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

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.