Every time I speak on hypoglycemia, I get very discouraged. Two days ago I spoke on this topic and jaundice in Bucharest Romania. So I am reposting about hypoglycemia. This was first on this page in December 2012. Hypoglycemia (low blood sugar)? There are so many questions around this issue it wont be easy to summarize them in this post. However: 1. Doing routine blood sugars on every baby at birth is another example of how worrying about being sued causes damage to babies and creates unnecessary anxiety in the parents and results in unnecessary treatment. But many hospitals in the US have this policy and more and more in Canada. Interestingly, most pediatricians and neonatologists dont seem to know what normal is. They look at a number and say give formula. 2. In fact, nobody agrees on what is a normal blood sugar in newborns. Everyone has a different number they consider “too low”. 3. The blood sugar in babies is more or less the same as the mothers at birth and then over the next 1 to 2 hours the sugar drops, for some babies into the range many would call too low. But this drop in the blood sugar is NORMAL! And the blood sugar rises again over the following hour or two even if the baby is not fed. This has been shown not only in humans but also in all mammals that have been studied. Treating low blood sugar in this circumstance is treating normal and thousands of babies across North America are being unnecessarily supplemented with formula for what is a normal blood sugar. 4. Skin to skin contact with the mother maintains a higher blood sugar in the baby than separation of the mother and baby. Skin to skin contact also affords the baby an opportunity to feed at the breast. 5. The mother’s colostrum is the best milk and bank breastmilk the second best to prevent and treat low blood sugar in newborn babies. For this reason, we recommend that mothers whose babies are at high risk for low blood sugar express and store their milk starting at 35 to 36 weeks gestation so the baby, if necessary, can get colostrum instead of formula. There is no evidence that hand expression of milk at this stage increases the risk of premature birth. 6. There is evidence that babies who are at risk for low blood sugar and are fed at the breast immediately after birth are less likely to become clinically hypoglycemic and actually have higher blood sugars than babies fed formula as their first feeding. 7. There is no evidence that a baby who is born big (some hospital policies say 4 kg=8lb 12oz or higher) is at risk for low blood sugar if his mother is not diabetic. On the contrary, such babies are at lower risk of hypoglycemia because they have lots of body fat that can be broken down into compounds called ketone bodies. 8. Ketone bodies protect the babys brain from the effects of low blood sugar and ketone bodies are present in much higher concentrations in the blood of babies breastfed (or fed colostrum or breastmilk) than in the blood of babies formula fed. Babies fed both breastmilk and formula have a lower but intermediate response. 9. There is no need for a baby at risk for low blood sugar (infants of diabetic mothers, both type 1 and type 2) to automatically go to special care. They should stay with the mother, skin to skin, be fed on demand and get help from the nursing staff to make sure the baby feeds well at the breast. Pre-expressed colostrum can be fed by spoon, syringe or lactation aid at the breast. 10. Bottom line? There is a lot of hysteroglycemia out there and the treatment of it is causing many babies to be unnecessarily supplemented with formula often with bottles. In one case of a mother who contacted me, the baby was admitted to the NICU because an unnecessary blood sugar was done shortly after birth (during the time that the blood sugar sometimes NORMALLY drops to hypoglycemic levels.) The baby had an intravenous was given formula. The mother was feeding with a nipple shield (for reasons that did not seem clear, probaby because the baby refused the breast after receiving bottles, but to me no reason for nipple shield use is clear) and pumping her breasts. The baby was in the NICU for several days at great cost to the health system. All because of an unnecessary blood sugar being done as a routine. This baby had no risk factors for hypoglycemia.
Posted on: Sat, 10 May 2014 05:09:41 +0000
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