Hypoglycemia in Newborns (Resources)

Hypoglycaemia from BabyCentre.com

AAP Policy Statement: Routine Evaluation of …Glucose in Newborns

… 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 extrauterine existence without the need for metabolic monitoring or interference with the natural breastfeeding process. Full-term infants are equipped with homeostatic mechanisms that preserve adequate energy substrate to the brain and other vital organs. Thermal stability and early, properly guided, frequent, exclusive breastfeeding are the keys to success. Thus, routine screening for blood glucose concentrations or feeding sugar water is not necessary and potentially counterproductive to the establishment of a healthy mother-infant dyad.

Cornblath M, et al. Controversies regarding definition of neonatal hypoglycemia: suggested operational thresholds. Pediatrics. 2000 May;105(5):1141-5.

Summary: The definition of clinically significant hypoglycemia remains one of the most confused and contentious issues in contemporary neonatology. In this article, some of the reasons for these contentions are discussed. Pragmatic recommendations for operational thresholds, ie, blood glucose levels at which clinical interventions should be considered, are offered in light of current knowledge to aid health care providers in neonatal medicine. Future areas of research to resolve some of these issues are also presented.

Hawdon JM. Hypoglycaemia and the neonatal brain. Eur J Pediatr. 1999 Dec;158 Suppl 1:S9-S12.

Abstract: There has been much controversy and confusion regarding potential damage caused to the neonatal brain by low blood glucose levels. Previous studies of outcome after neonatal hypoglycaemia are flawed by many factors including retrospective data collection and inability to control for co-existing clinical complications. There is no doubt that hypoglycaemic brain damage does occur but the severity and duration of low blood glucose levels required to cause lasting harm varies between subjects and is related to the ability of each baby to mount a protective response such as the production of ketone bodies which are alternative cerebral fuels. Evidence from studies of humans and other animals suggests that cortical damage and long-term sequelae occur after prolonged hypoglycaemia sufficiently severe to cause neurological signs.

CONCLUSION: Prolonged hypoglycaemia should be avoided by close clinical observation of vulnerable infants whilst avoiding excessively invasive management in populations of neonates which may jeopardize the successful establishment of breast feeding.

Hawdon JM, Platt MP, Aynsley-Green A. Neonatal hypoglycaemia–blood glucose monitoring and baby feeding. Midwifery. 1993 Mar;9(1):3-6.

Abstract: Recent concerns regarding neurological sequelae of neonatal hypoglycaemia have raised the question of whether demand breast feeding may increase the risks of neonatal hypoglycaemia and neurological handicap. In this review article neonatal hypoglycaemia is defined, monitoring of babies for this condition is discussed and implications for baby feeding practices are stated.

Hawdon JM, Ward Platt MP, Aynsley-Green A. Patterns of metabolic adaptation for preterm and term infants in the first neonatal week. Arch Dis Child. 1992 Apr;67(4 Spec No):357-65.

Abstract: There have been few comprehensive accounts of the relationships between glucose and other metabolic fuels during the first postnatal week, especially in the context of modern feeding practices. A cross sectional study was performed of 156 term infants and 62 preterm infants to establish the normal ranges and interrelationships of blood glucose and intermediary metabolites in the first postnatal week, and to compare these with those of 52 older children. Blood glucose concentrations varied more for preterm than for term infants (1.5-12.2 mmol/l v 1.5-6.2 mmol/l), and preterm infants had low ketone body concentrations, even at low blood glucose concentrations. Breast feeding of term infants and enteral feeding of preterm infants appeared to enhance ketogenic ability. Term infants had lower prefeed blood glucose concentrations than children but, like children, appeared to be capable of producing ketone bodies. This study demonstrates that neonatal blood glucose concentrations should be considered in the context of availability of other metabolic fuels, and that the preterm infant has a limited ability to mobilise alternative fuels.