How To Treat Low Blood Sugar In Newborn

What Happens When A Baby Has Neonatal Hypoglycemia

Hypoglycemia is defined as low glucose levels. The body produces insulin, a hormone that regulates glucose levels. If more glucose is produced than the body needs, or if there isnt enough glucose consumed, levels will drop. When blood sugar levels get too low, there may not be enough glucose reaching the brain . That may impair growth and cause brain cells to begin dying.

Neonatal hypoglycemia happens when a newborn baby has very low blood sugar levels. When a baby is born and no longer receives glucose from their mother through the umbilical cord, they need to get glucose from feeding. Babies who dont get enough from feeding or have problems feeding may have to be given medication to provide glucose. Its normal for a babys glucose levels to fall right after birth. However, levels typically return to a normal level after feeding.

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What Are The Treatment Options For Hypoglycemia

Children with hypoglycemia have different symptoms, and these vary from one child to another. But no matter what your childs symptoms, the overriding goal is the same to bring the blood sugar back up to normal as rapidly as possible and return your child to good health.

Most often, your childs blood sugar can be brought back up to normal by eating or drinking something that has sugar in it, such as fruit juice, regular soda, table sugar, maple syrup, candy, glucose tablets, glucose gel, or cake frosting. Consider encouraging your child to:

• eat regular meals throughout the day
• eat frequent snacks

For children with diabetes, the goal is to consistently maintain a blood sugar level that is in a healthy range. This involves testing blood sugar often, learning to recognize the earliest symptoms of low blood sugar, and treating the condition quickly, based on instructions given by your childâs healthcare providers.

If your child has recurrent or severe hypoglycemia, the first thing is to determine the cause, because different causes have different treatments. While the cause is determined, some children will receive glucose intravenously in the hospital to make sure their blood-sugar level stays normal.

Some causes of hypoglycemia can be treated with changes in your childs diet or medication. For some rare cases of severe hypoglycemia that dont respond to medical treatment, the doctor may recommend surgery to remove most of the pancreas.

Information About Your Child

We collect and use your childs information to provide your child with care and treatment. As part of your childs care, information about your child will be shared between members of a healthcare team, some of whom you may not meet. Your childs information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide your child with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your childs doctor, or the person caring for your child.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about your child. For further information visit the following page: Confidential Information about You.

If you need information about your childs health and wellbeing and their care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.

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Medication For Type 1 Diabetes Mellitus

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After You Have Low Blood Sugar

If your low blood sugar was mild , you can return to your normal activities once your blood sugar is back in its target range.

After you have low blood sugar, your early symptoms for low blood sugar are less noticeable for 48 to 72 hours. Be sure to check your blood sugar more often to keep it from getting too low again, especially before eating, physical activity, or driving a car.

If you used glucagon because of a severe low , immediately call your doctor for emergency medical treatment. If you have had lows several times close together , you should also tell you doctor. They may want to change your diabetes plan.

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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 may be in a place that is excessively cold
• A situation of birth asphyxia
• The baby may have liver disease
• The baby may have an infection
• The baby had breathing difficulties at birth
• The baby was born prematurely

Prevention Of Hypoglycemia In The Newborn:

There may not be any way to prevent hypoglycemia, only to watch carefully for the symptoms and treat as soon as possible. Mothers with diabetes whose blood glucose levels are in tight control will have lower amounts of glucose that go to the fetus. This will lower the fetal insulin production and reduce the risk of neonatal hypoglycemia.

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What To Do If An Infant Has Hypoglycemia

It is common for infants to temporarily have hypoglycemia immediately after birth. If this happens, a doctor will monitor their blood glucose to see if it returns to normal. If it does, treatment may not be necessary.

However, if an infant is showing signs of hypoglycemia in the days, weeks, or months after birth, call a doctor right away.

The doctor may advise giving breast milk, formula, or a mixture of glucose and water, if a person has any, to try to raise the infants blood sugar levels. They may also recommend visiting a health center to get a blood glucose test.

The symptoms of hypoglycemia in newborns are similar to those of many other conditions, so it is important to get help from a healthcare professional.

Prompt feeding at birth and ongoing, on-demand feeding can reduce the risk of hypoglycemia by ensuring that an infant gets adequate nutrition. If someone is nursing, frequent feeding also

There are several reasons that a newborn might develop hypoglycemia. These include the following.

Causes Of Hypoglycaemia In Newborn Babies

Various conditions that might be the causes of low blood sugar in new-born babies include:

• Infants of diabetic mother : Uncontrolled diabetes in the mother results in excessive insulin production. Although insulin does not cross the placenta, glucose and other nutrients do. So extra blood glucose goes through the placenta, giving the baby high blood glucose levels. This causes the babys pancreas to make extra insulin to get rid of the blood glucose.
• Premature births: Babies who are born before term are prone to hypoglycaemia.
• Birth weight: Less than 2 kg babies.
• Mothers on certain medications: Like Terbutaline, Propanolol, Labetalol, oral hypoglycaemic agents, etc.
• Advanced RH Haemolytic diseases : Rh Blood group mismatch between mother and child can cause hypoglycaemia.
• Congenital defects and metabolic diseases since birth: Genetic and metabolic disorders since birth may cause lower blood sugars in the new-born.
• Birth Asphyxia: Babies that have suffered low oxygen levels during birth and in the first few hours after birth are prone to hypoglycaemia.
• Cold stress : Hypothermia or abnormally low body temperatures may be a cause of hypoglycaemia.

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Treatment Of Neonatal Hypoglycemia

• Enteral feeding

• Sometimes IM glucagon

Most high-risk neonates are treated preventively. For example, infants of diabetic women who have been using insulin are often started at birth on a 10% D/W infusion IV or given oral glucose, as are those who are sick, are extremely premature, or have respiratory distress. Other at-risk neonates who are not sick should be started on early, frequent formula feedings to provide carbohydrates.

Any neonate whose glucose falls to 50 mg/dL should begin prompt treatment with enteral feeding or with an IV infusion of up to 12.5% D/W, 2 mL/kg over 10 minutes higher concentrations of dextrose can be infused if necessary through a central catheter. The infusion should then continue at a rate that provides 4 to 8 mg/kg/minute of glucose . Serum glucose levels must be monitored to guide adjustments in the infusion rate. Once the neonates condition has improved, enteral feedings can gradually replace the IV infusion while the glucose concentration continues to be monitored. IV dextrose infusion should always be tapered, because sudden discontinuation can cause hypoglycemia.

Canadian Paediatric Society Fetus And Newborn Committee

Members: Heidi Budden MD , Mireille Guillot MD , Leonora Hendson MD, Thierry Lacaze-Masmonteil MD, PhD , Brigitte Lemyre MD, Michael R. Narvey MD , Vibhuti Shah MDLiaisons: Radha Chari MD, The Society of Obstetricians and Gynaecologists of Canada James Cummings MD, Committee on Fetus and Newborn, American Academy of Pediatrics William Ehman MD, College of Family Physicians of Canada Roxanne Laforge RN, Canadian Perinatal Programs Coalition Chantal Nelson PhD, Public Health Agency of Canada Eugene H. Ng MD, CPS Neonatal-Perinatal Medicine Section Doris Sawatzky-Dickson RN, Canadian Association of Neonatal NursesPrincipal authors: Michael R. Narvey MD, Seth D. Marks MD

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Which Newborns Are At Risk For Hypoglycemia

Babies who are more likely to have hypoglycemia include those who are:

• Born to mothers with diabetes

• Small for gestational age or growth-restricted

• Preterm babies, especially those with low birth weights

• Born under significant stress

• Born to mothers treated with certain medicines such as terbutaline

• Large for their gestational age

Preventing A Low Blood Sugar Level

If you have diabetes, you can reduce your chance of getting a low blood sugar level if you:

• Check your blood sugar level regularly and be aware of the symptoms of a low blood sugar level so you can treat it quickly.
• Use a continuous glucose monitor or flash monitor to see how your blood sugar levels are changing. Ask your diabetes care team about getting a monitor if you do not already have one.
• Always carry a sugary snack or drink with you, such as glucose tablets, a carton of fruit juice or some sweets. If you have a glucagon injection kit, always keep it with you.
• Do not skip meals.
• Be careful when drinking alcohol. Do not drink large amounts, check your blood sugar level regularly, and eat a carbohydrate snack afterwards.
• Be careful when exercising eating a carbohydrate snack before exercise can help to reduce the risk of a hypo. If you take some types of diabetes medicine, your doctor may recommend you take a lower dose before or after doing intense exercise.
• Have a carbohydrate snack, such as toast, if your blood sugar level drops too low while you’re asleep .

If you keep getting a low blood sugar level, talk to your diabetes care team about things you can do to help prevent it.

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What Is Hypoglycemia And Low Blood Sugar

Hypoglycemia is the state of having a blood glucose level that is too low to effectively fuel the body’s cells.

Glucose, which comes from carbohydrates found in foods, is a main source of energy for all of the cells of the body and, especially, the brain. While the body is quite good at extracting glucose from the foods we eat, it relies on a hormone called insulin to actually get the glucose inside the cells of specific organs: the liver, fat, and muscle.

We can think of insulin as holding the key to a cell without insulin, the glucose just remains in the blood, where its also known as blood sugar. During an episode of hypoglycemia, theres not enough glucose in the blood. The normal range is approximately 70 to 150 mg/dl .

Hypoglycemia is most common in newborns. In older children, its most often seen as a complication of insulin therapy for diabetes but can sometimes have other causes as well.

In the majority of cases, hypoglycemia is temporary, easily treated, and usually does not have serious consequences. There are several rare disorders in which hypoglycemia is recurrent and potentially life-threatening. However, with timely diagnosis and appropriate treatment, these can be effectively managed.

Low Blood Sugars In Babies

We have recommended your baby be closely monitored because he or she is at risk of, or has had a low blood sugar level. Babies with a low blood sugar level may need to be admitted to the Newborn Intensive Care Unit for treatment until their blood sugar level reaches and is maintained within a normal range. However, many babies at risk of low blood sugars are able to be with their mother on the ward. A baby who has had a low blood sugar level with no complications does not need special checks after leaving hospital.

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Can Neonatal Hypoglycemia Cause Any Other Serious Conditions

While its known that severe, recurring low blood sugar in newborns can contribute to brain damage in areas of the brain that can lead to long-term disability, visual impairment, and epilepsy, research suggests no significant differences in neurodevelopment between infants with and without a history of neonatal hypoglycemia.

Rarely, newborns who are diagnosed with this condition can go on to experience recurrent seizures or heart failure, but these outcomes tend to be linked to underlying conditions, not low blood sugar itself.

How Should We Prevent Low Blood Sugar

• Good control of diabetes during the pregnancy can help prevent low blood sugar.

• Good control of diabetes during the labour and birth also is important.

• We, and postpartum departments all over the world , have suggested to our prenatal patients whose babies are at high risk of low blood sugar, to express their colostrum before the baby is born, starting at about 35 or 36 weeks gestation. Most can get a few ml. a day by hand expression and a mother can often get 30 or 40 ml saved before the baby is born. Some mothers can get a lot more. If the baby needs to be supplemented to control the blood sugar, the baby is given colostrum, not formula. See the photos in this link.

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For How Long Might Blood Glucose Checks Or Additional Treatment Be Required

Blood glucose levels in babies usually become normal within 12 hours to 72 hours of birth, especially once a regular feeding pattern is established. The risk of low blood glucose is greatest in the first 12 hours of life in large-for-dates and full-term babies, and up to 36 hours of life in small-for-dates and preterm babies.

It is rare for babies to continue to have difficulty maintaining their blood glucose levels. If this happens beyond 24 hours, speak with your babys doctor.

For more information on your babys growth and development, visit < www.caringforkids.cps.ca> .