Hypoglycemia is a condition in which the amount of blood glucose (sugar) in the blood is lower than normal. Transient hypoglycemia is normal in the first few hours after delivery and normally resolves quickly with frequent feedings. Not all healthy, full term infants need to have testing for hypoglycemia. Hypoglycemia testing should be reserved for those infants with symptoms or risk factors.
Hypoglycemia (Low Blood Glucose)
- Baby is small for their gestational age (SGA): < 10th percentile for weight.
- Babies with clinically evident wasting of fat and muscle.
- Baby is large for their gestational age (LGA): > 90th percentile for weight and fetal macrosomic appearance.
- Discordant twin: weight 10% < larger twin.
- All infants of diabetic mothers, especially if poorly controlled.
- Low birth weight infant (< 2,500 g).
- Infant prematurity (< 35 weeks, or late preterm infants with clinical signs or extremely poor feeding).
- Perinatal stress: severe metabolic acidosis (excess acid) or hypoxia-ischemia (brain doesn't receive enough oxygen or blood flow for a period of time).
- Cold stress (low metabolic heat production).
- Polycythemia (abnormally high concentration of red blood cells; venous Hct > 70%) or hyperviscosity syndrome (slowing and blockage of blood flow. It occurs when there are too many red blood cells in an infant's blood).
- Erythroblastosis fetalis (abnormal presence of erythroblasts in the infant’s blood).
- Beckwith–Wiedemann’s syndrome (overgrowth syndrome).
- Microphallus or midline genetic defect.
- Suspected infection.
- Respiratory distress
- Known or suspected inborn errors of metabolism or endocrine disorders
- Maternal drug treatment (e.g., terbutaline, beta-blockers, oral hypoglycemics).
- Infants displaying symptoms associated with hypoglycemia
Breastfed Baby with No Clinical Signs
- Maximize breastmilk intake.
- Feed immediately post birth, within the first hour if possible.
- Immediately after birth, dry infant, then initiate skin-to-skin contact using warm blankets and hat to cover infant and mother. Use continued skin-to-skin throughout the facility stay. Hypothermia can drive hypoglycemia.
- Encourage newborns to feed frequently: 8-12 times in a 24-hour period.
- Help her do breast compression and massage during feedings.
- Promote her hand expression and pumping between infant feedings if low milk intake is suspected. Have her feed expressed colostrum to the baby with a spoon or at the breast with a syringe and #5 or #8 feeding tube as a supplemental feeder.
- Consider her supplemental feeding at the breast as opposed to introducing a bottle at this early time.
- Encourage skin-to-skin contact of the mother and infant to maintain normal infant body temperature and reduce energy expenditure while stimulating suckling and milk production.
- Check the baby’s blood glucose level before each feeding until the value is adequate and stable.
- If the neonate is unable to suck or feedings are not tolerated, avoid forced feedings (e.g. nasogastric tube) and begin intravenous (IV) therapy. (Of note, there has been recent interest and research around using glucose gel as a means of supplementation, and some hospital systems have started using it with the goal of reducing NICU admissions related to IV glucose.)
- Breastfeeding may continue during IV glucose therapy when the infant is interested and will suckle. Wean the baby off of IV glucose as serum glucose normalizes and feedings increase.
- Carefully document signs, physical examination, screening values, laboratory confirmation, treatment and changes in the baby’s clinical condition (i.e. response to treatment).
Breastfeeding a Baby with Clinical Signs or Blood Glucose Levels <20 – 25 mg/dL
- Initiate an intravenous 10% glucose solution.
- Breastfeeding may continue during IV glucose therapy when the infant is interested and will suckle. Wean the baby off of IV glucose as serum glucose normalizes and feedings increase.
- Do not rely on oral or intragastric feeding to correct symptomatic hypoglycemia.
- The glucose concentration in symptomatic infants should be maintained >45 mg/dL.
- Adjust the intravenous rate by blood glucose concentration.
- Encourage frequent breastfeeding after the relief of symptoms.
- Monitor glucose concentrations before feedings as the IV is weaned, until the baby’s glucose values are stabilized off intravenous fluids.
- Carefully document signs, physical examination, screening values, laboratory confirmation, treatment, and changes in clinical condition.
Clinical Guidelines
- Holmes, A. V., McLeod, A. Y., & Bunik, M. (2013). ABM Clinical Protocol #5: Peripartum breastfeeding management for the healthy mother and infant at term, revision 2013. Breastfeeding Medicine, 8(6), 469–473.
- Wight, N., Marinelli, K. A., & Academy of Breastfeeding Medicine (2014). ABM clinical protocol #1: guidelines for blood glucose monitoring and treatment of hypoglycemia in term and late-preterm neonates, revised 2014. Breastfeeding Medicine, 9(4), 173–179.
References
- Campbell, S. H., Lauwers, J., Mannel, R., & Spencer, B. (2019). Core curriculum for interdisciplinary lactation care. Jones & Bartlett Learning.
- Lawrence, R. A., & Lawrence, R. M. (2016). Breastfeeding: A guide for the medical profession (8th ed.). Elsevier.
