Hypoglycemia and the Breastfed Newborn
by Anne Eglash MD, IBCLC, FABM
To this day, medical societies around the world do not share the same definitions for hypoglycemia (low blood sugar) in newborn infants.
The Academy of Breastfeeding Medicine’s recently updated hypoglycemia protocol concisely reviews normal blood sugar physiology for breastfed infants.
The authors state that healthy term newborns normally drop their blood sugars rapidly after birth, often reaching a blood sugar as low as 20-25 mg/dl (1.11-1.39 mmol/L) within the first 3 hours after birth. This low blood sugar is normal and not problematic for healthy term breastfed infants without risk factors for hypoglycemia because they have the physiologic resources to generate and rely on ketones as an alternative energy source during the first few days, just like we all do when fasting all night. During this time, the small volumes of colostrum are sufficient to meet the caloric demands of the healthy term newborn. By 12-24 hours of age, the blood sugar of a healthy newborn will reach 43-90 mg/dL (2.4-5mmol/L).
Of course, many infants have risk factors for low blood sugars early after birth, and these are listed in the protocol. Some infants have been exposed to high blood sugars in utero, which means that they are born with high insulin levels, and so need glucose supplementation. Other infants don’t have the maturity, strength, or adequate body tissue to raise their blood sugars on their own early after birth.
For non-formula feeding infants who have low blood sugars early postpartum, breastfeeding, administration of colostrum, and/or donor milk PLUS buccal 40% dextrose gel is recommended to maintain a blood sugar >45mg/dL (>2.5mmol.L).
- Mothers with gestational diabetes are encouraged to have tight control of their blood sugars.
- Skin to skin immediately after birth.
- Routinely check all breastfed newborns for low blood sugars.
- Feed the baby within 30-60 minutes after birth.
- Feed the baby at least every 3 hours after birth, or more often.
- Offer expressed colostrum in addition to breastfeeding for late preterms.
- Give 5-10ml of glucose water after every feeding at the breast.
See the Answer
This protocol does not have an abstract
This protocol is a nice update. It has a very useful flow chart on screening and management of low blood sugars, and a patient education handout for families.
The authors mention that women with a history of diabetes during pregnancy can prevent formula supplementation for their at-risk infants by storing colostrum that is collected antenatally after 36 weeks gestation, and providing this as supplementation postpartum. Hand expression of colostrum can also be achieved peripartum. Delaying the bath and frequent skin-to-skin both help to prevent physiologic stress, preventing increased glucose utilization.