Neonatal Hypoglycemia – Things You Need to be Aware About 

Last updated on September 28th, 2022

Neonatal hypoglycemia or glucose derangement in newborn babies is nothing new or unusual. In many cases, neonatal hypoglycemia remains for a few hours to 3-4 days in newborn babies. However, once they start breastfeeding, their blood sugar levels come to the normal range. Breast milk helps regulate the blood sugar levels in infants and nourishes them to fight several diseases. If neonatal hypoglycemia is not detected and treated early, it can lead to brain damage. You can prevent hypoglycemia in a newborn with the suggested preventive measures.

Hypoglycemia is a condition of low blood glucose levels in the body. Not only the adults but the newborns are also at risk of developing hypoglycemia. Hypoglycemia or low blood sugar levels can occur due to several reasons and leads to several health issues. In babies, hypoglycemia impairs growth, and their brain cells also start to die. It can even cause neonatal brain injury. It is not difficult to recognize hypoglycemia in babies and usually treatable.

What is Neonatal Hypoglycemia?

Neonatal hypoglycemia is a condition when the baby’s 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 baby’s 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.

Causes of Hypoglycemia in Newborns

The causes of hypoglycemia in the newborn are:

• Defects from birth
• Baby not receiving enough oxygen right after the birth
• Poorly controlled diabetes in the mother
• Mother having poor or lack of nutrition during pregnancy
• Incompatibility of blood types between the mother and the newborn
• Hormonal deficiencies or congenital metabolic diseases
• Infection due to the interaction of diabetes medication
• Production of more insulin in the blood of newborn due to the pancreatic tumor, hypothermia, polycythemia, or other reason

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Long-Term Effects of Neonatal Hypoglycemia

When neonatal hypoglycemia does not come under the early diagnosis or a baby does not get the treatment for a long time, it can cause several long-term effects. The long-term injuries due to neonatal hypoglycemia include:

• Vision problems: Low blood sugar levels can cause blurred vision or double vision in the newborn. Due to hypoglycemia, the brain cells die, and the nerve connecting the brain and the eye may not work effectively. Thus, it can cause vision problems in the long term.
• Neuropsychiatry disorder: Neonatal hypoglycemia leads to Neuropsychiatry disorder. It is the medical conditions that involve neurology and psychiatry in newborns. It impacts brain function and emotions.
• Brain damage: When the brain cells do not receive glucose at birth, they start to die. It causes brain damage and leads to mental disorders in children.
• Cerebral Palsy: It is a motor disability in children. The abnormality or damage in the part of the brain that controls the movement results in cerebral palsy. It causes musculoskeletal conditions that lead to bone and joints deformities.
• Leaning and development disabilities: Untreated hypoglycemia in newborns can lead to Learning and development disabilities. The learning disabilities include difficulty in learning, sorting, storing information, speaking, reading, writing, etc. The development disabilities prevent the newborn from reaching the developmental milestones at the expected time.
• Seizure: The abnormal electrical discharges in the brain due to chemical imbalance and brain damage causes neonatal seizures. It is one of the problems due to neonatal hypoglycemia. Delay in the identification of neonatal seizures can result in permanent damage to the baby’s brain.

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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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Signs and Symptoms of Neonatal Hypoglycemia

Sometimes, the newborns do not show any signs and symptoms of neonatal hypoglycemia. Routine blood test after birth helps in diagnosing their hypoglycemia. However, some signs and symptoms help in detecting neonatal hypoglycemia and blood test confirms it. Following are the signs and symptoms of hypoglycemia:

• Breathing problems
• Poor feeding or vomiting
• Tremor, shaking, seizure or sweating
• Pale skin or bluish-colored skin
• Irritability
• Floppy muscle
• Hypothermia
• Low birth weight

If the symptoms of neonatal hypoglycemia remain untreated for a long time, there can be brain damage that may lead to a temporary cessation of breathing.

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Treatment of Hypoglycemia in Newborns

Hypoglycemia is treatable in newborns through following ways:

Breast Milk Helps to Treat Hypoglycemia in Newborns

Within a week after the birth, the baby’s body can store glucose in the liver. Therefore, it helps the baby to cope with the transition from the womb to the world. Mother’s first milk is a rich and creamy substance called Colostrum. It has special enzymes that help your baby release the stored glucose from the liver. The liver of premature babies does not get enough chance to store glucose. They are, therefore, more prone to hypoglycemia. Breast milk helps in regulating blood sugar and treat hypoglycemia.

Drug Treatment for Hypoglycemia in Newborns

The early treatment of low blood sugar levels in newborns prevents the complications of neurologic damage. Feeding the newborn with breast milk or formula is encouraged to avoid hypoglycemia. The doctors use a nasogastric tube in newborns who are unable to drink breast milk or formula. Many newborns cannot protect their airways or are unable to drink milk. Drugs like dextrose, diazoxide, glucagon, and octreotide are administered to them with the help of IV, nasogastric tube, intramuscular, or intraosseous routes.

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Prevention of Hypoglycemia in Newborns

It is essential to recognize infants at risk of hypoglycemia.  You should also initial the strategies from birth to prevent hypoglycemia. Some other preventive measures include:

• Early breastfeeding.
• Skin to skin contact within the first hour of birth.
• Frequent breastfeeding at least after every 3 hours and assess the quantity of breastfeeds.
• Ongoing skin contact with the mother to control the body temperature of the baby.
• Control the blood sugar levels during the pregnancy.
• Give expressed breast milk to the baby unless the baby cannot take anything orally for some medical conditions.

With the mentioned preventive measures, you can prevent hypoglycemia in newborns. Pregnant women can lessen the chances of hypoglycemia in babies by the following tips:

• Take good nutritional and medical care of yourself throughout the pregnancy.
• Maintain control of your blood sugar levels before and during pregnancy.
• Avoid high doses of intravenous glucose sugar solution during labor unless it is medically necessary.
• Newborn stress can deplete a baby’s glucose stores. Thus, you should do whatever can reduce your baby’s stress during labor and delivery.

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Treatment to Manage Blood Sugar Levels in Pregnant Women

Some ways help in managing the blood sugar levels in women planning their pregnancy or already pregnant. It reduces the risk of hypoglycemia in newborn babies. Here are some of those measures:

• Routine screening for gestational diabetes: Pregnant women not having diabetes should take the routine screening for gestational diabetes. It helps them in the early detection of diabetes during pregnancy to avoid further complications. The screening for gestational diabetes includes a follow-up glucose tolerance test and an initial glucose challenge test.
• Lifestyle changes: Diabetes is a lifestyle disorder. Therefore, lifestyle changes before and during pregnancy help in maintaining healthy blood glucose levels in the body. Lifestyle changes include what you eat and how much you move. Try including lots of fiber and foods with a low glycaemic index to keep the blood sugar levels in control. Pregnant women should also stay active to manage their blood glucose levels. Regular exercise, walking, and some physical activities also help in relieving common discomforts of pregnancy.
• Medication: If the diet and exercise are not enough to manage your blood sugar levels, pregnant women may need insulin shots or diabetes medications to manage diabetes. Some doctors prescribe oral medications, whereas others believe injectable insulin safe and effective for controlling diabetes before and during pregnancy. Therefore, women with pre-existing diabetes should consult with a doctor before planning their pregnancy.

Also Read: Low Sugar and Pregnancy Risks Associated With Such a Condition

FAQs:

References:

1. https://medlineplus.gov/ency/article/007306.htm
2. https://www.caringforkids.cps.ca/handouts/pregnancy-and-babies/blood_glucose_in_newborn_babies
3. https://www.stanfordchildrens.org/en/topic/default?id=hypoglycemia-in-the-newborn-90-P01961
4. https://www.medindia.net/patients/patientinfo/neonatal-hypoglycemia.htm
5. https://ibconline.ca/information-sheets/hypoglycaemia-of-the-newborn-low-blood-sugar/

Last Updated on September 28, 2022 by Dr. Damanjit Duggal