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Neonatal Hypoglycemia - Causes, Risk Factors, Symptoms, Treatment, and Complications

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Neonatal Hypoglycemia - Causes, Risk Factors, Symptoms, Treatment, and Complications

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Neonatal hypoglycemia is a condition with low blood sugar in newborn babies. Read below to learn about the condition's causes, diagnosis, and treatment.

Medically reviewed by

Dr. Sajeev Kumar

Published At July 22, 2022
Reviewed AtMay 16, 2024

Introduction:

Glucose is an essential energy source for all the cells in the body. Unlike other organs that can survive using proteins and fats without glucose, the brain depends entirely on glucose for its energy and functioning. Insulin is a hormone released by the pancreas that helps maintain normal blood glucose levels in the body. An imbalance in insulin levels causes high or low blood sugars. Before birth, babies receive glucose from the mother through the placenta. After delivery, the baby's mother's milk and formula source glucose. A small amount of glucose is also produced in the baby's liver.

Hypoglycemia is a life-threatening condition and requires immediate attention. Neonatal hypoglycemia is a condition that occurs in newborn babies when their blood sugar levels become low and may persist for a few days after birth. One to three babies in every 1000 births show symptoms of neonatal hypoglycemia.

What Are the Causes of Neonatal Hypoglycemia?

A baby's blood glucose levels can fall due to the following reasons:

  • The baby does not produce enough glucose.

  • There is an increase in insulin levels in the body.

  • The baby is not able to take enough glucose from feeding.

  • A baby's body uses more glucose than the amount it is receiving.

Neonatal hypoglycemia is caused by conditions like:

  • Malnutrition of the mother during pregnancy.

  • Poorly controlled gestational diabetes in the mother.

  • Non-compatible blood types of the baby and mother.

  • Congenital hormonal imbalances or metabolic disorders present at birth.

  • Congenital disabilities.

  • Tumor of the pancreas that releases more insulin into the baby's blood and stools.

  • Perinatal asphyxia is when the newborn has oxygen deprivation and an inability to start spontaneous respiration.

  • Infection.

  • Liver disease.

What Are the Risk Factors for Neonatal Hypoglycemia?

Babies are at an increased risk for neonatal hypoglycemia if they have one or more of the risk factors mentioned below:

  1. Babies born to mothers with gestational diabetes.

  2. Babies who have restricted growth.

  3. Preterm babies with low birth weight.

  4. Babies that are small or large for their gestational age.

  5. Babies who are born under stressful conditions.

  6. Mothers treated with medicines like Terbutaline for conditions like coughing or asthma.

  7. Babies who required oxygen therapy right after birth.

What Are the Symptoms of Neonatal Hypoglycemia?

Newborn babies may not show any symptoms of low blood sugar. Therefore, the healthcare workers check the blood glucose levels to see if the baby has any risk factors. However, some symptoms that the doctor can notice include:

  • Pale skin with a bluish tint.

  • Irritable baby.

  • Breathing problems include rapid or slow breathing or a grunting sound during breathing.

  • Low body temperature.

  • Poor muscle tone causes loose muscles.

  • Lack of interest in feeding.

  • Lack of movement.

  • Sweating, tremors, and shakiness.

How Is Neonatal Hypoglycemia Diagnosed in a Newborn?

Testing for low blood sugar is mandatory if the newborn has any risk factors. The nurses perform a simple blood test using a heel stick to determine the blood glucose levels. Sugars need to be monitored regularly until they stabilize to average values for 12 to 24 hours.

Other possible diagnostic tests include screening tests to detect metabolic disorders.

How Is Neonatal Hypoglycemia Treated?

Treatment aims to restore the blood sugars to a standard value. The baby's gestational age, overall health, and risk factors are considered during treatment. Low blood sugars are corrected by giving extra breast milk, or formula feeds regularly. In some cases, the baby may require an intravenous (IV) infusion of water and glucose solution if the baby cannot take feeds through the mouth. Monitoring the sugar levels at regular intervals is done, and the treatment may need to be continued for the initial few hours to weeks. Infants with low birth weight, infection, or born early might need therapy for more extended periods.

In rare cases where hypoglycemia does not subside with initial treatment, the doctor may prescribe specific medicines. In addition, in very rare cases, the baby may require surgery to remove a part of the pancreas (which helps decrease the amount of insulin secreted).

What Are the Complications of Neonatal Hypoglycemia?

Hypoglycemia that occurs for longer periods can damage the brain, affecting the baby's mental development. In rare cases, seizures and heart failure can occur.

What Are the Measures to Prevent Neonatal Hypoglycemia?

The mother can take specific measures to help prevent hypoglycemia in newborns. Mothers with gestational diabetes must work together with the healthcare worker during pregnancy to keep their sugar levels within the range. In addition, newborns must be monitored to check their sugar levels.

When Should a Doctor Be Consulted?

Once the signs of low blood sugar are noted, a doctor's consultation is required. Then, on the doctor's advice, the child can be fed frequent feeds or a solution of water and glucosexa.

What Are the Steps to Be Followed for Subsequent Hospital Visits?

The following tips will help parents have a smooth follow-up visit to the hospital with the babies:

  • Be clear about the reason for the visit.

  • Write down the questions one wishes to ask the doctor.

  • Note any new medicines or treatments advised for the child at the visit.

  • Write down the further instructions that the doctor suggests for the baby.

  • Know the use of any new medicines prescribed and any side effects associated with them.

  • Enquire about alternate treatment plans for the child.

  • Know why a diagnostic test is advised and what the results of the tests mean.

  • Know what to expect if the baby or child rejects the prescribed medicine.

  • Note down the visit's date, time, and purpose for follow-up appointments.

What Is the Prognosis of Neonatal Hypoglycemia?

Newborns without symptoms or those responding well to treatment have a favorable prognosis. However, a small number of babies may experience a recurrence of low blood sugar levels after treatment cessation, warranting continued monitoring. Premature removal of intravenous fluids before readiness for oral feeding increases the likelihood of recurrence. Babies with severe symptoms, especially those of lower-than-average weight, born to diabetic mothers, or with other complications, are at higher risk of developing learning difficulties.

What Is the Differential Diagnosis for Neonatal Hypoglycemia?

The signs of neonatal hypoglycemia are general and may resemble symptoms of various other conditions, such as prematurity, sepsis, hypoxic-ischemic encephalopathy, and hyponatremia. While uncommon, persistent causes of hypoglycemia should be ruled out, as discussed earlier.

Conclusion:

Neonatal hypoglycemia is an alarming condition that needs to be diagnosed promptly, and treatment must be started immediately. Proper care and regular monitoring help to bring hypoglycemia under control very soon. Mothers diagnosed with gestational diabetes should have regular check-ups with their doctor and dietician. A healthy lifestyle, nutritious food rich in fiber, and regular exercise can help keep mothers' sugar levels normal. Babies born with low sugar levels and without symptoms tend to respond well to treatment and recover fast.

Frequently Asked Questions

1.

What Causes Neonatal Hypoglycemia?

Neonatal hypoglycemia is a condition where a newborn's blood glucose levels are below normal. It can be caused by low birth weight, prolonged labor, maternal diabetes, or an immature liver. It can be treated through dietary changes, intravenous glucose, or intravenous insulin.

2.

What Are the Symptoms of Neonatal Hypoglycemia?

Neonatal hypoglycemia is a condition caused by low blood sugar levels in newborns. Symptoms include 
- Lethargy, 
- Poor Suck Reflex, 
- Jitteriness, 
- Poor Feeding, 
- Seizures.

3.

For Neonatal Hypoglycemia, What Should Be the Initial Treatment?

Initial treatment of neonatal hypoglycemia should include a rapid intravenous bolus of glucose followed by a continuous glucose infusion to maintain normal blood glucose levels. This should be supplemented with frequent monitoring of glucose levels and appropriate adjustments in glucose infusion rates.

4.

What Is the Standard Blood Sugar of a Newborn?

Normal blood sugar levels for infants range from 70-100 mg/dL. Regular monitoring is important to ensure that babies get enough nutrition and that their blood sugar levels remain stable.

5.

What IV Fluids Are Administered for Hypoglycemia?

IV fluids are administered to treat hypoglycemia. The fluids help to restore blood glucose levels to normal. IV fluids typically consist of glucose and electrolyte solution that helps replace lost fluids. This helps to reduce the risk of further complications.

6.

What Are the Three P’s of Hypoglycemia?

The three P's of hypoglycemia are: 
- Prevention.
- Preparation.
- Prompt Recognition and Treatment.
 
Prevention involves monitoring blood sugar levels, eating regular meals and snacks, and avoiding skipping meals. Preparation involves carrying snacks and glucose tablets to treat hypoglycemia. Prompt recognition and treatment of hypoglycemia are essential to prevent more serious complications.

7.

How Is Neonatal Hypoglycemia Identified?

Neonatal hypoglycemia is identified through a blood test that measures the baby's glucose levels at birth. If the baby's glucose levels are low, then the baby is diagnosed with hypoglycemia. The baby's doctor may also prescribe additional tests to determine the cause and severity of the condition

8.

What Is the Treatment Regimen for Hypoglycemia?

The treatment regimen for neonatal hypoglycemia includes frequent feedings, using glucose-containing solutions, and monitoring blood glucose levels. If necessary, intravenous glucose infusion may maintain normal blood glucose levels.

9.

What Are the Implications Of Neonatal Hypoglycemia?

Neonatal hypoglycemia can have serious implications, such as brain damage, developmental delays, and even death. Monitoring and treating hypoglycemia in newborns is important to avoid these complications.

10.

What Is the Fastest and Most Efficient Way to Treat Hypoglycemia?

Consuming glucose or other sugar, such as a sugary drink, fruit, or candy, is the fastest and most efficient way to treat hypoglycemia. These immediate sources of sugar can help raise blood sugar levels quickly.

11.

Which Medication is Responsible for Neonatal Hypoglycemia?

Neonatal hypoglycemia is treated with frequent feedings of a high-calorie formula and by administering glucose intravenously or orally. If the condition is severe, medications such as diazoxide and octreotide may be prescribed to help regulate insulin and glucose levels.

12.

What Are the Types of Hypoglycemia?

There are three types of neonatal hypoglycemia: transient, persistent, and profound. Transient hypoglycemia is the most common and usually resolves itself. Persistence is more serious and requires treatment, while profound hypoglycemia is the most severe and can lead to brain damage.

13.

How to Prevent Neonatal Hypoglycemia?

Breastfeeding should be initiated as soon as possible after birth to ensure adequate nutrition and prevent neonatal hypoglycemia. Frequent feedings should be given if formula feeding is necessary, and blood sugar levels should be monitored.

14.

What Is the Purpose of Dextrose Gel in Neonatal Hypoglycemia?

Dextrose gel treats neonatal hypoglycemia, a condition in which the baby's blood sugar levels are low. The gel is applied orally and absorbed quickly, rapidly increasing blood sugar levels and restoring normal glucose metabolism.
Dr. Sajeev Kumar
Dr. Sajeev Kumar

Pediatrics

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