., Skerritt, L., Chou, J. H., Dukhovny, D., & Puopolo, K. M. (2020). Clinical impact of neonatal hypoglycemia screening in the well-baby care. Journal of Perinatology, 40(9), 1331–1338. https://doi.org/10.1038/s41372-020-0641-1

Puchalski, M. L., Russell, T. L., & Karlsen, K. A. (2018). Neonatal Hypoglycemia. Critical Care Nursing Clinics of North America, 30(4), 467–480. https://doi.org/10.1016/j.cnc.2018.07.004

Rozance, P. J., & Hay, W. W. (2016). New approaches to management of neonatal hypoglycemia. Maternal Health, Neonatology and Perinatology, 2(1). https://doi.org/10.1186/s40748-016-0031-z

van Kempen, A. A. M. W., Eskes, P. F., Nuytemans, D. H. G. M., van der Lee, J. H., Dijksman, L. M., van Veenendaal, N. R., van der Hulst, F. J. P. C. M., Moonen, R. M. J., Zimmermann, L. J. I., van ’t Verlaat, E. P., van Dongen-van Baal, M., Semmekrot, B. A., Stas, H. G., van Beek, R. H. T., Vlietman, J. J., Dijk, P. H., Termote, J. U. M., de Jonge, R. C. J., de Mol, A. C., . . . Boluyt, N. (2020). Lower versus Traditional Treatment Threshold for Neonatal Hypoglycemia. New England Journal of Medicine, 382(6), 534–544. https://doi.org/10.1056/nejmoa1905593

Voormolen, D. N., de Wit, L., van Rijn, B. B., DeVries, J. H., Heringa, M. P., Franx, A., Groenendaal, F., & Lamain-de Ruiter, M. (2018). Neonatal Hypoglycemia Following Diet-Controlled and Insulin-Treated Gestational Diabetes Mellitus. Diabetes Care, 41(7), 1385–1390. https://doi.org/10.2337/dc18-0048

Zhao, T., Liu, Q., Zhou, M., Dai, W., Xu, Y., Kuang, L., Ming, Y., & Sun, G. (2020). Identifying risk effectors involved in neonatal hypoglycemia occurrence. Bioscience Reports, 40(3). https://doi.org/10.1042/bsr20192589

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