Ornament

The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Ornament

Newborn Hypoglycemia

Why women shouldn't fear home birth
by Mayim Bialik, Ph.D.
This short essay is humorous, honest, insightful and inspiring.

 

See also:



Food for Thought - Treatment of Physiological Hypoglycemia May Be Harmful

Just-born babies have a very specialized form of nutrition.  Their bodies are designed to thrive with their predictable sequence of events after birth . . . about twenty minutes after birth (after they've mastered breathing and have initialized the visual part of the brain through gazing behavior), they follow their instinct to jump-start the production of breastmilk through suckling.  Their instincts lead them to suckle frequently and for long periods of time in the first few days to signal the mother's body that she has successfully birthed a healthy baby and that her body should continue the transition to full lactation.  Newborn bodies are perfectly adapted to thrive during this transitional period by metabolizing their specialized brown fat.  This brown fat has the amazing property that it can be metabolized directly by the brain, reducing the baby's need for blood sugar.  Thus, a lowered blood sugar level does not necessarily indicate a pathological condition; in fact, in the absence of clinical signs of hypoglycemic stress, a lowered blood sugar level may be healthy.  This non-symptomatic "hypoglycemia" should more accurately be referred to as "normal physiological neonatal hypoglycemia".

It is possible that nutritional supplementation for physiological hypoglycemia may actually be harmful to the newborn by disrupting the natural process--raising the newborn's blood sugar interrupts the newborn's metabolism of ketones and subsequent brain processes.  In particular, ketone metabolism in the newborn's brain may be part of the essential process of transitioning from intrauterine physiology to extrauterine physiology, and interference with ketone metabolism may disrupt this transition.

Those who study the production of ketones in fasting physiology know that ketones induce a noticeably different state of consciousness from glucose metabolism in the brain.  Since this is the state that the baby's body is expecting, interfering with this process may be harmful to the baby in ways we cannot guess.  These may be states of consciousness that are important in the establishment of familial bonding, learning about the environment, or other extrauterine adaptations.  We can even postulate that there is a secondary effect with disruption of ketone production that may increase the risk of autistic tendency through disruption of social bonding.

A bit of folk wisdom comes to mind - "If it ain't broke, don't fix it."  If a baby is maintaining body temperature and behaving normally, don't assume that a lower blood sugar level is an indication of a problem, and don't try to "fix it" through artificial nutritional supplementation or other unnecessary interference with the baby's metabolism.


Hypoglycæmia of the Newborn (Low blood sugar) from Dr. Jack Newman

"As a matter of fact, most of the babies who are tested for low blood sugar do not need to be tested and most of those who receive formula do not need formula. By giving the formula, especially as it almost always is given by bottle, we interfere with breastfeeding and give the impression that formula is good medicine."


Womb to World: A Metabolic Perspective by Suzanne Colson has a nice section on Neonatal Hypoglycemia, including, "A blood glucose concentration in isolation offers very little diagnostic information."


Hypoglycaemia of the Newborn - Review of the Literature, World Health Organization, Geneva, 1997
Here is a great link. It shows BF superior to formula for hypoglycemic infants and also refutes the notion that SGA, LGA infants need to be supplemented. There is data to show that testing procedures are flawed (heel sticks) and that there isn't a good basis for setting the BS number at 40,38,35.


Neonatal hypoglycaemia-blood glucose monitoring and baby feeding

Term babies, especially those who are breast fed, are prone to low blood glucose concentrations in the first 2-3 days after birth. However, in view of their ability to generate ketone bodies, which are used as alternative fuels for the brain, it is likely that this has no clinical implication for otherwise healthy and asymptomatic babies.

Womb to World: A Metabolic Perspective by Suzanne Colson - has a great section on Neonatal Hypoglycemia


I don't do blood sugar levels, I observe for hypoglycemia by seeing if the baby is jittery, lethargic, pale, can't hold his/her temp, etc.  In the face
of a healthy baby, sugar levels are ludicrous.   If the baby is NOT doing well, O2 and 10% glucose should do the trick.  I carry 10% and 5% in my stuff.  I've used it twice.


In order to avoid nipple confusion, we use a newborn "sippy cup" from La Leche League.  Or some midwives just rub some corn syrup or maple syrup on the baby's gums.  (Never use honey for newborns because of the risk of botulism spores in the honey.)


AAP Sets Guidelines for Neonatal Hypoglycemia [2011]

"Clinically significant NH is the result of an imbalance between glucose supply and other fuels such as ketone bodies, which are released from fat. Blood glucose concentrations often dip to 30 mg/dL within 1 to 2 hours after birth in healthy neonates, but they typically return to more than 45 mg/dL with normal feeding within 12 hours.

"According to the guidelines, the infants at highest risk for clinically significant NH are small for gestational age, large for gestational age, born to mothers who have diabetes, or late-preterm. Routine screening and monitoring of blood glucose is recommended only for infants who have these risk factors or who have clinical manifestations of NH such as jitteriness, cyanosis, seizures, an apneic episode, tachypnea, weak or high-pitched cry, floppiness, or lethargy, poor feeding, or eye-rolling.

"The guidelines call for immediate intravenous glucose for infants who are symptomatic and have glucose levels lower than 40 mg/dL.

"For asymptomatic at-risk infants, the initial feed should be within 1 hour of birth, with glucose screening 30 minutes after the first feed. Because there is no point-of-care screening method reliable enough to be used as the sole method for screening for NH, the blood or plasma glucose concentration must be confirmed by laboratory testing ordered stat.

[Ed: Take home message . . . breastfeeding is important and should be given priority over routine assessments and non-emergency treatments.  Honestly, I don't know what to think when I read things like, "Any kind of standardization that will get people to test more is a good thing."

How about "Any kind of standardization that will get people to consider the initiation of breastfeeding to be paramount is a good thing."

All this emphasis on meaningless lab numbers comes from a system that is focused on liability issues and does not have continuous care for new mothers and babies.  It is largely irrelevant at a homebirth, where the midwife observes the newborn constantly for the first hour and puts breastfeeding above everything else.]


PRACTICAL ISSUES IN MANAGEMENT OF NEONATAL HYPOGLYCEMIA


http:

5. If glucose <60 by rapid blood glucose (<40 if newborn) or unable to measure and patient is clinically hypoglycemic[3], administer:
          Neonate: 0.5-1 g/kg = 5-10 ml/kg of D10W.[4]
          Infants & children: 0.5-1 g/kg = 2-4 ml/kg of D25W or 1-2 ml/kg D50W.[3]
          Adolescents and adults: 0.5-1 g/kg = 1-2 ml/kg of D50W.


Neonatal Hypoglycemia

 




SEARCH gentlebirth.org

Main Index Page of the Midwife Archives

Main page of gentlebirth.org         Mirror site

Please e-mail feedback about errors of fact, spelling, grammar or semantics. Thank you.

Permission to link to this page is hereby granted.
About the Midwife Archives / Midwife Archives Disclaimer