Newborns with hypoglycemia are at a high risk for developing severe neurologic problems. They have an underlying medical condition, such as diabetes or an eating disorder, which causes their blood glucose (sugar) levels to be low. Symptoms of hypoglycemia in newborns include diaphoresis, tachycardia, lethargy, poor feeding, coma, seizures, and hypothermia.
Identifying and treating the cause of the hypoglycemia is critical to preventing these problems. This includes a detailed medical history, complete physical exam and initial laboratory testing to rule out specific causes of the problem.
The most common reasons for low blood sugar (hypoglycemia) in newborns are a failure of the fetus to absorb sufficient amounts of glucose from the mother’s blood stream and an inability of the mother to produce enough insulin. A number of medical conditions may lead to low glucose levels in newborns, such as prematurity, placental insufficiency, perinatal asphyxia, and certain drugs, such as opioids.
Hypoglycemia in infants caused by a failure of the mother to supply adequate quantities of glucose to the fetus can be prevented. For instance, pregnant women who have diabetes can reduce the amount of glucose their babies absorb by ensuring that their own blood sugar is well controlled with medications before and after birth. This will lower the fetal insulin production and decrease the risk of developing hypoglycemia in newborns.
Treatment of hypoglycemia in at-risk neonates
At-risk infants who have signs or symptoms of hypoglycemia, such as diaphoresis, tachycardia, and lethargy, need immediate BG monitoring. This is especially important for infants who have been born to mothers with diabetes, extremely premature infants, and infants with respiratory distress. If a baby has an abnormally low BG level, the ED physician can immediately start preventive treatment with oral or IV glucose and monitor closely.
Use dextrose gel for asymptomatic or mildly symptomatic hypoglycemia in newborns [16-21]. Therapeutic use of dextrose in these infants is recommended because of its low toxicity and ease of administration.
Glucose injections are also used to treat infants with a history of hypoglycemia or when they are too sick for normal milk feeding. The dosage of the medication varies, but it is typically 2 to 5 mL/kg every 30 minutes.
Give glucagon right away if your child is unable to keep down juice or food, has a seizure, or can’t wake up. This will make them alert within 15 minutes and increase their blood sugar level so they can eat or drink something sweet.
Do not give any more sugar until you check the blood glucose level again and make sure it is higher than before giving the glucagon. Repeat these steps until your child’s blood sugar level is back to normal.
If the BG is still too low, give an intravenous bolus of dextrose (0.2 g/kg over 5 to 15 minutes). This infusion is repeated at a rate of 1.6 mg/kg/min until the BG reaches the target range.
Glucose injections are usually given for only a short time, as they have significant adverse effects. However, they can be used in combination with glucocorticoids and other medications to treat recurrent hypoglycemia when other treatments are unsuccessful.
