Sunday, January 19, 2014

Newborn Hypoglycemia and Breastfeeding

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By Glenni Lorick, IBCLC

I received a call several days ago from a good friend whose baby had just been born. The pediatrician said they HAD to give the newborn a bottle of formula because his blood sugar had dropped to 30. The parents were very upset because they were planning to exclusively breastfeed. Unfortunately, this scenario happens all too often, catching parents unaware, frightening them, and all-too-often disrupting the breastfeeding relationship.

What Is Hypoglycemia in an Infant?

When the blood sugar level of a newborn drops below 30mg/dL (1.65mmol/L) in the first 24 hours of life or below 45mg/dL (1.25mmol/L) in a baby older than 24 hours, it is considered neonatal hypoglycemia. This is the most common metabolic problem in newborns. Left untreated, it can cause some serious problems including seizures, mental retardation and even cardiac issues.

What Are the Risk Factors?

There are certain factors that may predispose a newborn to this condition. The include the following:
  • Being pre-term or post-term
  • Being either small OR large for gestational age
  • The mother being diabetic
  • The mother receiving a large dose of IV glucose solution during labor
  • A complicated or stressful delivery
  • Respiratory distress or breathing difficulties requiring oxygen right after delivery
  • Infants with low thyroid hormone levels
  • Infants with certain rare genetic disorders

What Should I Do If They Say My Baby Has Hypoglycemia?

The fact is that transient hypoglycemia occurs in nearly all newborn mammals. Normally, even in the absence of a feed, glucose levels spontaneously rise within  2-3 hours. If a baby isn't showing any symptoms, the American Academy of Breastfeeding Medicine protocol discourages glucose testing in normal, term newborns. Colostrum contains ketone bodies which provide glucose-sparing fuel to the newborn brain, thereby protecting the neurologic function, so even if glucose may be slightly low, in an asymptomatic term newborn, it shouldn't be a problem.

However, if a baby is having symptoms like bluish colored skin, problems breathing, loose or
floppy muscles, problems maintaining body temperature, tremors, shakiness, sweating or seizures, then treatment is definitely indicated. Some babies may actually need intravenous glucose. However, many respond to a dose of infant formula. If the baby is able to be put to the breast, the formula should be given via curved tip syringe at the breast. This not only preserves breastfeeding, but it also allows baby to get some all-important colostrum!

A study just published in Lancet in December, 2013, indicates that 40% Dextrose Gel 200mg/kg applied inside the cheek three times a day for the first two days of life makes a statistically significant difference in the outcome of treatment for neonatal hypoglycemia. It is definitely worth insisting that your baby receive this very inexpensive, non-invasive treatment if there is any concern at all about hypoglycemia.

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