Hypoglycemia in the Newborn

Newborns may experience lower than normal levels of glucose in their blood. This is called hypoglycemia in the newborn or neonatal hypoglycemia. A glucose value of less than 40 mg/dL (2.2 mmol/L) in babies represents hypoglycemia. A blood glucose level of less than 30 mg/dL (1.65 mmol/L) in the first 24 hours of life and less than 45 mg/dL (2.5 mmol/L) thereafter represents hypoglycemia in the newborn.

Experts estimate that about 0.2% of all newborns in the US may experience this condition. It is important to screen for glucose levels in newborns because glucose is a very important nutrient in the first few days of life. Glucose supplies energy for the brain and body in newborns. Long-term effects of neonatal hypoglycemia include neurological problems resulting in mental retardation, recurrent seizures, delayed growth, and personality disorders. Some studies show that severe hypoglycemia in newborns may cause cardiovascular problems.

According to the Newborn Nursery QI Committee, there are certain groups that require screening for hypoglycemia in the first hour of life. These include any of the following risk conditions:

*Newborns who weigh more than 4 kg or less than 2 kg

*Large for gestational age

*Infants born from insulin-dependent mothers

*Gestational age less than 37 weeks

*Newborns suspected born to a mother suspected of having chorioamnionitis

*Newborns with symptoms suggestive of hypoglycemia (see bellow)

Causes

There are many factors that may cause hypoglycemia in newborns including: infections, metabolism, improper oxygen flow near birth, a premature birth, certain endocrine problems, small gestational age, a diabetic mother, and intrauterine growth impediment. However, the mother's improper or deficient nutrition nutrition during pregnancy may be the main cause of this condition in newborns.

Signs and Symptoms

Hypoglycemia in the newborn may appear without any signs or symptoms. However, red flags should be raised for parents if newborns experience any o the following signs:

*Irritability

*Bluish or pale skin

*Breathing problem

*Tremors

*Nausea

*Vomiting

*Sweating

**Poor feeding

Being lethargic

Treatment

Hypoglycemia in newborns first-line treatment is giving the newborn a fast-acting glucose source based on overall health, gestational age, and medical history. This may done orally with a water/glucose mixture or intravenously in some severe cases.

Once blood glucose levels are under control, they should be monitored frequently to prevent hypoglycemia to reappear. If hypoglycemia appear frequently certain medications to raise blood glucose and lower insulin levels may be needed. If the hypoglycemia is frequent a genetic condition may be present in the baby (it is called congenital hyperinsulinism). In this case a removal of some of the pancreas (surgically) is needed to regulate blood insulin levels (and glucose levels too)

Sources:

Neonatal Hypoglycemia: http://www.nlm.nih.gov/medlineplus/ency/article/007306.htm

http://emedicine.medscape.com/article/802334-overview

Newborn Nursery QI Committee. Portland (ME): The Barbara Bush Children's Hospital at Maine Medical Center; 2004 Jul. Neonatal hypoglycemia: initial and follow up management. National Guideline Clearinghouse. 2004