OVERVIEW
The low blood sugar level in the baby means that blood glucose levels less than 40 milligrams per dl in your child. It is also called hypoglycemia in medical terms. There are a variety of causes that lead to a baby with low blood sugar levels like neonatal infection or birth asphyxia. The incidence of low blood sugar level in newborn varies between 1-2 per thousand live births. There are 8.1 % of full-term infants to develop the condition. There are 50% chances of the baby to born with a low blood glucose level if the mother is diabetic.
Causes of Baby with Low Blood Sugar
- Decreased sugar stores
- Premature child
- Post mature child
- Decreased calorie intake
- Inadequate feeding
- Increased utilization of glucose
- An infant born to a diabetic mother
- Erythroblastosis fetalis
- Beckwith Wiedemann syndrome
- Miscellaneous
- Infection
- Sepsis
- Low-temperature levels
- Polycythemia
- Blood transfusion
- Glycogen storage diseases
- Mother taking drugs for blood pressure like beta-blockers e. g Inderal or propranolol
Galactosemia - Large for gestational age infants
Why Does This Condition Happen?
The blood sugar crosses the Placenta of the child by diffusion and usually, the glucose levels of the child are approximately 2/3rd of the Glucose level of the mother. When the umbilical cord is cut down after the birth of the baby, the source for glucose to the baby is stopped and the blood sugar level of the child falls down in the first two hours of the life. The levels are usually stabilized in three to four hours if early feeding begins. The blood sugar level reaches 65-71mg/dl. This condition can be prevented by feeding the child early as soon as the baby is delivered. The requirement of sugar for the baby born is 6mg/kg/ minute.
Signs and Symptoms of Baby with Low Blood Sugar
The onset of the symptoms occurs within a few hours after birth. The low blood sugar may be present in the child without any symptoms in high risk babies so there needs a high index of suspicion for hypoglycemia. There may be non-specific sometimes in child and they may be due to some neonatal disease. If the symptoms disappear when the glucose infusion started, then the symptoms are suggestive of low blood glucose levels:
- The child may turn blue
- tremors
- apathy in child
- convulsions
- increased Heartbeat of child
- intermittent apneic spells
- difficulty in feeding
- Lethargy
- limpness
- High pitched cry
- Sweating
- turning of complexion to yellow
- low body temperature
- cardiac arrest
- Up rolling of eyes
- cardiac failure
How The Condition Can Be Diagnosed Early?
Blood glucose levels:
The blood glucose levels are initially measured by dextrostix but these are the strips that measure the whole blood glucose level and it is 10% lower than the blood plasma level. Before we can diagnose hypoglycemia in the child the laboratory confirmation is required. The blood glucose levels are measured in the baby at 1, 2, 4, 6, and 24 hours of age. If the blood glucose levels are not stabilized, you need to continue checking the Glucose level until the child becomes healthy. If it does not happen, you need to discontinue monitoring blood glucose levels after 24 hours.
Complete blood count:
The complete bed examination of the child is obtained to evaluate the infection going on inside the child. Neutrophils and lymphocytes may be raised in case of infection.
Differential blood count: Differential blood count in a baby with low blood sugar evaluate for sepsis in the child. It is usually done to rule out any cause of infection or septicemia.
What Are The Complications?
Variety of complications can occur in the child which are:
- Permanent Central nervous system damage
- Intraventricular hemorrhage
- Apnea
- Convulsions
- Cardiac arrest
- Heart failure
- Death
How to Treat Baby with Low Blood Sugar?
It is usually required to anticipate in advance with a high risk of low blood sugar level and it is a crucial step in management.
Blood glucose levels ( 20 – 45 mg/dl)
Usually, the blood glucose level who are in the range of 20 to 45 milligrams per DL does not have symptoms of hypoglycemia. if the baby is alert give him glucose about 6 milligrams per kilogram per minute.
Blood glucose level < 45mg/dl
The children with a blood glucose level of fewer than 45 milligrams per DL have mild symptoms of hypoglycemia. You need to give him a Bolus of dextrose water 2 milligrams per kilogram followed by continuous infusion of glucose tell the symptoms to resolve.
Blood glucose levels < 20mg/dl
The child may or may not have symptoms of low blood sugar. You need to assess IV and if you are not able to access that umbilical vein can be used to infuse the sugar inside the body.
Drugs which can be given:
- Glucagon especially when in an emergency when intravenous access is not obtained
- Growth hormone can be given 1unit/24 hours
- Diazoxide 10-25 mg7kg/day in two to three different division of doses
- Prednisolone in divided doses
- Hydrocortisone every 6 hours
Surgical options:
If the baby with low blood sugar is suffering from insulin-producing tumors surgery is considered.
What Is Prognosis Of Baby With Low Blood Sugar?
Usually, the prognosis is good if the therapy is promoted earlier. If the seizures or convulsions occur in a child having low blood sugar the central nervous system effects are usually seen. Central nervous system Side Effects are also seen with persistently low blood sugar levels due to insulin-producing tumors. The prognosis can be made better if the treatment is started earlier.
When to Seek Medical Help?
The baby with low blood glucose level suffers seizures, not taking enough feed, cyanosed, lethargic, and suffer pallor, you should not wait to seek medical help. Your doctor will diagnose the baby in detail and will begin the treatment to let your baby survive low blood sugar levels. The treatment if beginning on time will let the child survive. Any delay in treatment can bring deadly effects on your child’s health.
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