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A newborn’s brain relies on glucose to fuel development. Low blood glucose levels (hypoglycemia) at birth have been associated with brain injury and intellectual and developmental disabilities. Infants are typically screened at birth for low blood glucose, which is common and easily treated. However, clear evidence to support a specific threshold for hypoglycemia treatment has been lacking. An international team led by Dr. Jane E. Harding of the University of Auckland, New Zealand, examined the relationship between glucose concentrations in newborns and subsequent brain function at 2 years of age. The research was funded in part by NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). Results appeared on October 15, 2015, in the New England Journal of Medicine. The researchers followed 404 newborns at a hospital in New Zealand. All were born at risk of hypoglycemia, mainly because the mother had diabetes, the birth was preterm (before 37 weeks), or the birth weight was very low or very high. Of the infants, 216 (53%) had blood glucose levels less than 47 milligrams per deciliter (mg/dl), which is a well-accepted threshold for hypoglycemia. These infants were treated with a combination of additional feedings and oral or intravenous glucose to maintain their blood sugar above this threshold. Hospital staff periodically monitored the infants’ blood glucose for up to 48 hours. The researchers also fitted the infants with a device that continuously monitored their blood glucose every 5 minutes. (This information was not available to the hospital staff.) The researchers assessed the children’s neurosensory functions at 2 years of age. These included developmental progress, cognitive and language skills, vision, hearing, physical coordination, and executive functioning (ability to concentrate and carry out age-appropriate tasks). Infants treated for hypoglycemia fared similarly in these areas to the infants who didn’t need treatment for hypoglycemia. The continuous glucose monitoring revealed that episodes of low blood glucose were common in both the treated infants and in those thought to have normal blood glucose levels. These episodes weren’t detected with standard intermittent blood glucose testing and weren’t associated with neurosensory impairment. The scientists found that neurosensory impairment was more likely at age 2 if infant glucose levels had fluctuated widely or were higher during the first 48 hours after birth. “It may be that it’s not only important to keep blood glucose levels from dropping too low, but also to keep them from swinging too high, too fast,” Harding says. The team is reassessing the children for neurosensory impairment at around age 4 to see if the effects of hypoglycemia might emerge later in development. They are also exploring therapies to maintain blood glucose levels at a safe, stable concentration. Related Links
References: Neonatal Glycemia and Neurodevelopmental Outcomes at 2 Years. McKinlay CJ, Alsweiler JM, Ansell JM, Anstice NS, Chase JG, Gamble GD, Harris DL, Jacobs RJ, Jiang Y, Paudel N, Signal M, Thompson B, Wouldes TA, Yu TY, Harding JE; CHYLD Study Group. N Engl J Med. 2015 Oct 15;373(16):1507-18. doi: 10.1056/NEJMoa1504909. PMID: 26465984. Funding: NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Health Research Council of New Zealand, and the Auckland Medical Research Foundation. In this article
What is hypoglycaemia?Hypoglycaemia means low blood sugar, or low blood glucose. Your baby's blood sugar levels are regulated by his hormones, the key hormone being insulin. Insulin helps your baby's body to store sugar and release it when he needs it. When everything is working well, your baby's hormones keep his blood sugar levels balanced. When the balance is out, hypoglycaemia can happen (Hoffman 2017, Sunehag and Haymond 2016a). What causes hypoglycaemia in newborns?After birth, your baby's blood sugar levels drop. This is a normal part of adapting to life outside your womb (uterus). In your womb, your baby had a near-constant supply of glucose via the placenta. Now, he has to rely on getting a glucose boost only when he is fed. So it’s important to give your baby a good feed in the first three to six hours after he's born, and regular feeds after that (Rozance 2017a, Sunehag and Haymond 2016a). When your baby has just had a feed, his sugar levels will go up. As the next feed draws closer, his sugar levels will start to dip. Keeping the right level of sugar in the blood is a delicate balancing act. Most healthy babies can cope easily with these normal ups and downs in blood sugar. If you feed your baby whenever he wants, he will take the milk he needs to ensure his sugar levels remain balanced. However, some babies can be more vulnerable to hypoglycaemia, including babies born to mums who have diabetes. These babies may produce too much insulin when they are born, making them prone to lower blood sugar (BAPM 2017, Hoffman 2016, Rozance 2017a). Babies are also susceptible to hypoglycaemia if they:
How can I tell if my baby has hypoglycaemia?If you're a new parent, it's hard to tell what's normal for your baby, and most babies don’t show any symptoms of hypoglycaemia. Any signs of low blood sugar are usually subtle (Rozance 2017a). Your baby could be jittery or irritable, or very sleepy and floppy (Rozance 2017a). The most accurate way to diagnose hypoglycaemia is with a blood test within your baby's first 24 hours (Rozance 2017a). Your doctor or midwife will offer the test if they think there's a chance your baby could have hypoglycaemia (Rozance 2017a). Your midwife will take a pinprick of blood from your baby’s heel (BAPM 2017). It's over very quickly and shouldn't upset your baby too much. Your baby's blood will be tested for blood sugar levels either on the ward or in the hospital laboratory. Each hospital has its own policy on testing, although there are national guidelines (BAPM 2017). In some hospitals, these blood tests are routinely offered to babies who are thought to be at high risk (BAPM 2017, Rozance 2017a). However, doctors do not always agree on a safe level of blood glucose in a newborn baby (BAPM 2017, Rozance 2017b, Sunehag and Haymond 2016a). Too many tests may just worry parents and it could also make it harder to bond and get breastfeeding started (Rozance 2017b). Staff have to weigh this knowledge against the risk of missing a problem if they do not test your baby's blood. Keep an eye on your baby if he hasn't had a blood test to rule out hypoglycaemia. When you are first getting to know your baby, it's hard to know what is normal, so don't hesitate to ask your midwife to check him. Trust your instincts (BAPM 2017). Even if it is not hypoglycaemia, your baby could be ill for some other reason. If your baby's blood sugar is low and it's not treated, it could be harmful to his health (BAPM 2017, Rozance 2017a, b, Sunehag and Haymond 2016a). Your baby could start fitting, which means he'll turn blue and may struggle to breathe. These are signs that something very serious is happening and you'll need to call an ambulance (BAPM 2017).
What healthcare will we get from the NHS after birth? Health visitor Penny Lazell explains who’ll be giving you professional support after the birth.More baby expert videos What is the treatment for hypoglycaemia?It depends when your baby was born and how well he's doing after the birth. If your baby was born near to or at full term and seems otherwise well, feeding him regularly will help him to recover (BAPM 2017). Breastmilk is best for regulating your baby's blood sugar, so hospital staff will support you to get breastfeeding started (BAPM 2017, Rozance 2017b). Your midwife or doctor may agree a feeding plan with you. This is likely to mean feeding your baby at least every three hours (BAPM 2017). Planning his feeds in this way can help his blood sugar levels to even out (BAPM 2017). Keep your baby near to you, preferably skin-to-skin on your chest. This will encourage him to breastfeed (BAPM 2017, Moore et al 2016). Being skin-to-skin also keeps your baby warm, which helps to reduce hypoglycaemia (BAPM 2017). Being cold can make hypoglycaemia worse, so your midwife may suggest your baby has a hat on to keep him cosy (BAPM 2017). If your baby is struggling to latch on to your breast, he can still have your breastmilk. The nurses will encourage you to express your milk (BAPM 2017). Then you or a nurse can feed your baby from a bottle or a cup. Expressed breastmilk is best, but if you can't express milk, try not to blame yourself. The nurses will give your baby something else to keep up his sugar levels, probably formula milk (BAPM 2017, Rozance 2017b). If your baby is breastfeeding, but his sugar levels are still a bit low, it can be difficult to decide if he should have a top-up of formula milk. The staff should talk this through with you (BAPM 2017). Get all the help you can to express your milk and get a supply going in the meantime, and to get your baby back on your breast as soon as possible. In most cases, hypoglycaemia improves within a day or two, and your baby will be fine from then on (BAPM 2017). Babies who are premature or smaller than expected at birth are likely to need to go to a neonatal or special care baby unit for treatment with glucose (Rozance 2017b). There are three main ways to give glucose:
Invasive treatments are bound to be upsetting for you, but hopefully you'll feel reassured that your baby is getting the help that he needs to recover. Once your baby's blood sugar levels have stabilised, he can start having feeds and gradually come off the sugar drip or feeding tube. Rarely, hypoglycaemia doesn't get better with treatment, because an underlying medical condition is causing it (BAPM 2017, Sunehag and Haymond 2016b). Your doctor will recommend tests as soon as possible to find out whether your baby has such a condition (Rozance 2017a). Your baby may need to spend time in the neonatal intensive care unit (NICU), where he can get the best care while doctors find out what's causing the hypoglycaemia to persist (BAPM 2017). How does breastmilk help my baby recover from hypoglycaemia?In the weeks before birth, your baby's body got ready for the drop in sugar after birth by storing glucose in his liver (Sunehag and Haymond 2016). The glucose stores help your baby to cope with the transition from womb to world (Rozance 2017, Sunehag and Haymond 2016). Your first milk, a rich, creamy substance called colostrum, has special enzymes that help your baby's liver release the stored glucose (Lowmaster Csont et al 2014). Premature babies are particularly prone to hypoglycaemia because their livers haven't had a chance to lay down a store of glucose (Rozance 2017a). If your baby is not feeding for a while because he is on a drip, try to keep your milk flow going, so he can breastfeed again when he's ready. You can do this by expressing milk frequently. Holding your baby close, with skin-to-skin contact, also helps. Most of the time, there is no reason why you can't eventually get your baby back on your breast, with a little help and advice. If you need help with breastfeeding, you can always ask your midwife or health visitor, or there may be a breastfeeding specialist at your local hospital or health centre. You can also get extra advice and encouragement from:
Will my baby need to stay in hospital if he has hypoglycaemia?You and your baby will need to stay in hospital for about 24 hours after the birth, or until your medical team is sure that your baby's blood sugar levels have stabilised (BAPM 2017). This means your baby will need two tests in a row showing his blood sugar measurements are more than 2.0mmol/l. Hospital staff will also check that breastfeeding is going well, and that you can give your baby the regular feeds he needs (BAPM 2017). After that, you and your baby will be able to go home (BAPM 2017). You won't need any special care once you're home. Just keep an eye on your baby, and call your midwife or doctor if anything is worrying you (BAPM 2017). They expect to get lots of calls from new parents, so, even if you just want reassurance, give them a ring. Will having hypoglycaemia affect my baby in the long run?It's very unlikely that hypoglycaemia will affect your baby as he grows, as long as he gets the right treatment, quickly (BAPM 2017, Hoffman 2017). The babies who may be affected long-term generally have an underlying medical condition for which they continue to need treatment (Hoffman 2017, Sunehag and Haymond 2017). Your medical team will work hard to prevent or minimise problems for your baby (BAPM 2017, Sunehag and Haymond 2017). They will explain what's causing your baby to continue to have hypoglycaemia and what treatment is suitable for him (BAPM 2017). Find out if gestational diabetes will affect your health after your baby is born. ReferencesBAPM. 2017. Identification and management of neonatal hypoglycaemia in the full term infant. British Association of Perinatal Medicine. www.bapm.org [Accessed August 2018] Hoffman RP. 2017. Pediatric hypoglycemia. Medscape. emedicine.medscape.com [Accessed August 2018] Lowmaster Csont G, Groth S, Hopkins P, et al. 2014. An evidence-based approach to breastfeeding neonates at risk for hypoglycemia. JOGNN (43)71-81 Moore ER, Bergman N, Anderson GC, et al. 2016. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev (11): CD003519. http://onlinelibrary.wiley.com [Accessed August 2018] Rozance PJ. 2017a. Pathogenesis, screening and diagnosis of neonatal hypoglycemia. UpToDate Rozance PJ. 2017b. Management and outcome of neonatal hypoglycemia. UpToDate Sunehag A, Haymond MW. 2016a. Approach to hypoglycaemia in infants and children. UpToDate [Accessed August 2018] Sunehag A, Haymond MW. 2016b. Pathogenesis, clinical features, and diagnosis of persistent hyperinsulinemic hypoglycemia of infancy. UpToDate [Accessed August 2018] Sunehag A, Haymond MW. 2017. Treatment and complications of persistent hyperinsulinemic hypoglycemia of infancy. UpToDate [Accessed August 2018] What happens when a newborn has low blood sugar?A newborn's brain relies on glucose to fuel development. Low blood glucose levels (hypoglycemia) at birth have been associated with brain injury and intellectual and developmental disabilities. Infants are typically screened at birth for low blood glucose, which is common and easily treated.
What are 4 signs and symptoms of hypoglycemia in a newborn?Signs and Symptoms of Hypoglycemia. Restlessness / jitteriness.. Pale skin coloring.. Stopping breathing (apnea). Poor body tone.. Poor feeding.. Sluggishness (lethargy). Seizures.. How long can a newborn have low blood sugar?Blood glucose levels usually get back to normal within 12 hours to 72 hours (3 days) of birth, especially once your baby is feeding regularly. It's rare for full-term babies to continue having trouble with their blood glucose levels. If this happens beyond 24 hours, your baby's doctor may want to do more tests.
Why do some newborns have low blood sugar?Sometimes babies have low blood sugar after they are born. Babies who are born early (premature) have high energy needs. But they don't have a lot of energy stored up in their bodies. That's why they are more likely to have low blood sugar.
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Symptoms of low blood sugar in newborn
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