When feeding interventions are administered, blood glucose levels should always be rechecked 30 minutes later to ensure response. If increasing enteral carbohydrate intake is not effective, the next intervention would traditionally have been to administer IV glucose. More recently, however, dextrose gels have been gaining traction in the management of hypoglycemia see below.
A response to IV glucose should occur within 30 minutes, and should be confirmed in a timely manner [ 66 ]. The short duration of action for glucose suggests that after one or two boluses of dextrose, the rate or concentration of dextrose infusion should be increased. There is both observational evidence and clinical consensus that unwell hypoglycemic infants, particularly those with neurological signs, should be treated immediately with an IV infusion of glucose.
Response to IV glucose should be rechecked after 30 minutes. Failure to respond to this first intervention requires a stepwise increase in glucose supply, with a review of levels 30 minutes after each increment. Online calculators can help the practitioner to determine the effects of dextrose concentration or infusion rates [ 67 ].
In most cases, referral to endocrinology and investigation for cause of persistent hypoglycemia should wait until the infant is 72 hours old unless the presence of an endocrine or metabolic condition is also strongly suspected. Administering glucagon by IV bolus 0. Alternative therapies include hydrocortisone, diazoxide, and octreotide, but data in support of their use for initial management of hypoglycemia are limited. No difference in rate of IV loss was noted for infants randomized to receive dextrose in more highly concentrated solutions [ 73 ].
In the transitional period, breastfeeding can be continued without risk of over-hydration because the volume of colostrum is small. When these levels are utilized, careful monitoring of serum electrolytes is required. IV dextrose can be weaned when levels have been stable for 12 hours.
Intrabuccal 0. Glucose gel should be provided with a breastfeed or measured quantity of expressed breast milk or donor milk from an approved milk bank or, if neither of these options is possible, formula. The Sugar Babies trial [ 74 ] compared administration of dextrose gel with placebo for treating hypoglycemia. The cohort from the Sugar Babies trial and a second trial of infants who received dextrose gel upon admission to NICU for monitoring with amplitude-integrated EEG were evaluated together at 2 years of age [ 18 ].
For the Sugar Babies cohort alone, no difference in developmental outcomes was noted between control and dextrose gel groups. Combining the patients from the two trials found no difference in neurosensory impairment RR 0. Reasons for the high rate of neurosensory impairment overall are unclear. Whether such outcomes were caused by conditions that often underlie hypoglycemia or by detrimental effects of hypoglycemia itself is not yet known.
Supporting the former theory is research showing that both late preterm and IUGR infants have independent risk for neurosensory impairment, even with normoglycemia [ 75 ]. While this result was not strong enough to have statistical significance, it raises the question of whether overcorrecting low blood glucose may cause harm.
As noted above, infants experiencing hypoglycemia in the first 72 hours post-birth generally do not require investigation unless there is a clinical suspicion of an underlying condition with risk for persistent, recurrent, or severe hypoglycemia. Infants with hypoglycemia that persists beyond 72 hours should be evaluated further.
The workup should include a confirmatory plasma glucose, beta-hydroxybutyrate, bicarbonate, lactate, free fatty acids, insulin, growth hormone, cortisol, carnitine, and acylcarnitine profiling. Further workup should be conducted in collaboration with specialists in endocrinology and inborn errors of metabolism.
While transient blood glucose levels as low as 1. A higher threshold for investigation of 2. Checking blood glucose in newborn babies. Supplementary Figure 1. The authors wish to acknowledge and thank Drs. The authors also wish to thank these members of the Canadian Pediatric Endocrine Group for their review: Drs. Narvey MD, Seth D. A leading indicator of our success is the feedback we get from our patients. Hypoglycemia in infants is when the level of glucose in the blood is too low.
Glucose is a type of sugar that the body uses for energy. The body cannot work the right way when levels are low. The body releases insulin to lower high levels of glucose. It releases stored glucose when glucose levels drop too low. Hypoglycemia happens when the body can no longer do this. It is normal for some infants to have hypoglycemia during the first two hours after birth.
Other problems that can lead to it are:. This problem is more common in infants who are too small or large, born pre-term or post-term, or born to mothers with diabetes.
Other things that raise the risk are:. Mothers with diabetes may be able to prevent this problem in their newborn by breastfeeding or formula feeding early and often.
Causes of high blood glucose and low blood glucose. Healthy Children—American Academy of Pediatrics website. Updated May 1, Accessed December 31, Kids Health—Nemours Foundation website. Neonatal hypoglycemia occurs when the glucose level of a newborn causes symptoms or is below the range considered safe for the baby's age. It occurs in about 1 to 3 out of every births. 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. Newborns at risk for hypoglycemia should have a blood test to measure blood sugar level frequently 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 include newborn screening for metabolic disorders, such as blood and urine tests. 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. Sometimes a sugar gel may be given by mouth temporarily if there is not enough 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.
Treatment will depend on your baby's gestational age and overall health. Treatment includes giving the baby a fast-acting source of glucose. This may be as simple as a glucose and water mixture or formula as an early feeding. Or your baby may need glucose given through an IV intravenous line.
The baby's blood glucose levels are checked after treatment to see if the hypoglycemia occurs again. The brain needs blood glucose to function. Not enough glucose can harm the brain's ability to function.
Severe or long-lasting hypoglycemia may cause seizures and serious brain injury. In many cases, there may not be a way to prevent hypoglycemia in a newborn baby.
For a baby with risk factors, healthcare providers will need to watch carefully for the signs and start treatment as soon as possible. Mothers with diabetes should keep their blood glucose levels in a normal range during pregnancy. This may help lower the risk for their baby. Give your baby formula or a glucose and water mixture, if advised.
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