Neonatal Hypoglycaemia

Question 1

When babies are born, how do they utilize energy?

Answer 1

When babies are born, they use up their glucose stored first then their brown fat stores. Brown fat stored are broken down into ketones and lactates.

Question 2

What are the risk factors of neonatal hypoglycaemia? (Ref)

Answer 2

British Association of perinatal medicine (2017)
IUGR
LBW
Diabetic mother
Sepsis
Hypothermic 
Preterm

Question 3

Recognising hypoglycaemia

Answer 3

Cry
Lethargy
Poor muscle tone
Jittery 
Tachypneoa/Apnoea 
Cyanosis
seizures

Question 4

What do the guidelines state about blood sugar levels?

Answer 4

BAPM (2017) state that blood sugar level of 2.0mmol on two occasions, <1.0mmol/l or <2.5mmol/l with other risk factors should be treated for hypoglycaemia.

Question 5

When can blood sugar levels be measured?

Answer 5

Usually prefeed second feed. NOT 2 hours following birth as they are likely to be very low at this time.

Question 6

Care plan for hypoglycaemia

Answer 6

Identify Symptoms
Keep parents informed with verbal and written information. Always gain consent.
Do BMs pre-feed
Document.
Paediatric review
Feeding plan - increase in frequency and volume
Possible buccal dextrose 40% 200mg/kg if BS with feeding plan if BS are between 1.0 and 1.9mmol/l
If there is severe or persistently low blood sugars baby should be for immediate medical review.

Question 7

When is buccal dextrose used?

Answer 7

According to BAPM (2017) buccal dextrose gel is used when blood sugar levels are between 1.0 and 1.9mmol/l 40% buccal dextrose gel is given 200mg/kg may be given alongside feeding support.
If blood sugar levels are below 1.0mmol/l IV arrange for urgent medical review which will include IV cannula with IV glucose.