Hypoglycemia
Glucose screening is recommended for infants in the following categories who are at increased risk for pathological hypoglycemia: Born to mothers with gestational diabetes or diabetes mellitus Large for gestational age (LGA) (>8 pounds 12 ounces or >3969g) Small for gestational age (SGA) (<5 pounds 12 ounces or <2608g) Premature (<37 weeks gestation) Low birth weight (<2500g) Smaller twin when sizes are discordant Polycythemia (hct >70%) Hypothermia Low Apgar scores (<5 at one minute, <6 at five minutes) Stress (sepsis, respiratory distress, etc) Glucose screening is also recommended for infants with clinical signs consistent with hypoglycemia: Tremors, jitteriness, irritability Exaggerated Moro reflex High pitched cry Lethargy, listlessness, hypotonia Cyanosis, apnea, tachypnea Hypothermia, temperature instability Poor suck, refusal to feed Transiently low blood glucose levels are physiologic in the newborn and the distinction between hypoglycemia and euglycemia is not always clear. Even though precise interpretation of a given glucose level may not be possible, the following guidelines (representing expert concensus) have been adopted by the American Academy of Pediatrics. Within the first 4 hours of life: Any glucose level less than 40 mg/dL in a baby with symptoms requires immediate IV fluid therapy. In an asymptomatic baby, an initial glucose level (within the first 4 hours of life) of less than 25 mg/dL should prompt an immediate feeding with another glucose check in an hour. If the subsequent test is still <25 mg/dL, immediate IV fluid therapy is indicated. If the subsequent test is >25 but <40 mg/dL, the infant should again be fed and retested, although IV fluid therapy may be indicated for some patients in this group. Between 4 - 24 hours of life: Any glucose l Continue reading >>
Neonatal Hypoglycemia And Breastfed Babies
Edie Orr and Betty Crase We provide articles from our publications from previous years for reference for our Leaders and members. Readers are cautioned to remember that research and medical information change over time. Important Points about Hypoglycemia Breastfeeding early and often will stabilize blood glucose levels. Routine glucose supplements are not necessary for all newborns. Glucose IVs during labor can increase the risk of hypoglycemia in the newborn. If supplements are needed, they can be given by IV, dropper, or cup to avoid nipple confusion. The pregnant woman is sitting quietly during your La Leche League meeting, absorbing the wealth of information the mothers in your Group have to share. At the end of the discussion on childbirth and the early weeks of breastfeeding, you ask if there are any questions. The expectant mother asks, "Do I have to give my newborn sugar water to prevent hypoglycemia? That's what my friend's pediatrician told her." You take a deep breath and explain that while you are not qualified to give medical advice, you do know that breastfeeding early and often will almost always prevent hypoglycemia in newborns. Hypoglycemia is the technical term for low blood sugar (low concentrations of glucose, the sugar found in blood). When the body's rate of use of glucose is greater than the rate of glucose production, the plasma glucose concentration falls (Rudolph 1982). If it falls too far, too fast in the newborn period, hypoglycemia results. Symptoms may include lethargy, limpness, sweating, jitteriness, tremors, refusal to eat, feeding difficulties, rapid respiration, and pallor. Symptomatic neonatal hypoglycemia is largely due to delayed or inadequate feeding and is more likely to occur when mother and baby are separated after birth. Inste Continue reading >>
The Significance Of Blood Sugar Measurements In Newborns
So, let’s say have new term baby with a measured glucose of 28. Does that baby have symptoms? Kids without symptoms are doing something right. We do not need to intervene because our exam told us the baby looked good. The number did not add to our management and therefore we did not need it. That glucose of 28 may mean nothing if the baby makes up for it with creation of alternative fuels (which they do normally). Kids with no symptoms from their low blood sugar (however we define it) do not need to be treated. Our next step is to do what we should be doing already: skin-to-skin snuggling, feeding within an hour after birth, and frequent breastfeeding with rooming-in. When we treat an asymptomatic child with a "low" blood sugar (again, however it is defined) with something other than breastmilk, the production of alternative fuels gets messed up. The baby needed a low blood glucose to start the pathways that create alternative fuel production. When we give formula or glucose water, we are giving glucose, and those other pathways that created ketone bodies, pyruvate and lactate as compensation for the low blood sugar are now not needed. Those other newborn pathways may be delayed in working or just stop. Because we messed with normal physiology, and may have interrupted alternate fuel production, the babies may need continued supplementation to maintain normal blood glucose. The production of alternative fuels does not just work to meet the energy needs of the brain. Ketone bodies are also used in brain myelination (nerve growth) and the creation of lung surfactant (lung function). That means that the normal dip in blood glucose, which creates other fuels, leads to brain energy, nerve growth and lung development. We want that to occur without interruption. We should no Continue reading >>
Infant Of Diabetic Mother
Women may have diabetes during pregnancy in 2 ways: Gestational diabetes is high blood sugar (diabetes) that starts or is first diagnosed during pregnancy. If the diabetes is not well controlled during pregnancy, the baby is exposed to high blood sugar levels. This can affect the baby and mom during the pregnancy, at the time of birth, and after birth. Infants who are born to mothers with diabetes are often larger than other babies. Larger infants make vaginal birth harder. This can increase the risk for nerve injuries and other trauma during birth. Also, C-sections are more likely. The infant is more likely to have periods of low blood sugar (hypoglycemia) shortly after birth, and during first few days of life. Mothers with poorly controlled diabetes are also more likely to have a miscarriage or stillborn child. If the mother had diabetes before her pregnancy, her infant has an increased risk of birth defects if the disease was not well controlled. Continue reading >>
Babies With Hypoglycemia
If you’ve been told that your newborn baby has hypoglycemia (low blood sugar) or is at risk of developing this condition, you should also know that there are ways that breastfeeding can help the situation. Low blood sugar occurs when the body’s demand for glucose (a simple sugar) is greater than its supply. Infants get glucose from the lactose (milk sugar) that is in milk and colostrum. Some infants have greater difficulty maintaining an adequate blood sugar than others. While an occasional dip in blood sugar is harmless, prolonged periods of low blood sugar can damage the central nervous system. Babies at risk for developing hypoglycemia include: preterm or post-term babies, infants of diabetic mothers, babies of mothers who were given a large dose of glucose solution intravenously during labor, infants who are either small or large for gestational age, and infants who experience respiratory distress, breathing difficulties, or who are the product of a complicated delivery. Babies at risk for hypoglycemia need to breastfeed frequently. Here’s how breastfeeding can help: Focus your energy on encouraging your baby to nurse well and often. Small, frequent, high protein, high calorie meals of colostrum are much better for your baby than the bottles of sugar water offered by hospital staff. See “Latch-on basics” and “Waking the sleepy baby” for tips on getting newborns to breastfeed effectively. Keeping baby from wasting energy will help keep blood sugar at appropriate levels. Frequent breastfeeding has an energy-sparing effect. Babies use less energy at the breast than they do crying or taking milk from a bottle. Offer the breast often, for comfort as well as food. If supplements are medically indicated in your baby’s first days of life, use infant formula Continue reading >>
Hypoglycæmia Of The Newborn (low Blood Sugar)
ISSUES & CONCERNS - BABIES Introduction The fear of low blood sugar of the newborn has become the new “acceptable” reason to separate mothers and babies and give babies supplements of formula in the immediate hours and days after the baby’s birth. The reason paediatricians and neonatologists are worried about low blood sugar is that it can cause brain damage, so there truly is a concern. However, there has developed a sort of ‘hyper’-concern about low blood sugar that is simply not warranted. As a matter of fact, most of the babies who are tested for low blood sugar do not need to be tested and most of those who receive formula do not need formula. By giving the formula, especially as it almost always is given by bottle, we interfere with breastfeeding and give the impression that formula is good medicine. Some truths about hypoglycæmia of the newborn The best way to prevent low blood sugar is to feed the baby with milk. However, formula and breastmilk (specifically colostrum in these early days) are not equivalent and colostrum is far better to prevent and treat low blood sugar than formula (See point #5 below). A little bit of colostrum maintains the blood sugar better than a lot of formula.1,2,3 Having the baby skin to skin with the mother immediately after birth maintains the baby’s blood sugar higher than if the baby is separated from her. (See the information sheet The Importance of Skin to Skin Contact). 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 (60 mg %) is now considered the lowest acceptable blood sugar. This is patently aberr Continue reading >>
Can You Breastfeed If You Have Diabetes?
Approximately 81.1% of mothers breastfeed their babies when they are born. About half of those are still breastfeeding 6 months later. There are many benefits for breastfeeding moms and babies if they are able to stick with it for at least 6 months. For moms with diabetes, there are even more benefits. However along with the benefits, there may also be some challenges as well. The following article provides information about the advantages of breastfeeding for all moms and babies as well as the things to look out for which are unique for nursing mothers with diabetes. The perks of breastfeeding Breastfeeding is very beneficial for the nursing mother as well as the baby. It provides lifelong benefits and can decrease the risk of developing diseases and problems later in life for both of them. For mothers who have diabetes, it can also help them manage their disease and prevent further complications. Benefits for all breastfeeding moms Breastfeeding reduces the risk of several diseases for mothers that nurse for 6 months or longer. These include: Heart disease Diabetes Mellitus Obesity Osteoporosis Rheumatoid Arthritis Ovarian Cancer Breast Cancer Uterine Cancer The risk of developing these diseases can be reduced up to 86%! Breastfeeding also releases a hormone that is called Oxytocin. This hormone is responsible for decreasing stress and increasing mood, which can be very helpful to new mothers that need more rest and a boost of confidence. One study found that for every 6 months that a mother breastfeeds, her BMI (body mass index) is decreased by 1% after she hits menopause. This is wonderful because an increased BMI can lead to many problems including heart disease and diabetes. Breastfeeding also burns calories, and it can help the new mother lose the extra weight th Continue reading >>
Diabetes And Breastfeeding
Breastfeeding is the normal and natural way to feed and nurture a baby. If you have diabetes you may be concerned about whether you can breastfeed. The answer is yes. All mothers experience metabolic and hormonal changes after giving birth. A mother with diabetes who breastfeeds has an advantage as breastfeeding reduces the impact of these changes. When you breastfeed, your body continues to support you and your baby, making your diabetes easier to manage in the days after birth. Later on, gradual weaning helps you to maintain control of your diabetes. Gestational diabetes Benefits of breastfeeding What about medications? Be prepared Blood glucose control Babies can have a hypo after birth Antenatal expression of colostrum Get breastfeeding off to a good start Looking after yourself Adjusting your diet Gestational diabetes It can be a shock if you are diagnosed with gestational diabetes during your pregnancy. This is usually a temporary condition in which your body fails to produce enough insulin to meet your extra needs while you are pregnant. It is usually diagnosed from the fourth month of pregnancy. Just like mothers who are on long-term treatment for diabetes, good control of blood glucose levels will minimise any problems for you and your baby. You may not need any extra medical care during labour and delivery. Diabetes treatment is usually unnecessary once you have given birth. Benefits of breastfeeding For you as a mum with diabetes • It is easier to control your blood glucose levels as your body adjusts after the birth of your baby. • Depending on the type of diabetes you have, you may need less insulin or other medications. • Breastfeeding suppresses your periods and monthly hormonal changes. • Oxytocin and prolactin hormones are calming and help to re Continue reading >>
Guidelines On Neonatal Hypoglycemia
Few newborn conditions generate greater controversy than neonatal hypoglycemia (low blood sugar), particularly when it occurs in breastfed infants. The ongoing debate is fueled by the fact that experts disagree not only on how to manage neonatal hypoglycemia (NH) but also on how to define it. What is neonatal hypoglycemia? Blood glucose (sugar) is the body’s source for energy. When blood glucose levels are low, a condition known as hypoglycemia occurs and the body is unable to function properly. Nearly all newborns experience hypoglycemia after birth. Blood glucose levels typically fall during the first 1–2 hours, dipping as low as 30 mg/dL (milligrams per dram liter), then rise over the next 12 hours (assuming babies are adequately fed), reaching levels of 45 mg/dL or more. These changes often occur without any medical intervention. Although there is no evidence to show that a few hours of low blood sugar in asymptomatic (symptom-free) babies is harmful, many health care providers routinely screen newborns for hypoglycemia, including those with no signs of low blood sugar—signs include jitteriness, irritability, cyanosis (blue-gray discoloration of the skin), seizures, high pitched cry, poor feeding habits, weakness, exaggerated Moro (startle) reflex, and eye rolling. Neonatal hypoglycemia can cause neurological damage in newborns if left untreated. Yet, routine screening has been widely criticized as costly, invasive, and unreliable. Moreover, it increases the risk of unnecessary supplementation in breastfed infants. Screening for neonatal hypoglycemia Acknowledging the lack of data on neonatal hypoglycemia, the ongoing controversy, and the need for guidance, the American Academy of Pediatrics (AAP) Committee on Fetus and Newborn, in 2011, issued a clinical repo Continue reading >>
Hypoglycemia In The Newborn
6 Hypoglycemia in newborns, as with adults, can be a medical emergency and in any case needs immediate treatment. At particular risk are newborns whose mothers had gestational diabetes (GDM) or prepregnancy type 1 or type 2 diabetes mellitus. My particular facility has standing orders to check a heelstick blood glucose on any baby whose mother had any of the above conditions at one, two, and four hours of age. While in utero, glucose from the maternal bloodstream crosses the placental barrier and into fetal circulation to be used for growth. The fetal pancreas functions much as would an adult pancreas; that is, it facilitates glucose uptake by the cells that need it. However, in a situation in which the mother has diabetes, the risk for neonatal hypoglycemia increases, especially if the mother's blood glucose levels were not well controlled. What happens is that the fetal pancreas accomodates the extra maternal glucose; however once delivered, the baby is not receiving maternal glucose. The pancreas continues to function as though it needed to accomodate the extra maternal glucose, however. This is a set-up for hypoglycemia. Definition of hypoglycemia varies slightly between institutions; for my facility, hypoglycemia is defined as blood glucose less than 40mg/dl in a neonate less than 24 hours old. If we find a baby with hypoglycemia, we feed them as soon as possible. If baby is breastfed, we give mom the option breastfeed. Often this works well to bring up the baby's glucose to an acceptable level. I say 'option' not because I am against breastfeeding (quite the contrary), but on occasion the mother is ill or does not at the moment want to breastfeed, and when dealing with hypoglycemia, time is of the essence in feeding the baby. (The human brain functions solely on g Continue reading >>
How To Treat Low Blood Sugar In Newborns
Low blood sugar in newborns is referred to as neonatal hypoglycemia, and is generally experienced in the first few days after birth. The condition is experienced by 2 in every 1,000 newborns. In newborns, sugar is important for the energy supply of the brain during birth. Babies get their supply of sugar from the mother through the placenta before birth. After birth, the baby stores sugar in the heart, liver and muscles. Neonatal hypoglycemia can be caused by a number of reasons, and can be well managed to ensure the well-being of the baby. Causes of Low Blood Sugar in Newborns Sugar levels usually drop in the first few hours after a child is born. And everything will get back to normal after the baby has had first meal with the glucose your baby gets from milk. The baby's blood sugar levels will experience alternate periods of high and low between meals. For healthy babies, these blood sugar ups and downs can be easily balanced as long as they're properly fed. However, some babies are at higher risk of low blood sugar levels. Generally, low blood sugar in newborns is caused by conditions that reduce the amount of glucose in the blood, prevent the storage of glucose in the baby's body, exhaust glycogen stores or inhibit the use of glucose by the body. Factors that may increase the baby's chances of getting neonatal hypoglycemia include: The presence of very high levels of insulin in the blood of the newborn The baby may not be producing enough glucose The newborn may be using up more glucose than is being produced The newborn may not able to consume enough to maintain the glucose levels The baby may not have received sufficient nutrition during pregnancy The newborn may be suffering from a severe case of hemolytic disease The newborn may have a birth defect The newborn Continue reading >>
Booby Traps Series: Say No To Routine Blood Glucose Monitoring For Healthy Babies
This is the 30th in a series on Booby Traps, made possible by the generous support of Motherlove Herbal Company. Blood sugar. It’s a concept familiar to those of you who are diabetic or have had gestational diabetes, but to others it’s the last thing we think we have to learn in preparation for our babies’ birth. But in some hospitals, all babies are checked for low blood sugar. In spite of recommendations from the American Academy of Pediatrics to the contrary, “many hospital nurseries,” says this journal article, “continue the clinical practice of routine early glucose screening on healthy, term newborns.” This has significant consequences for breastfeeding. But let’s back up a bit. Why would anyone want to know about a baby’s blood sugar levels? Glucose is the primary source of energy for our cells, and it’s transported by our bloodstream. Low glucose levels can cause anything from irritability and jitteriness to seizures in babies. But only a small percentage of babies are at risk for low blood glucose. Healthy, term newborns born after a normal pregnancy and delivery are not at risk, yet they are sometimes screened anyway. Why would routine screening of all babies for blood glucose levels be detrimental to breastfeeding? Because a low blood glucose reading often results in formula supplementation, and sometimes separation of the mother and baby. Supplementation can lead to problems with milk supply and sometimes with the ability of babies to feed from the breast. According to the Academy for Breastfeeding Medicine, “it is clear that the routine monitoring of blood glucose in healthy term infants is not only unnecessary but is potentially harmful to the establishment of a healthy mother-infant relationship and successful breastfeeding patterns. Continue reading >>
Beware Of Accidentally Starving Your Breastfed Newborn, Warns The Fed Is Best Foundation
The Fed is Best Foundation turns the “breast is best” adage on its head in an effort to inform new parents that insufficient feeding in the early days of life, before mother’s milk comes in, can have serious, lasting consequences. The resulting low blood sugar, jaundice and dehydration can cause brain injury, and Fed is Best works to educate, increase awareness and offer solutions. Moms feel the pressure to breastfeed well before baby arrives, and while benefits of breastfeeding are well known, the potential harms in the first few days remain largely unrecognized among parents. Though studies suggest benefits, like decreased likelihood of allergies, asthma and illness, and higher IQ and wages, breast milk is only marginally better than formula when taking confounding factors into account. (It’s important to note that this is only in the developed world, where we have access to safe drinking water with which to prepare formula.) This column won’t focus on the exaggeration of breastfeeding benefits, but on the effects of insufficient feeding in exclusively breastfed newborns, the potential complications, and how to prevent them. For more information on common misrepresentations about breastfeeding, see this article from FiveThirtyEight and this one from The Philadelphia Inquirer, both of which are good primers. Also on Forbes: The Fed is Best Foundation is a non-profit volunteer organization of parents and health professionals who study the scientific literature on infant feeding and real-life infant feeding experiences of mothers. Dr. Christie del Castillo-Hegyi, M.D., an emergency physician who researches newborn brain injury and breastfeeding complications, is the co-founder of Fed is Best, along with Jody Segrave-Daly, a newborn ICU nurse and IBCLC (lactatio Continue reading >>
Hypoglycemia And The Breastfed Newborn
We provide articles from our publications from previous years for reference for our Leaders and members. Readers are cautioned to remember that research and medical information change over time. Hypoglycemia is the technical term for low blood sugar (low concentrations of glucose, the sugar found in blood). When the body's rate of use of glucose is greater than the rate of glucose production, the plasma glucose concentration falls. If it falls too far too fast in the newborn period, hypoglycemia results. Hypoglycemia is not a common condition in newborn babies, and breastfeeding early and often will almost always prevent it. Further, the baby who is not showing any symptoms of hypoglycemia does not need glucose supplements. They should not be given routinely. Symptomatic hypoglycemia in newborns is largely due to delayed or inadequate feeding and is more likely to occur when mother and baby are separated after birth. Some newborns are given sugar water on the erroneous assumption that this will prevent hypoglycemia. Instead, giving glucose water causes a sudden rise in the blood glucose levels, which in turn stimulates the secretion of insulin by the pancreas. The high level of insulin results in an equally sudden drop in glucose levels. It is interesting to note that the treatment for hypoglycemia in adults is small, frequent, high-protein meals. That is exactly what the baby gets when he is allowed to breastfeed on demand from birth. Immediate and frequent feedings of colostrum, preferably ten to twelve feedings per day in the first few days, stabilize blood glucose levels. Undiluted human milk is the best food, particularly for preterm infants. Infants at risk for hypoglycemia include those who are small- or large-for-gestational age, preterm, have some type of neona Continue reading >>
Hypoglycemia In Newborns
Neonatal hypoglycemia occurs when a newborn has low blood sugar levels in the first few days after birth. It occurs in about 1-3 out of every 1,000 births. A normal blood sugar level, also known as glucose, is crucial for a baby’s energy and brain development. Severe or prolonged hypoglycemia may result in seizures and serious brain injury. During pregnancy, the baby gets all nutrients, including glucose from the mother, through the umbilical cord in a constant stream. At birth, the umbilical cord is clamped then cut effectively removing the baby’s source of nutrients. Most babies have glucose stored in the liver, which helps maintain a normal blood sugar until the baby begins to nurse. Colostrum, the very early milk produced by a mother is very high in glucose. Some babies have difficulty producing enough glucose to maintain their blood sugar levels prior to nursing. Glucose levels can drop if there is too much insulin in the blood, if the body is not producing enough glucose, if it is using more than can be produced, and if the baby is not feeding enough to keep the glucose levels up. For example, low glucose levels are more common for infants who: Were born prematurely or are under significant stress such as having difficulty breathing or when they are battling an infection. The premature liver does not have adequate glucose stores to support a normal blood sugar for long if at all. The stressed newborn metabolizes glucose faster than a healthy full term baby. Have a mother with diabetes due to over production of insulin. Have low thyroid hormone levels (hypothyroidism) Had poor growth in the womb again because the liver did not adequately store glucose prior to delivery. Infants with low blood sugar don’t always show symptoms. But nurses and doctors know to ch Continue reading >>
