Neonatal Hypoglycemia and breastfeeding issues Flashcards
Name 5 types of Infants at risk of neonatal hypoglycemia
Premature ( baby has not developed Brown fat until 3rd trimester)
IUGR/SGA( low reserves)
Sepsis
Hyporthemic (needs extra glucose and oxygen keep warm)
Babies of mother with IDDM/Gestational Diabetes
Perinatal stress/asphyxia
Inborn errors of metabolism(e.g.PKU)
Beckwith-Wiedemann syndrome
What is neonatal hypoglycemia?
Insufficient circulating glucose to meet the metabolic demands of the body particularly the brain.
Symptoms of neonatal hypoglycemia
General
- Abnormal cry
- poor feeding
- hypothermia
Cardiac respiratory
- Tachypnoea
- Apnea
- Cyanosis
Neurologic
- tremors
- Irritability
- lethargy
- hypotonic
- Seizures
Name some of the prevention and treatment for neonatal hypoglycemia
Keep babies warm Identify at risk group Follow local guidelines Dry, put had on,akin to skin Feed within 60mins of delivery Frequent feeding Supportive feeding Appropriate monitoring Staff competent when blood sampling Measure 2nd feed Glucose gel EBM/Formula Naso-Gastric
3 Neonatal Hypoglycemia facts
One of the most frequently encountered problems I’m first 48hrs
It can happen go healthy term infants
It can cause neonates to be compromised, stressed and Ill.
When is Neonatal Hypoglycemia regarded?
When neonates plasma glucose concerntration is below 2.0mmol/l
Why is neonatal hypoglycemia more prone in preterm infants?
- Majority of glycogen is stored in 3rd trimester which, may have not been reached yet.
- Brown fat is composed in the last few weeks of pregnancy
- immature counter regulatory response to low glucose concerntrations
Why is neonatal hypoglycemia more prone in Small for Gesational AGE infants?
- low glycogen and fat stores
- inadequate metabolic control
- chronically stressed fetus may use most of the placentally transferred glucose for growth and survival.
Why is neonatal hypoglycemia more prone in infants with Dibetic mothers?
- Glucose crosses placenta/insulin does not
- Fetal glucose level 70-80% of mother’s
- Infant produces insulin in response to higher blood sugars
- At cord clamping, glucose supply is removed but insulin production in infant remains elevated
- May take several days to down regulate insulin production
Name 5 Preventions or Treatments for Neonatal Hypoglycemia
- Keep babies warm
- Identify at risk group
- Follow local guidelines
- Immediately after birth
- Dry and put on a hat, then skin-to-ski
What would you do in the case of neonatal Hypoglycemia?
Follow local guidelines
•Ensure that you are competent to do blood sugar testing
•Keep parents informed
•Accurately record observation
What is Glucose gel?
A gel that is mixed with dextrose and water that, is frequently used by diabetics and those with hypoglycemia to raise their blood sugar when it becomes very low.
Name the benefits of using glucose gel
Keep mother and baby together
•Potentially no interruption in breastfeeding
•Decrease use of formula•Easy to administer
•Low cost
•Reduced admission to neonatal care
What should u do as continuing support?
Prior to feeds assess baby for: level of consciousness, tone, temperature, respiratory rate, colour
•Once baby has had two consecutive blood glucose measurements of 2.6mmol/L or above then blood glucose monitoring can be stopped
•Parents should be advised about what signs and symptoms to be aware of
•Continue support with breastfeeding until well established
•Listen to the mother’s concern
What do the BFI recommend regarding hypoglycaemia
Health professionals should be supported to recognise the risk factors of hypoglycemia, however, some are not obvious
Families should be given a care pathway of early provision of energy, regular assessment of feeding etc.
Breast milk is ideal source of energy.
(Dr Jane M Hawdon, BFI, 2017)
