Why does a newborn's sugar drop?
During the prenatal period, glucose enters continuously through the placenta, and the child has almost no need for its own regulation. After birth, mechanisms are activated that break down glycogen stores in the liver and form glucose again. For a healthy, full-term baby, this takes several hours, and the first breastfeeding helps the process. Problems arise when supplies are low, consumption is high, or hormonal regulation is disrupted. So, in a child from a mother with diabetes, the pancreas is used to working in excess and continues to secrete a lot of insulin after birth.
- Low glycogen reserves in premature and low birth weight infants
- Excess insulin in children of diabetic mothers
- Increased glucose consumption during cold and infection
- Delayed start of feeding
- Rare endocrine and metabolic diseases
Who's at risk
The protocols involve measuring glucose in certain groups of children, regardless of how they feel. These are children born prematurely, too large or, conversely, low weight for their gestational age, babies from mothers with any type of diabetes, including gestational diabetes. Children who have suffered a difficult birth and asphyxia, are hypothermic, with signs of infection, as well as those who were unable to start feeding in the first hours are added. A baby outside of these groups with good sucking usually does not need finger pricking.
- Premature babies
- Large and low birth weight babies
- Children of mothers with diabetes, including gestational diabetes
- Asphyxia and difficult birth
- Hypothermia
- Suspicion of infection
- Late start of feeding
Symptoms
There are no specific signs, and this is the main difficulty. Minor trembling of the hands and chin, increased excitability or, conversely, severe lethargy and drowsiness, weak sucking, an unusual cry, episodes of respiratory arrest, pallor or cyanosis, and a decrease in body temperature are alarming. In severe cases, seizures occur. All these manifestations also occur with infection, brain damage, and calcium metabolism disorders, so the diagnosis is made not by symptoms, but by measured glucose levels.
- Trembling hands and chin
- Lethargy, drowsiness, difficulty waking up
- Weak sucking and breast refusal
- Apnea episodes
- Unusual weak or high-pitched cry
- Decreased body temperature
- Seizures in severe hypoglycemia
How to examine
Sugar is measured with a portable glucose meter at the bedside, and low results are confirmed by laboratory analysis, since meters can be erroneous in newborns. Blood is taken before feeding according to a set schedule: usually in the first hours, then before the next feedings, until the values become stable. For most children, clinical guidelines focus on a threshold of about 2.6 mmol/L, below which intervention is required. If hypoglycemia persists for more than several days or requires large volumes of glucose, an extensive examination is performed to exclude hyperinsulinism and metabolic diseases.
- Measuring glucose with a glucometer before feedings
- Laboratory confirmation of low values
- Control until indicators stabilize
- Calcium, electrolytes, blood gases
- For persistent hypoglycemia - insulin, cortisol, ketones
- Consultation with a pediatric endocrinologist
Treatment and prevention
The most effective measure is early breastfeeding in the first hour of life and frequent feedings on demand, at least every two to three hours. With a moderate decrease, the doctor may prescribe a glucose gel to the buccal mucosa along with feeding. If sugar levels are low, symptoms are present, or feeding is not possible, glucose is given intravenously at a gradually reduced rate as recovery occurs. At the same time, the thermal regime is maintained: a cooled child spends a lot of energy. For persistent forms, the pediatric endocrinologist selects special treatment.
- Attachment to the breast in the first hour of life
- Feeding every 2–3 hours, including at night
- Skin to skin contact and warmth maintenance
- Glucose gel for the cheek as prescribed by a doctor
- Intravenous glucose for severe hypoglycemia
- Monitoring maternal sugar levels during pregnancy
- Observation by an endocrinologist for persistent forms