Neonatal Hypoglycaemia – All You Need to Know

Neonatal Hypoglycaemia means abnormally low plasma glucose levels in the new-born. Low blood sugar in babies is normal as the sugar levels tend to crash for infants shortly after birth. However, one must only start with their feed to ensure it goes up. Failure to do so may result in long-term issues including seizures and permanent neurological damage.

What is Hypoglycaemia?

Neonates are newborns until the age of 4 weeks. Hypo means ‘low’ and glycemia is the term used for ‘blood sugar levels’. Neonatal Hypoglycaemia is defined as a plasma glucose level of less than 30mg/dl in the first 24 hours of life and less than 45mg/dl thereafter. The body’s sugar levels are regulated by one’s hormones, the key hormone being insulin. Insulin regulates the body sugar (blood glucose) and looks after its utilization and metabolism (breakdown). When the organs and hormones are in homeostasis (balanced), your baby’s hormones keep their blood sugar levels under control but when the balance is out, hypoglycaemia in infants can happen.

Causes of Hypoglycaemia in Newborn Babies

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

• Malnutrition in the Pregnant Mother: Malnutrition may be a direct cause of low blood glucose in the baby.
• Increased Insulin Output By The Baby Born To A Mother With Diabetes: Uncontrolled diabetes in the mother results in excessive insulin production which crosses the placental barrier and lowers the blood sugars in the baby.
• Premature births: Babies who are born before term are prone to hypoglycaemia.
• Advanced Haemolytic Diseases (incompatibility of the baby’s blood group with the mother): Unmatched blood groups and types between mother and child may lead to 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 (conditions that are too cold): Hypothermia or abnormally low body temperatures may be a cause of hypoglycaemia
• Liver diseases
• Infections: New-borns with maternal or congenital infections may suffer low blood sugars.

Symptoms of Hypoglycaemia (Low Blood Sugar) in New-borns

Neonatal Hypoglycaemia symptoms may not always be present. Careful and repeated clinical examinations may pick up symptoms suggestive of low blood sugars, they may include:

• Bluish discolouration or pale skin: It may be associated with poor vascular and oxygen supply to the body leading to cyanosis or pallor.
• Breathing problems, including pause(apnea), rapid shallow breathing, or a grunting sound
• Irritability or listlessness
• Loose or floppy muscles
• Poor feeding or vomiting
• Problems keeping the body warm or hypothermia
• Tremors, shakiness or seizures: Hypoglycaemia may cause temporary or permanent neurological damage including fits or delayed milestones and significant developmental delay.

Which Newborns are at Risk for Neonatal Hypoglycaemia?

Following conditions pose a higher risk of neonatal hypoglycaemia:

• Diabetes in the Mother: Excess glucose from the mother may stimulate high insulin production in the baby which acts against and lowers the glucose levels of the baby significantly, causing symptoms.
• Prematurity: Babies who are smaller than expected for their gestational time or babies with retarded growths may have few glycogen stores.
• Babies Born Under Stressful Conditions: Difficult labour or prolonged obstructed delivery may lead to hypoglycaemia in the baby.
• Unstable Temperatures: Babies exposed to unstable temperatures or when certain drugs (like terbutaline) cause hypothermia in the mother.
• Large Babies: Babies larger for their age of gestation (months of pregnancy) tend to show symptoms of hypoglycaemia This might be associated usually with gestational diabetes, but are also reported with congenital hyperinsulinism.

What Are the Complications of Neonatal Hypoglycaemia?

Prompt detection of signs of hypoglycaemia in newborns and early initiation of treatment may prevent harmful effects of hypoglycaemia. However, the following complications may occur:

• Seizure disorder
• Cardiac conditions, including heart failure
• Developmental delays and permanent brain damage, including cerebral palsy

Diagnosis of Hypoglycaemia in Newborn Babies

If a baby exhibits symptoms or associated risk factors for hypoglycaemia, a clinician may conduct a quick clinical assessment and order blood sugar levels of the new-born instantly and at fixed intervals for constant monitoring.

• Plasma glucose levels: Finger prick, heel prick or umbilical vein sample.
• Serum insulin: In cases of recurrent or permanent hypoglycaemia. Insulinoma, a rare pancreatic tumour may cause hypoglycaemia.
• Checking Urine Sugars: Urine sugars may be checked from time to time to detect the presence of glucose or ketones.
• Screening for Metabolic Errors: This may be required for a detailed workup of new-borns with hypoglycaemia.

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 baby’s vitals.
• Oral liquids high in sugar, like orange juice, may be administered in conscious and babies with a maintained airway.
• Intravenous 5 or 10 percent 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 the pancreas may be suggested for congenital hyperinsulinism.

Can Hypoglycaemia in the Newborn Babies Be Prevented?

Early and adequate breastfeeding helps prevent recurrence of hypoglycaemia in new-born babies. Mothers with diabetes can prevent neonatal hypoglycaemia by tightly controlling their blood glucose levels to maintain them in a normal range. However, neonatal hypoglycaemia may not be totally preventable. One can only watch for symptoms and treat the problem at the earliest.

Can I Breastfeed if My Baby is Suffering From Hypoglycaemia?

Breastfeeding a hypoglycaemic neonate depends on the clinical condition of the new-born and their ability to suck and latch-on. If the new-born appears conscious and not drowsy or jittery, one may breastfeed safely with proper medical supervision and advice.

Breastfeeding is advised to prevent recurrence of hypoglycaemia, with due emphasis on early initiation and close body contact under kangaroo care.

When Should I Call the Doctor?

A doctor’s opinion will be needed if you notice your baby appearing sluggish or excessively sleepy, jittery, shaky, not feeding well or bluish discolouration especially of the nose or fingertips.

Conclusion: Neonatal Hypoglycaemia is a serious yet treatable common metabolic condition in newborns. It may have a significant impact on the neurological health of the baby. Adequate preventive measures and early diagnosis with prompt treatment may help counter this potential problem in newborns.