Newborn Care: When To Check Blood Glucose?

what indicates the need to check a newborns blood glucose

Blood glucose is a sugar that provides energy to all the cells in the body. Babies with normal blood glucose levels have the energy they need for healthy growth and development. However, in rare cases, blood glucose levels can fall too low and cause a baby to become sick. Low blood glucose, also known as hypoglycemia, can be caused by various factors such as insufficient glucose supply at birth, poor glucose production, increased glucose use, or increased metabolic demand. Certain groups of babies, such as preterm babies, infants of diabetic mothers, and small or large for gestational age babies, are at higher risk of developing hypoglycemia. To prevent and treat hypoglycemia, early and frequent breastfeeding is recommended. In some cases, extra feeds or intravenous glucose therapy may be necessary.

Characteristics Values
Blood glucose level 25-110 mg/dL within the first 2 hours of life, rising to 60-100 mg/dL within the first few days, and 70-150 mg/dL during the first 4 weeks
Symptoms Shakiness, blue tint to the skin, breathing and feeding problems, low body temperature, floppy muscles, lethargy, irritability, listlessness, tremors, sweating, seizures
Risk factors Preterm birth, low birth weight, poor growth in the womb, smaller or larger than expected for gestational age, born to a mother with diabetes, born to a mother with poor nutrition during pregnancy, incompatible blood types of mother and baby, born under significant stress, exposure to certain medicines in the womb, born to a mother treated with insulin

shunchild

Premature birth

Premature babies are at an increased risk of both hyperglycaemia (increased blood glucose) and hypoglycaemia (reduced blood glucose). Preterm infants have limited energy stores and immature organs involved in the regulation of energy metabolism, such as the liver, pancreas, brain, and endocrine organs. As a result, they are more susceptible to fluctuations in blood glucose levels compared to full-term neonates.

It is crucial to carefully monitor blood glucose levels in premature infants, especially those who are small for their gestational age or have a low Apgar score. Early feeding, preferably within 24 hours of birth, is beneficial for maintaining normal blood glucose levels during the first week of life.

In a clinical study, 29 out of 141 premature babies (21%) experienced hypoglycaemia, and 42 (30%) experienced hyperglycaemia during the first week of life. The median blood glucose level was lowest one hour after birth and gradually increased over the next seven days.

To summarise, premature babies are at a higher risk of abnormal blood glucose levels, and careful monitoring and early feeding are essential for their health and development.

shunchild

Gestational age

  • Preterm Babies: Preterm babies, or those born more than three weeks before their due date (36 weeks gestation or less), are at a higher risk of having low blood glucose levels. This is because they may not have sufficient glucose stores and might require extra feedings to maintain their blood glucose levels. Routine glucose checks are recommended for these babies starting at around two hours after birth.
  • Small for Gestational Age: Babies who are small for their gestational age ("small-for-dates") are also at risk of low blood glucose. This is particularly true if their growth was poor in the final weeks of pregnancy. These babies may have impaired gluconeogenesis, which is the process of maintaining normal blood glucose levels.
  • Large for Gestational Age: On the other hand, babies who are large for their gestational age ("large-for-dates") can also experience difficulties in maintaining blood glucose levels. This is often associated with the mother's diabetes or other hormonal imbalances.
  • Term Babies: Healthy babies born at full term typically do not require routine blood glucose checks. They usually have enough stored energy to last until breastfeeding is established, which is usually by the third day of life.
  • Timing of Screening: The timing of screening for at-risk infants is important. Screening is recommended to start at around two hours after birth and continue at regular intervals, especially before feedings. For large-for-gestational-age infants, screening can be discontinued after 12 hours if blood glucose levels remain stable. For small-for-gestational-age and preterm infants, screening can be discontinued after 36 hours if feeding is established and blood glucose levels are normal.
  • Normal Blood Glucose Levels: It's important to note that normal blood glucose levels vary with age. In newborn babies, the normal blood glucose level is typically under 2 mmol/L in the first hour or two after birth and gradually rises to adult levels (over 3 mmol/L) within two to three days.

In summary, gestational age plays a crucial role in determining the need for blood glucose checks in newborns. Preterm babies, small for gestational age, and large for gestational age infants are at higher risk of low blood glucose levels and require routine checks. Term babies usually do not need routine checks unless they exhibit other risk factors. The timing and frequency of screening vary depending on the gestational age and the stability of blood glucose levels.

Newborn Lip Care: Chapped Lips Normal?

You may want to see also

shunchild

Maternal diabetes

Infants born to mothers with diabetes are called infants of diabetic mothers (IDM) and are at a higher risk of developing low blood sugar (hypoglycemia) shortly after birth and during the first few days of life. This is because, in the womb, these infants are exposed to high blood sugar levels from their mother and produce higher levels of insulin to compensate. After birth, the infant's insulin levels remain high, and it can take several days for them to adjust, leading to low blood sugar. IDMs are also more likely to experience breathing difficulties due to less mature lungs, high red blood cell count (polycythemia), high bilirubin levels (newborn jaundice), and thickening of the heart muscle between the ventricles.

To prevent and manage low blood sugar in IDMs, early and frequent feeding is crucial, preferably with breast milk. If the mother's breast milk is not yet established, donor milk or formula supplementation may be necessary. In some cases, dextrose (glucose) gel may be given inside the baby's cheek, and if low blood sugar persists, intravenous treatment with glucose solution may be required.

Additionally, infants born to mothers with diabetes are often larger than average, especially if the diabetes is not well-controlled. This can make vaginal birth more challenging and increase the risk of nerve injuries and other birth trauma. As a result, cesarean births are more common in mothers with diabetes.

To summarise, maternal diabetes can lead to infants with higher insulin levels that are at risk of low blood sugar after birth, larger infant size, and various health complications. Careful management of blood sugar levels during pregnancy and close monitoring of the infant's blood sugar, heart, and lungs after birth are essential to prevent and manage these potential issues.

shunchild

Low birth weight

Newborns with low birth weight are at an increased risk of developing hypoglycaemia due to their limited glucose stores. Small and preterm babies, especially those born more than three weeks before their due date, may not have sufficient glucose reserves to maintain normal glucose levels without additional feedings. This puts them at a higher risk of hypoglycaemia during the first 24 hours of life.

The mother's health during pregnancy can also impact the newborn's risk of hypoglycaemia. Babies born to mothers with diabetes, especially those requiring insulin or with poorly controlled diabetes, may struggle to utilise their glucose stores effectively. As a result, their blood sugar levels may not rise adequately after birth.

Additionally, newborns with low birth weight may experience difficulty in feeding, which can further contribute to low blood glucose levels. It is crucial for healthcare providers to closely monitor these newborns and provide extra feedings or intravenous glucose solutions if necessary.

Low blood glucose levels in newborns can lead to serious health complications, including long-term problems with brain development and function. Therefore, it is essential to monitor and treat hypoglycaemia promptly to ensure the newborn's health and well-being.

shunchild

Medical complications

Low blood glucose, or hypoglycemia, in newborns can lead to several medical complications, some of which can be severe and long-lasting. Here are some of the potential issues:

  • Neurological problems: The brain relies on glucose as its main source of fuel, and severe or prolonged hypoglycemia can harm the brain's ability to function. This can lead to seizures, serious brain injury, and long-term problems with development and learning.
  • Cardiac issues: In rare cases, hypoglycemia can lead to heart failure.
  • Respiratory distress: Low blood glucose can cause breathing problems, such as pauses in breathing (apnea), rapid breathing, or grunting sounds.
  • Thermoregulation difficulties: Newborns with hypoglycemia may have problems maintaining their body temperature and can develop hypothermia.
  • Metabolic disorders: Newborns with hypoglycemia may undergo newborn screening for metabolic disorders, such as blood and urine tests, to identify any underlying conditions.
  • Endocrine disorders: In some cases, hypoglycemia can be related to endocrine pathology, particularly hyperinsulinism, which requires further investigation and specialist referral.
  • Inborn errors of metabolism: While rare, inborn errors of metabolism can occur in newborns with hypoglycemia, and may require further investigation and management.
  • Diabetic ketoacidosis (DKA): Undiagnosed neonatal diabetes can lead to DKA, a serious complication that can result in neurological damage and even death.

It is important to note that some of these complications may be due to the underlying cause of hypoglycemia rather than a direct result of low blood glucose itself. However, prompt diagnosis and treatment of hypoglycemia are crucial to prevent potential medical complications and ensure the newborn's health and well-being.

Frequently asked questions

Blood glucose is a sugar that moves through the bloodstream and provides energy to all the cells in the body. It is one of a newborn's most important sources of energy.

Blood glucose levels change with age and are usually lower in newborn babies than in older children and adults. When a newborn is just 1 to 2 hours old, the normal level is just under 2 mmol/L, but it will rise to adult levels (over 3 mmol/L) within two to three days.

Newborns at risk for hypoglycemia should have their blood sugar levels checked frequently after birth. This is especially true if the newborn exhibits the following symptoms: bluish-colored or pale skin, breathing problems, irritability or listlessness, loose or floppy muscles, poor feeding or vomiting, problems keeping the body warm, and tremors, shakiness, sweating, or seizures.

Written by
Reviewed by
Share this post
Print
Did this article help you?

Leave a comment