Types Of Newborn Hypoglycemia
There are two different types of neonatal hypoglycemia: transient and persistent . Babies who have transient NH typically have a deficiency of glycogen stores at birth. This is common in babies that are born premature, who are small for gestational age, or experienced birth asphyxia. Transient NH babies also may experience hyperinsulinism, which occurs most often in babies born to diabetic mothers.
Newborn hypoglycemia can also occur if an IV infusion of glucose is interrupted for example, if the umbilical catheter is incorrectly positioned or the baby has sepsis. If the baby experiences NH due to an error of medication administration, this is medical malpractice.
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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What Is An Abnormal Blood Sugar Level
The lowest normal blood sugar level for a newborn baby is above 2.6mmol/L. This level of blood sugar is needed for the brain to function properly. It is important for your babyâs level to be increased to the normal range as quickly as possible as untreated low blood sugar can result in brain damage.
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Why Do Some Babies Have Low Blood Glucose
- In healthy full-term babies , blood glucose levels are at their lowest 1 to 2 hours after birth. After this, the levels usually start to rise as your babys body starts to use healthy sugar and fat stores.
- Small and preterm babies may not have enough stores to keep the level up without extra feedings. These babies are most at risk for low blood glucose in the first 24 hours of life.
- Babies whose mothers have diabetes may have trouble using their glucose stores. The normal rise in blood sugar that takes place after birth may not happen right away.
- Babies who are large for their gestational age may have the same kind of problem during the first 12 hours of life.
Usually, low blood glucose levels will only last for a few hours, but can last up to 24-72 hours. Once your babys levels become normal, he shouldnt have further problems with hypoglycemia .
In very rare cases, low blood sugar can be severe or last a long time. If this happens, your doctor will do special tests to look for other causes.
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.
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How Is Blood Glucose Checked
Blood glucose is checked with just a few drops of blood, usually taken from your babys heel.
If your baby is at-risk but doing well, blood glucose will be checked around 2 hours of age and then again before your baby feeds. In total, it will be checked about 3 to 5 times during the first and second days of life.
Symptoms Of Neonatal Hypoglycemia
Mild symptoms of neonatal hypoglycemia may include jitteriness or tremors, but infants with pale or bluish skin, vomiting or poor feeding, or low body temperature may be screened for the condition via heel prick. In more severe cases, an infant might present as particularly lethargic , or experience seizures, sweating, or a coma. That said, there are frequently cases where neonatal hypoglycemia is asymptomatic and only uncovered through glucose screening performed due to a heightened risk of developing the condition.
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Reasons Of Isogenic Neonatal Hypoglycemia
The most common reason of isogenic neonatal hypoglycemia are:
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What Causes Neonatal Hypoglycemia
During pregnancy, the fetus is supplied with glucose and other essential nutrients through the placenta. The placenta stores some of the glucose in the form of glycogen. During the delivery, the infants brain uses up these glycogen stores. A part of glucose is also stored in the liver, and some other parts of the body. These are used up after the baby is born. After delivery, the child gets the needed nourishment through mothers milk. In the first few days after birth, the childs immune system is strengthened with the antibodies present in the milky secretion called colostrum.
The composition of breast milk changes in the weeks that follow. While water forms a substantial part of the mature milk, other components of milk include carbohydrates, fats, proteins and other essential nutrients. Since the baby is dependent on milk for all the essential nutrients, the chances of child suffering from neonatal hypoglycemia would be high if the baby is not being breastfed well. If a child is not breastfed well, it will most likely lead to drop in blood sugar levels that might make the child irritable.
The child will lose more energy from episodes of crying that follow. It is therefore, extremely important that nursing mothers find out all about the ways to breastfeed the infant properly.
What Is The Average Level Of Blood Glucose In A Baby
Blood glucose is measured in millimoles per litre which is a standard medical test report result. What is considered to be normal blood sugar levels changes with age but are usually lower in newborn babies than in older children.
Babies who need treatment for low blood glucose, are preterm, or are at risk for low blood glucose should aim to get to a level over 2.5 mmol/L, and this can take a bit longer to achieve.
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Which Newborns Are At Risk For Hypoglycemia
Babies are more likely to have hypoglycemia include:
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- Preterm babies, especially those with low birth weights
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- Babies with mothers treated with certain medicines such as terbutaline
- Babies who are large for their gestational age
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What Do I Do If My Baby Has Low Blood Glucose Levels
Your baby will be checked for signs of illness. He will need extra feedings if his levels dont rise on their own. The extra feeds can be given:
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If the extra feedings dont raise the blood glucose level, glucose gel can be provided with a feed to raise the blood sugar. This can be repeated once, but if your babys blood sugar remains low or if your baby is not able to feed well, they will need intravenous treatment . Preterm babies or babies with low birth weight often have an intravenous started when they are born.
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Treatment For Neonatal Hypoglycaemia
Management of Hypoglycaemia in newborns is diverse and can range from the simple task of feeding to surgical intervention. Some of the treatments include:
- Adequate and timely feeding, assessing the consciousness levels and seeking early medical help is one approach to take before admitting the baby to a hospital.
- Initial stabilization and supportive care include supplemental oxygen, intravenous access and monitoring of the babys vitals.
- Intravenous 5 or 10 per cent dextrose solution may be administered to severely ill babies or in recurrent cases.
- Anti-Epileptic drugs may be necessary for recurring or refractory seizures.
- Surgical removal of a part of the pancreas may be suggested for congenital hyperinsulinism.
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