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Links: Hypoglycemia in Newborns
Hypoglycemia
and the Breastfed Newborn by Edie Orr and Betty Crase
Hypoglycaemia
from BabyCentre.com
AAP Policy Statement:
Routine Evaluation of ...Glucose in Newborns
... no study
has shown that treatment of a transient low blood glucose level
offers a better short-term or long-term outcome than the outcome
resulting with no treatment. ... Furthermore, there is no evidence
that asymptomatic hypoglycemic infants will benefit from treatment.
The Academy
of Breastfeeding Medicine: Guidelines for Glucose Monitoring and
Treatment of Hypoglycemia in Term Breastfed Neonates Includes
a definition of hypoglycemia with levels of lower limits at various
hours after birth, risk categories, and management of asymptomatic
and symptomatic infants.
Hypoglycemia
in the Breastfeeding Newborn by Sallie Page-Goertz, MN, CPNP,
IBCLC
Hypogylcaemia
of the Newborn An extensive paper on this subject from the World
Health Organization, with 10 pages of references.
de Rooy L, Hawdon J. Nutritional
factors that affect the postnatal metabolic adaptation of full-term
small- and large-for-gestational-age infants. Pediatrics. 2002
Mar;109(3):E42.
Conclusion: Neonatal ability to generate
ketone body when blood glucose values are low depends more on
successful breastfeeding than on size for gestational age or neonatal
nutritional status. Routine blood glucose monitoring of LGA infants
with no additional risk factors is not necessary. Routine formula
milk supplementation for LGA and SGA infants should not be recommended.
Eidelman AI. Hypoglycemia
and the breastfed neonate. Pediatr Clin North Am. 2001 Apr;48(2):377-87.
This article article outlines a set of clinical guidelines for
rational management of the prevention and treatment of hypoglycemia
in breastfed infants.
Summary:
Healthy, full-term infants are functionally and metabolically
programmed to make the transition from their intrauterine dependent
environment to their extrauterine existence without the need for
metabolic monitoring or interference with the natural breastfeeding
process. Full-term infants are equipped with homeostatic mechanisms
that preserve adequate energy substrate to the brain and other
vital organs. Thermal stability and early, properly guided, frequent,
exclusive breastfeeding are the keys to success. Thus, routine
screening for blood glucose concentrations or feeding sugar water
is not necessary and potentially counterproductive to the establishment
of a healthy mother-infant dyad.
Cornblath M, et al. Controversies
regarding definition of neonatal hypoglycemia: suggested operational
thresholds. Pediatrics. 2000 May;105(5):1141-5.
Summary: The definition of clinically significant
hypoglycemia remains one of the most confused and contentious
issues in contemporary neonatology. In this article, some of the
reasons for these contentions are discussed. Pragmatic recommendations
for operational thresholds, ie, blood glucose levels at which
clinical interventions should be considered, are offered in light
of current knowledge to aid health care providers in neonatal
medicine. Future areas of research to resolve some of these issues
are also presented.
Hawdon JM. Hypoglycaemia
and the neonatal brain. Eur J Pediatr. 1999 Dec;158 Suppl 1:S9-S12.
Abstract:
There has been much controversy and confusion regarding potential
damage caused to the neonatal brain by low blood glucose levels.
Previous studies of outcome after neonatal hypoglycaemia are flawed
by many factors including retrospective data collection and inability
to control for co-existing clinical complications. There is no
doubt that hypoglycaemic brain damage does occur but the severity
and duration of low blood glucose levels required to cause lasting
harm varies between subjects and is related to the ability of
each baby to mount a protective response such as the production
of ketone bodies which are alternative cerebral fuels. Evidence
from studies of humans and other animals suggests that cortical
damage and long-term sequelae occur after prolonged hypoglycaemia
sufficiently severe to cause neurological signs.
CONCLUSION:
Prolonged hypoglycaemia should be avoided by close clinical observation
of vulnerable infants whilst avoiding excessively invasive management
in populations of neonates which may jeopardize the successful
establishment of breast feeding.
Hawdon JM, Platt MP, Aynsley-Green A. Neonatal
hypoglycaemia--blood glucose monitoring and baby feeding.
Midwifery. 1993 Mar;9(1):3-6.
Abstract:
Recent concerns regarding neurological sequelae of neonatal hypoglycaemia
have raised the question of whether demand breast feeding may
increase the risks of neonatal hypoglycaemia and neurological
handicap. In this review article neonatal hypoglycaemia is defined,
monitoring of babies for this condition is discussed and implications
for baby feeding practices are stated.
Hawdon JM, Ward Platt MP, Aynsley-Green A. Patterns
of metabolic adaptation for preterm and term infants in the first
neonatal week. Arch Dis Child. 1992 Apr;67(4 Spec No):357-65.
Abstract:
There have been few comprehensive accounts of the relationships
between glucose and other metabolic fuels during the first postnatal
week, especially in the context of modern feeding practices. A
cross sectional study was performed of 156 term infants and 62
preterm infants to establish the normal ranges and interrelationships
of blood glucose and intermediary metabolites in the first postnatal
week, and to compare these with those of 52 older children. Blood
glucose concentrations varied more for preterm than for term infants
(1.5-12.2 mmol/l v 1.5-6.2 mmol/l), and preterm infants had low
ketone body concentrations, even at low blood glucose concentrations.
Breast feeding of term infants and enteral feeding of preterm
infants appeared to enhance ketogenic ability. Term infants had
lower prefeed blood glucose concentrations than children but,
like children, appeared to be capable of producing ketone bodies.
This study demonstrates that neonatal blood glucose concentrations
should be considered in the context of availability of other metabolic
fuels, and that the preterm infant has a limited ability to mobilise
alternative fuels.
Page last modified:
03/03/2005
