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 >>
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 >>
Bogus Neonatal Low Blood Sugar Derails Hospital Breastfeeding
Most expectant Mothers who intend to breastfeed their newborns are aware that giving birth in the hospital runs the risk of having your baby get a bottle of sugar water (aka “baby crack”) by a well intentioned but seriously misguided nurse, perhaps to pacify a fussy baby in order to let Mom sleep. Another reason a newborn may be given sugar water is for “pain management” when the baby receives the synthetic vitamin K shot, the liver damaging Hep B jab or newborn screening tests involving a heel prick. Besides the fact that this sugar water contains glucose derived from genetically modified (GMO) corn, giving a baby an artificial nipple before breastfeeding is established is a great threat to the future breastfeeding relationship between Mom and baby. As a result, clued in Moms are now advised to include a “no sugar water” clause in their birth plans, with doulas and other birthing advocates remaining watchful while Mom is resting or baby is out of the room for whatever reason. Now, there is a new game in town that is commonly being used to derail breastfeeding after a hospital birth and arbitrarily give GMO laced commercial formula to babies. This reason is neonatal hypoglycemia or low blood sugar. I first became aware of this problem when a friend sent me an email about it. She had been made aware of the situation by a doula from New Mexico who said that women who start off breastfeeding in the hospital are being told by the nurses that their babies have low blood sugar and they need to have formula right away. This misguided advice caused a large number of mothers to stop breastfeeding out of concern that neonatal hypoglycemia might cause harm such as brain damage. So what’s the truth? Do babies ever need formula instead of rich, immunity building colost 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 >>
Blood Sugar Monitoring And Treatment In The Nicu
Blood sugar is the amount of sugar in the blood. The body needs sugar to function. Blood sugar must stay within a certain range for the body to be healthy. A body chemical (hormone) called insulin helps the body maintain a normal blood sugar level. In many newborns, blood sugar is either too high or too low. So doctors will carefully watch your baby’s blood sugar level during his or her stay in the neonatal intensive care unit (NICU). If your baby's blood sugar is too high or too low, treatment will bring it back under control. Why is my baby’s blood sugar abnormal? Low blood sugar is common in many babies right after birth, as the baby’s body gets used to regulating its blood sugar level without help from the mother’s body. Infants of mothers who have diabetes may have more difficulty regulating their blood sugar. High blood sugar can be caused by illness or stress. It’s also common in preemies born very early, because the organ that makes insulin (pancreas) is not fully developed. How is blood sugar monitored? A healthcare provider uses a tiny blade (lancet) to take a drop of blood from your baby’s foot. The blood is put on a small test strip. This measures the sugar in the drop of blood. How are blood sugar problems treated? If blood sugar is too low, you may feed your baby more often. The natural sugar in your breastmilk or formula helps raise blood sugar level. A healthcare provider may also give your baby supplemental sugar (glucose) through an IV (intravenous) line. If blood sugar is too high, a healthcare provider may give your baby insulin. This helps the baby's body use up more of the sugar in the blood. If the baby is being fed through an IV, a healthcare provider may also lower the amount of glucose in the IV fluid. But babies need some sugar to 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 >>
Low Blood Sugar In Newborns
Hypoglycemia & Breastfeeding Breastfeeding the baby with low blood sugar. Is low blood sugar in newborns serious? It is actually common for babies to have low blood sugar after birth, but breastfeeding early and often can prevent and help with low blood sugar in a baby. When a baby has low blood sugar, it does not mean that he will develop diabetes; most of the time, the blood sugar levels will normalize after the baby starts to drink well. The low blood sugar is treated immediately, because if it is left for too long it can cause other serious problems like brain damage. Causes of Low Blood Sugar in Newborns While a baby is inside his/her mother, his blood sugar is controlled by hers, via the umbilical cord. The baby will then store some glycogen in his/her liver during the last three months in utero. This is why low blood sugar is more common in premature babies, due to the fact that they do not yet have the stored glycogen in their liver for regulating sugar. Another reason why a baby might have low blood sugar, is when the mother has diabetes that is poorly managed. This will cause a baby to produce too much insulin after birth. The baby may be too cold, stressed out or might cry too much after birth, which can also cause hypoglycemia. A baby born with low blood sugar may be producing too little glucose, which can be caused by brain injury or metabolic problems. This is a very rare occurrence. Babies that are at Higher Risk of developing Hypoglycemia Babies who are premature or who are a very low birth weight are at higher risk. A smaller twin has a higher risk of becoming a low blood sugar baby. Babies with colds or respiratory problems after birth. Mothers who had long labors. Babies who are under stress during delivery. Babies who get too cold after birth and are Continue reading >>
Abm Clinical Protocol #1: Guidelines For Blood Glucose Monitoring And Treatment Of Hypoglycemia In Term And Late-preterm Neonates, Revised 2014
Go to: A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. Go to: To provide guidance in the first hours/days of life to: • Prevent clinically significant hypoglycemia in infants • Appropriately monitor blood glucose levels in at-risk term and late-preterm infants • Manage documented hypoglycemia in infants • Establish and preserve maternal milk supply during medically necessary supplementation for hypoglycemia or during separation of mother and baby Go to: Background Physiology The term “hypoglycemia” refers to a low blood glucose concentration. Clinically significant neonatal hypoglycemia reflects an imbalance between the supply and utilization of glucose and alternative fuels and may result from several disturbed regulatory mechanisms.1 Transient hypoglycemia in the first hours after birth is common, occurring in almost all mammalian newborns. In healthy, term human infants, even if early enteral feeding is withheld, this phenomenon is self-limited, without clinical signs, and considered to be part of adaptation to postnatal life, as glucose levels spontaneously rise within the first 24 hours after birth (for some, it is even longer but still physiological).2–6 Most neonates compensate for this “physiological” low blood glucose with endogenous fuel production through gluconeogenesis, glycogenolysis, and ketogenesis, collectively called “counter-regulation. Continue reading >>
Dextrose 'wards Off Brain Damage In Newborns With Low Blood Sugar Level'
A small dollop of dextrose gel inside the mouth of a newborn baby with dangerously low blood sugar levels can prevent the child becoming brain damaged, new research shows. Giving the gel will help the 5% to 15% of newborn babies born with hypoglycaemia avoid the serious neurological damage that the condition can cause, suggests a study in The Lancet medical journal. Doctors and midwives last night hailed the results of the trial as a potentially significant breakthrough in the treatment of newborns with hypoglycaemia and urged the NHS to make it routinely available in hospitals. The gel, which costs only about £1.25p per child, works better than the standard existing treatment of breastfeeding and regular blood tests, researchers found. "Our study is the first report in babies showing that dextrose gel massaged into the inside of the cheek is more effective than feeding alone for treating hypoglycaemia, and is safe and simple to use," said Jane Harding, a professor at the University of Auckland, New Zealand, and leader of the study. The gel could reduce the number of babies who have to spend time in a neonatal intensive care unit being treated with intravenous glucose. That would mean mothers could stay with their babies instead of being separated, which would in turn allow more time to establish breastfeeding, Harding said. Growing numbers of babies are ending up in intensive care with hypoglycaemia because more are being born prematurely and more mothers are developing diabetes in pregnancy or are obese. Diabetes and obesity both raise the risk of low blood sugar in a baby. Dextrose gel is already used to reverse hypoglycaemia in people with diabetes. Harding and her colleagues examined 514 babies born in Waikato women's hospital in New Zealand between 2008 and 2010. Continue reading >>
Hypoglycaemia In Babies
What is hypoglycaemia? Hypoglycaemia means low blood sugar. If your baby's blood sugar is low, and it is not treated, it could put his health at serious risk. If it stays low for a long time, it even could cause brain damage. However, if your baby is not premature, and otherwise healthy, he is unlikely to have low blood sugar. Don't worry if he is at risk of having low blood sugar. A host of medical professionals will be on hand to make sure that your baby's health is safeguarded. After he's born, your midwife and other staff will make sure that he is feeding well. They will check your baby's glucose level with a blood test if they are worried. In some hospitals, these blood tests are routinely offered to babies who are thought to be at high risk. What causes hypoglycaemia in newborns? Every cell in the body needs a supply of sugar, or glucose, to function well. We get glucose from the foods we eat and newborn babies get it from milk. Keeping the right level of sugar in the blood is a delicate balancing act. After we eat a meal, or when babies have just had a feed, sugar levels go up. When it is time for the next feed, levels start to dip. Sugar levels are regulated by our hormones, particularly insulin, which helps certain cells take up glucose for storage. When everything is working well, the hormones keep the blood sugar levels within an even range. When the balance is out, hypoglycaemia can happen. Your baby's blood sugar levels go down in the first few hours after birth and this is normal. Most healthy babies can cope easily with normal dips in blood sugar level. If they're given breastfeeds whenever they want, they will take the milk they need to ensure their sugar levels remain healthy. However, some babies are at risk, including babies born to mothers who have d Continue reading >>
Hypoglycemia In Newborns (resources)
Hypoglycaemia from BabyCentre.com … no study has shown that treatment of a transient low blood glucose level offers a better short-term or long-term outcome than the outcome resulting with no treatment. … Furthermore, there is no evidence that asymptomatic hypoglycemic infants will benefit from treatment. The Academy of Breastfeeding Medicine: Guidelines for Glucose Monitoring and Treatment of Hypoglycemia in Term Breastfed Neonates Includes a definition of hypoglycemia with levels of lower limits at various hours after birth, risk categories, and management of asymptomatic and symptomatic infants. Hypoglycemia in the Breastfeeding Newborn by Sallie Page-Goertz, MN, CPNP, IBCLC Hypogylcaemia of the Newborn An extensive paper on this subject from the World Health Organization, with 10 pages of references. de Rooy L, Hawdon J. Nutritional factors that affect the postnatal metabolic adaptation of full-term small- and large-for-gestational-age infants. Pediatrics. 2002 Mar;109(3):E42. Conclusion: Neonatal ability to generate ketone body when blood glucose values are low depends more on successful breastfeeding than on size for gestational age or neonatal nutritional status. Routine blood glucose monitoring of LGA infants with no additional risk factors is not necessary. Routine formula milk supplementation for LGA and SGA infants should not be recommended. Eidelman AI. Hypoglycemia and the breastfed neonate. Pediatr Clin North Am. 2001 Apr;48(2):377-87. This article article outlines a set of clinical guidelines for rational management of the prevention and treatment of hypoglycemia in breastfed infants. Summary: Healthy, full-term infants are functionally and metabolically programmed to make the transition from their intrauterine dependent environment to their extrauter Continue reading >>
Breastfeeding And Diabetes: What’s The Connection?
Did you know August is National Breastfeeding Month? Launched in 2011 by the United States Breastfeeding Committee through the U.S. Department of Health and Human Services, this campaign aims to highlight research that demonstrates the benefits of breastfeeding for infants and mothers. In celebration of National Breastfeeding Month, we’re offering new and soon-to-be mothers with diabetes some tips for breastfeeding and the advantages it may provide both you and your child. Benefits for Your Baby Breast milk is widely considered to be the most beneficial source of nutrition for infants. Studies have shown breastfeeding offers many advantages to newborns, including decreased risks of high respiratory infections, high blood pressure, asthma, atopy (a disorder marked by the tendency to develop allergic reactions) and diabetes. A mom who has gestational diabetes during pregnancy increases the risk that her child will become obese during childhood. However, one study found that breastfeeding a baby for at least six months neutralizes that risk. Breastfed children of mothers with diabetes were no more likely to be overweight at ages six to 13 than kids whose moms didn’t have diabetes. Breastfeeding for less than six months, though, showed no benefit in reducing obesity. Some people believe baby formula can lead to infant weight gain, but the bottle itself may be part of the problem. Another study found that babies who get breast milk only from bottles gain weight more rapidly than those who get it exclusively from mothers’ breasts—three ounces more per month during their first year. This could be because babies can control how much milk they swallow during breastfeeding, while parents often take the lead with bottles. Looking to babies for hunger cues may help parents Continue reading >>
Breastfeeding Basics: Tips For Moms With Newborns
Breastfeeding can be a challenging experience. Most moms attempt to nurse after the baby is born, and some are successful immediately. Others go through pain, discomfort and frustration before they are successful, too. And others choose to bottle feed. A What is happening inside my baby's body? When a fetus grows inside the womb, nutrition is provided 24 hours a day, seven days a week through the umbilical cord. This means that a growing fetus receives continuous nutrition. But when a baby is delivered and the cord is cut, he does not get fed around-the-clock anymore. Instead he has to work by sucking a breast or bottle every two to three hours. Many times parents cannot believe how often their newborn wants to eat, sometimes as often as every hour. But despite how frequent this feeding schedule may seem to an adult, it is far less than the constant nutrition the baby was used to receiving prior to delivery. For your baby, a couple of hours is a long wait between each meal. Most newborns manage the two or three hour wait between feedings with no difficulty. There is one catch, however. Humans are not designed to produce breast milk until around the third day of a baby's life. Before then, the breast-feeding baby gets a very concentrated liquid called colostrum. Colostrum is packed with antibodies (which help fight infections), but very little comes out of the breast with each feed an ounce at a time at best. Again, this is normal, so most babies do fine until the third day of life, when the milk comes in. Because of this delay in breast-milk production, most breast-fed babies lose weight in the first few days of life. Newborns are built to deal with this by having as much as a pound of extra water weight at birth, as you can see in the swollen eyes and puffy cheeks of r Continue reading >>
Hypoglycemia In Newborns
What is hypoglycemia? Hypoglycemia means low blood sugar. If your baby's blood sugar is low, and it is not treated, it could put his health at serious risk. If it stays low for a long time, it even could cause brain damage. Certain factors put babies at higher risk of having hypoglycemia including being born prematurely, being small or large for gestational age (the smallest and largest 10 per cent of babies), having a diabetic mom, and being sick. However, if your baby does not have one of these risk factors, and is otherwise healthy, he is unlikely to have low blood sugar. Don't worry if he is at risk of having low blood sugar. A host of medical professionals will be on hand to make sure that your baby's health is safeguarded. After he's born, your midwife or doctor will make sure that he is feeding well. They will check your baby's glucose level with a blood test if they are worried. In some hospitals, these blood tests are routinely offered to babies who are thought to be at high risk. What causes hypoglycemia in newborns? Every cell in the body needs a supply of sugar, or glucose, to function well. We get glucose from the foods we eat and newborn babies get it from milk. Keeping the right level of sugar in the blood is a delicate balancing act. After we eat a meal, or when babies have just had a feed, sugar levels go up. When it is time for the next feed, levels start to dip. Sugar levels are regulated our hormones, particularly insulin, which helps certain cells take up glucose for fuel. When everything is working well, the hormones keep the blood sugar levels within an even range. When the balance is out, hypoglycemia can happen. It’s normal for your baby's blood sugar levels go down in the first few hours after birth because your baby is separated from the sup Continue reading >>
