from: NEW BEGINNINGS, Vol. 14 No. 4, July-August
1997, pp. 107-8
By Edie Orr and Betty Crase
Hypoglycemia is the technical term for low
blood sugar (low concentrations of glucose,
the sugar found in blood). When the body's rate
of use of glucose is greater than the rate of
glucose production, the plasma glucose concentration
falls. If it falls too far too fast in the newborn
period, hypoglycemia results.
Hypoglycemia is not a common condition in newborn
babies, and breastfeeding early and often will
usually prevent it. Further, the baby who is
not showing any symptoms of hypoglycemia does
not need glucose supplements. They should not
be given routinely.
Symptomatic hypoglycemia in newborns is largely
due to delayed or inadequate feeding and is
more likely to occur when mother and baby are
separated after birth. Some newborns are given
sugar water on the erroneous assumption that
this will prevent hypoglycemia. Instead, giving
glucose water causes a sudden rise in the blood
glucose levels, which in turn stimulates the
secretion of insulin by the pancreas. The high
level of insulin results in an equally sudden
drop in glucose levels. It is interesting to
note that the treatment for hypoglycemia in
adults is small, frequent, high-protein meals.
That is exactly what the baby gets when he is
allowed to breastfeed on demand from birth.
Immediate and frequent feedings of Colostrum,
preferably ten to twelve feedings per day in
the first few days, stabilize blood glucose
levels. Undiluted human milk is the best food,
particularly for preterm infants.
Infants at risk for hypoglycemia include those
who are small- or large-for-gestational age,
preterm, have some type of neonatal infection,
are oxygen deprived, chilled, show meconium
staining, have a central nervous system abnormality,
congenital glucose metabolic problems, or other
perinatal stress. If left untreated, symptomatic
hypoglycemia does need to be taken seriously.
The definition of hypoglycemia in any newborn
a serum/plasma blood glucose concentration lower
than 40 mg/dl (whole blood glucose level lower
than 35 mg/dl). The limit is allowed to go lower
by some physicians in the absence of symptoms--whole
blood concentrations of 30 mg/dl for full-term
infants, and 20 mg/dl for premature or small-for-gestational
age babies. In one study, asymptomatic (except
for jitteriness) newborns with blood glucose
levels below 20 mg/dl were given human milk
alone. These children were neurologically tested
a number of years later and found to have no
Pregnant women who have healthy diets and avoid
smoking lower the risk of newborn hypoglycemia
by having healthier babies. However, there are
some maternal risk factors that may increase
the chances of newborn hypoglycemia such as
diabetes (including gestational), toxemia, drug
ingestion, pregnancy-induced hypertension, a
difficult labor, or glucose solutions given
intravenously during labor.
Glucose IVs should be avoided during labor unless
necessary. If the mother receives a glucose
IV during labor and delivery, the baby's glucose
level also rises.
This steady source of glucose is abruptly cut
off at birth and the infant becomes fully dependent
upon his own resources unless he is given glucose
from other sources, for example, by being put
immediately to the breast.
A difficult labor can stress a newborn, depleting
his glucose stores. Laboring women should be
encouraged to walk, eat, change positions, and
avoid epidural anesthesia to help labor progress.
Lying on one's back during labor can also increase
the risk for hypoglycemia by stressing the fetus.
Mothers with insulin-dependent diabetes mellitus
or gestational diabetes need to be aware that
their infants may be at higher risk for hypoglycemia.
If the mother had uncontrolled diabetes during
her pregnancy, her baby is more likely to be
premature and experience respiratory distress
syndrome or physiologic jaundice. The baby may
be cared for in a neonatal intensive care unit
or may not nurse well. Early and frequent Colostrum
feedings will help stabilize the baby's blood
glucose level. If the diabetic mother maintains
a normal glucose level throughout pregnancy,
labor, and birth, her baby is not likely to
have serious problems.
In some hospital settings, newborns are at risk
for developing hypoglycemia even after an uneventful
labor and delivery. Babies who are not fed soon
after birth, are left uncovered in a nursery
warmer, or are left in a nursery to cry, are
under stress. As a result, they use up their
stores of glucose and are at risk for developing
hypoglycemia. It is important to put the baby
to the breast immediately after birth, make
sure the baby is kept warm and dry (preferably
in the mother's arms), and not allow long separations
when the baby may be left to cry.
If a healthy, full-term baby is sleepy and not
nursing well in the early days, the mother may
wish to express her milk and supplement breastfeeding
with this milk, giving it to him with a spoon.
Bedding-in with the baby or being at home will
give her frequent opportunities to offer the
breast. Nighttime feedings are important to
help establish a milk supply.
If the baby is at risk for hypoglycemia, the
new mother may want to try waking the baby frequently
during the day. It is important that the baby
breastfeed efficiently and often in the early
days. Avoiding pacifiers will help prevent nipple
confusion and aid in getting breastfeeding off
to a good start.
The best way to stabilize blood sugar and prevent
hypoglycemia in all infants is prompt and frequent
feedings of Colostrum and human milk.
to Breastfeeding Problem