Low blood sugar - newborns

A low blood sugar level in newborn babies is also called neonatal hypoglycemia. It refers to low blood sugar (glucose) in the first few days after birth.

Causes

Babies need blood sugar (glucose) for energy. Most of that glucose is used by the brain.

The baby gets glucose from the mother through the placenta before birth. After birth, the baby gets glucose from the mother through her milk or from formula, and the baby also produces it in the liver.

Glucose level can drop if:

• There is too much insulin in the blood. Insulin is a hormone that pulls glucose from the blood.
• The baby is not producing enough glucose.
• The baby's body is using more glucose than is being produced.
• The baby is not able to feed enough to keep the glucose level up.

Neonatal hypoglycemia occurs when the newborn's glucose level causes symptoms or is below the level considered safe for the baby's age. It occurs in about 1 to 3 out of every 1,000 births.

Low blood sugar level is more likely in infants with one or more of these risk factors:

• Born early, has a serious infection, or needed oxygen right after delivery
• Mother has diabetes (these infants are often larger than normal)

  Diabetes

  A fetus (baby) of a mother with diabetes may be exposed to high blood sugar (glucose) levels throughout the pregnancy.

   

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• Have slower than usual growth in the womb during pregnancy
• Are smaller in size than normal for their gestational age

  Gestational age

  Gestation is the period of time between conception and birth. During this time, the baby grows and develops inside the mother's womb. Gestational ag...

   

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Symptoms

Infants with low blood sugar may not have symptoms. If your baby has one of the risk factors for low blood sugar, nurses in the hospital will check your baby's blood sugar level, even if there are no symptoms.

Also, blood sugar level is very often checked for babies with these symptoms:

• Bluish-colored or pale skin

  Bluish-colored or pale skin

  Cyanosis is a bluish color to the skin or mucous membrane that is usually due to a lack of oxygen in the blood.

   

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• Breathing problems, such as pauses in breathing (apnea), rapid breathing, or a grunting sound
• Irritability or listlessness
• Loose or floppy muscles

  Loose or floppy muscles

  Hypotonia means decreased muscle tone.

   

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• Poor feeding or vomiting
• Problems keeping the body warm
• Tremors, shakiness, sweating, or seizures

  Seizures

  A seizure is the physical findings or changes in behavior that occur after an episode of abnormal electrical activity in the brain. The term "seizure...

   

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Exams and Tests

Newborns at risk for hypoglycemia should have a blood test to measure blood sugar level every few hours after birth. This will be done using a heel stick. The health care provider should continue taking blood tests until the baby's glucose level stays normal for about 12 to 24 hours.

Other possible tests:

• Newborn screening for metabolic disorders, including blood and urine tests

Treatment

Infants with a low blood sugar level will need to receive extra feedings with mother's milk or formula. Babies who are breast-fed may need to receive extra formula if the mother is not able to produce enough milk. (Hand expression and massage can help mothers express more milk.)

The infant may need a sugar solution given through a vein (intravenously) if unable to eat by mouth, or if the blood sugar level is very low.

Treatment will be continued until the baby can maintain blood sugar level. This may take hours or days. Infants who were born early, have an infection, or were born at a low weight may need to be treated for a longer period of time.

If the low blood sugar continues, in rare cases, the baby may also receive medicine to increase blood sugar level. In very rare cases, newborns with very severe hypoglycemia who do not improve with treatment may need surgery to remove part of the pancreas (to reduce insulin production).

Outlook (Prognosis)

The outlook is good for newborns who do not have symptoms, or who respond well to treatment. However, low blood sugar level can return in a small number of babies after treatment.

The condition is more likely to return when babies are taken off feedings given through a vein before they are fully ready to eat by mouth.

Babies with more severe symptoms are more likely to develop learning problems. This is more often true for babies who are at a lower-than-average weight or whose mother has diabetes.

Possible Complications

Severe or persistent low blood sugar level may affect the baby's mental function. In rare cases, heart failure or seizures may occur. However, these problems may also be due to the underlying cause of the low blood sugar, rather than a result of the low blood sugar itself.

Prevention

If you have diabetes during pregnancy, work with your health care provider to control your blood sugar level. Be sure that your newborn's blood sugar level is monitored after birth.