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What is Hypoglycemia in a Newborn baby?

Hypoglycemia can be described as a condition whereby blood glucose levels are too low. In human beings, glucose is the main source of energy for both the brain and body. Babies can have low blood sugar levels at birth for several reasons.

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Hypoglycemia in infants can cause them to have feeding and breathing difficulties, it can cause them to be shaky and may have a blue tint to their skin. Hypoglycemia is the medical term used to describe low blood sugar.

In newborns, hypoglycemia mostly occurs immediately after birth. In most cases, hypoglycemia in babies corrects itself once the newborn starts to feed regularly. Most cases of hypoglycemia are detected while the baby is still in the hospital before they are discharged.

Newborns with hypoglycemia are not sent home until their blood sugar level stabilizes. In some cases, hypoglycemia may not resolve easily and may also come back. Hypoglycemia that occurs within the first 48 hours of the baby being born is usually a sign of an underlying medical condition.

In newborns, hypoglycemia is very much treatable. However, if not treated as soon as possible hypoglycemia in newborns can cause lasting damage. Once the family or caregiver notices the symptoms of hypoglycemia, they should act very fast.

Once the symptoms have been reported, the doctor may recommend more regular feeding, sugar gel, or supplementing the mother’s milk with formula.

Signs of Hypoglycemia in Newborns

Hospitals and health centers should test the blood sugar levels of babies who are at risk of hypoglycemia. Infants should be tested at birth and the next tests should be done at regular intervals.

For a newborn to be diagnosed with hypoglycemia, their blood sugar level should be below 47 milligrams per deciliter. If an infant has hypoglycemia, the caregiver or parent may notice:

• low body temperature
• a lack of interest in eating
• shakiness
• seizures
• blue or white discoloration of the skin and lips
• weak or floppy muscles
• low energy

Hypoglycemia could worsen if the blood sugar levels continue to decrease or remain low for 3 days or more.

Causes of Hypoglycemia in Newborns

A newborn may develop hypoglycemia for several reasons. These include:

1. Transitional hypoglycemia – as the baby transitions to life outside the uterus, it is normal for their blood glucose to reduce. This condition is known as hypoglycemia. Hypoglycemia that remains mild and temporary is not harmful to the infant.

While in the uterus, the fetus receives nutrients from the placenta through the umbilical cord. Once the baby is born, the umbilical cord is clamped and cut. This stops the supply of nutrients to the baby. It is during this period that transitional hypoglycemia occurs.

Transitional hypoglycemia does not need treatment because it corrects itself once the baby starts feeding. However, in some babies, this drop in blood sugar is too large and may cause dangerously low blood glucose that could be fatal.

1. Medical Conditions – babies can be born with several medical conditions that can make feeding difficult or make it hard to absorb and store energy. If this occurs, it can cause persistent hypoglycemia.

These medical conditions include:

• Soto syndrome
• hypothyroidism
• galactosemia
• congenital hyperinsulinism
• Costello syndrome
• beckwith-Wiedemann syndrome
• fructose intolerance
• Inadequate food – some newborns do not get adequate food at birth. This is likely to happen if feeding is delayed probably because the caregiver or parent does not feed on demand or early or if the mother has problems with milk supply.

1. Antenatal steroids – hypoglycemia is known to be a side effect of steroid medication such as betamethasone. Betamethasone is a steroid medication given to pregnant women who are at risk of preterm labor. This drug is given to speed up the development of the lungs in the fetus.

Studies also show that in preterm infants, hypoglycemia can be prevented by delaying the clamping of the cord.

Babies need blood sugar which is mostly used by the brain. Unborn babies receive blood glucose from their mothers through the placenta. After birth, the newborn obtains blood sugar from the mother through breastmilk or baby formula.

Levels of blood sugar may drop for several reasons including:

• if the body of the baby is using more glucose than is being produced
• if the baby is unable to produce enough glucose
• if there is too much insulin in the blood
• if the baby is not able to take in enough glucose through feeding.

Hypoglycemia in babies occurs when the blood sugar level is lower than the range considered normal for their age. Hypoglycemia is not very common in newborns. Babies with certain risk factors are more likely to develop hypoglycemia. These risk factors include:

• larger or smaller in size than expected for their gestational age
• born early, has a serious infection or needed oxygen immediately after being born
• slower than expected growth in the womb during pregnancy
• mother has diabetes (in such cases, babies are larger than normal)

What to do if a Newborn has Hypoglycemia?

Several babies have hypoglycemia immediately after birth. If a baby develops hypoglycemia. it is important to let the doctor know so that they can keep an eye on the blood glucose level of the baby to see if it stabilizes.

Treatment is not necessary in cases where hypoglycemia goes away on its own. If a baby develops hypoglycemia days, weeks, or months after being born, the parent or guardian should call the doctor right away.

In response, the doctor might advise the mother to give the baby breastmilk, a mixture of glucose and water or formula. Doctors may also recommend the mother to visit a healthcare center to have a blood glucose test done.

Hypoglycemia in newborns presents symptoms that could be easily mistaken for other conditions. It is therefore very important to get the help of a professional healthcare provider. Mothers can easily reduce the risk of their babies developing hypoglycemia by feeding them immediately after birth, providing ongoing and on-demand feeding. This helps to ensure the newborn gets enough nutrition. For nursing mothers, feeding frequently can also help.

Risk Factors for Hypoglycemia in Newborns

Babies with the following characteristics are likely to develop hypoglycemia;

• Small size at birth – newborns who are smaller for their gestational age have less storage of fats and glycogen. What this means is that their ability to produce glucose is reduced and they are likely to develop hypoglycemia especially if this issue is further compounded by delayed feeding.
• large size at birth – infants that are larger than they should be according to their gestational age will have increased metabolism and need for glucose. This means that they are not able to obtain enough glucose from either breastmilk or formula. Parents with diabetes are likely to have babies that are larger for their gestational age.
• Prematurity – babies born prematurely have problems similar to those of babies born smaller for their gestational age. Additionally, these babies will experience issues with breast milk supply or have a hard time nursing. Late preterm infants born between the 34^th and 36^th week are more likely to develop hypoglycemia.
• Complications during birth – perinatal stress increases the chances of an infant developing hypoglycemia. Perinatal stress includes birth complications for example fetal distress, hypothermia, and eclampsia. These babies have high energy needs. Infants who undergo perinatal stress may develop high levels of insulin temporarily. This may result in a low blood sugar tendency that could last for days or weeks.

Diagnosis and Treatment of Hypoglycemia in Newborns

It is important to keep an eye on the blood sugar levels of babies at risk for hypoglycemia. If the blood sugar level of an infant goes below 40 mg per deciliter within their first 4 hours of being born, the healthcare provider should recommend increasing the interval of feeding to increase blood glucose.

Blood glucose can be raised with breast milk. If breast milk is not available, donor breast milk can be used. Donor milk is breast milk obtained from another person who is not the birthing mother.

If there are problems with the supply of breast milk, doctors may suggest supplementing with formula. However, feeding the baby with formula may affect lactation later. Currently, doctors recommend starting with oral sugar to increase the blood sugar level of newborns because unlike formula, it does not affect lactation.

Severe hypoglycemia or hypoglycemia that does not go improve with oral sugar can be treated by putting the infant of IV glucose. Newborns with severe hypoglycemia should be put in neonatal intensive care unit where they can be easily and effectively monitored.

Complications of Hypoglycemia in Newborns

Hypoglycemia however remains to be a severe condition that if left untreated can have serious implications. Complications that may result from hypoglycemia may include:

• brain damage
• death of the newborn
• developmental problems
• death
• seizures

Conclusion

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