Hypoglycemia and the Breastfed Newborn
By Edie Orr and Betty Crase
From: NEW BEGINNINGS, Vol. 14 No. 4, July-August 1997, pp. 107-8
We provide articles from our publications from previous years
for reference for our Leaders and members. Readers are cautioned to
remember that research and medical information change over time.
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
almost always 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.
Researchers and physicians
have differing opinions as to what blood glucose levels constitute hypoglycemia.
The most current research-based definition of hypoglycemia in any newborn
in the United States is 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 problems.
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 which
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
(IV).
Glucose IVs should be avoided
during labor unless absolutely 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 by methods other than artificial nipples. Rooming-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's 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.
References
Crase, B.L. Hypoglycemia
and the breastfed newborn. BREASTFEEDING ABSTRACTS 1995; 15(2):11.
Gentz, J. et al. On the diagnosis
of symptomatic neonatal hypoglycemia. Acta Paediatr Scand 1969;
58:449-59.
Mohrbacher, N. and J. Stock.
THE BREASTFEEDING ANSWER BOOK. Schaumburg, Illinois. La Leche League
International, 1997.
Pagliara, A.S. et al. Pediatrics.
Seventeenth Edition. Norwalk, Connecticut: Appleton-Century-Crofts,1982.
"Hypoglycemia," pp. 283-88.
Sexson, W.R. Incidence of
neonatal hypoglycemia: a matter of definition. J Pediatr 1984;
105(1):149-50.
Smallpiece, V. et al. Immediate
feeding of premature infants with undiluted breastmilk. Lancet
1964; 2:1349-52.
Last updated Wednesday, October 11, 2006 by njb.
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