- Reference Number: HEY1049/2022
- Departments: Maternity Services
- Last Updated: 1 March 2022
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What is low blood glucose?
- You have been given this leaflet because your baby is at increased risk of having low blood glucose (also called low blood sugar or hypoglycaemia).
- Babies who are small, premature, unwell at birth, or whose mothers are diabetic, have gestational diabetes, or have taken certain medication, may have low blood glucose in the first few hours and days after birth, and it is especially important for these babies to keep warm and feed as often as possible in order to maintain normal blood glucose levels.
- If your baby is in one of these “at risk” groups, it is recommended that they have some blood tests to check their blood glucose level and a period of monitoring their clinical well-being and feeding prior to discharge. Extremely low blood glucose, if not treated, can cause brain injury resulting in developmental problems. If low blood glucose is identified quickly, it can be treated to avoid harm to your baby.
Blood glucose testing
- Your baby’s blood glucose is tested by a heel-prick blood test. A very small amount of blood is needed and it can be done while you are holding your baby in skin-to-skin contact. The first blood test should be taken between 3-4 hrs of age. This is usually prior to the second feed. It will be repeated prior to feeds until blood glucose levels are stable.
- You and your baby will need to stay in hospital for the blood tests and monitoring of clinical well being
- You will know the result of the test straight away.
- If your baby is born between 36-37 weeks or you are diabetic or gestational diabetic, your baby will require a minimum of at least four blood glucose tests as per our guideline.
- If your baby’s blood glucose is being checked for other reasons they will require a minimum of two blood glucose tests as per our guideline.
- Sometimes your baby may require more blood glucose tests if they are not stable.
- Another reason your baby may require more blood glucose tests is because the blood glucose tests need to be based on your intended feed type. For example, if you plan to breastfeed and your baby has required any supplementation due to a low blood glucose test then a further blood glucose test would be carried out based on when you have breastfed baby. To avoid needing to supplement your baby, you may wish to consider antenatal colostrum collection as discussed in the ‘how to avoid low blood sugars’ section within this leaflet.
Monitoring of clinical wellbeing & feeding
After the blood glucose testing is completed, all babies require a period of monitoring their clinical well-being and feeding prior to discharge. The Midwife will monitor your baby’s skin colour, alertness, temperature and breathing rate as well as assessing how well they are feeding.
- If your baby is born between 36-37 weeks, you and your baby will be required to stay for a minimum of 48 hours in hospital following your baby’s birth to complete the blood sugars and monitoring as per our guideline. It is important to note however, that babies born between 36- 37 weeks often need to stay in hospital beyond this length of time to establish feeding and or to prevent/treat jaundice. Therefore, it is important that you are prepared for a possible extended length of stay in hospital after your baby is born.
- If your baby is having blood glucose testing for any other reason than the above, the guideline is that you and your baby will be required to stay in hospital for 24hrs from birth to complete the testing and monitoring. However, it is again important to note that every baby and circumstances is different, and some babies may need to stay in hospital beyond this length of time to ensure that they are clinically suitable to be discharged.
How to avoid low blood sugars
Antenatal colostrum collection
If you are receiving this information antenatally because your baby is likely to be in an “at risk” group for low blood glucose, then you may want to consider antenatal collection of your colostrum. This involves hand expressing colostrum antenatally, then freezing and storing this to be brought in and defrosted for use when baby is born. A research study has shown that in light of no other risk factors antenatal hand expressing can be safely performed from 36 weeks pregnant (DAME trial 2017). It is thought that colostrum activates the babies own natural responses which help to protect against low blood sugars. It can therefore be beneficial to give some initial colostrum to your baby to help protect against low blood sugars, whether you plan to breastfeed long term or not. For further advice and information please refer to the leaflet Antenatal colostrum collecting, which can be found on the Trust website, in the Patient Leaflet section and/or speak to your Midwife or one of the hospitals Infant Feeding team.
Skin-to-skin contact with your baby on your chest helps keep your baby calm and warm and helps to encourage your babies’ natural instincts to feed. We therefore encourage skin to skin not only at the time of birth but regularly at least until your baby has established feeding.
Keep your baby warm
Keeping your baby in skin to skin contact on your chest covered with a blanket is one of the best ways to keep your baby warm. Research shows that a mother’s chest temperature rises and falls in a way that helps the baby to reach and maintain their correct body temperature.
Put a hat on your baby until they are able to maintain their own temperature effectively. Once your baby can maintain their temperature effectively, the hat should be removed in line with safer sleep guidance. Your Midwife will be able to advise you with this.
When in the cot use appropriate blankets to keep your baby warm but again ensure safer sleep guidance is followed. Your midwife will be able to advise you in relation to this.
Feed as soon as possible after birth
Ask a member of staff to support you with your chosen method of feeding until you are confident. Make sure you know how to tell if breastfeeding is going well, or if formula feeding, how much formula to give your baby.
Feed as often as possible in the first few days
Whenever you notice “feeding cues” which include rapid eye movements under the eyelids, mouth and tongue movements, body movements and sounds, sucking on a fist, offer your baby a feed.
Do not wait for your baby to cry – this can be a late sign of hunger
Feed for as long, or as much, as your baby wants
To ensure your baby gets as much milk as possible.
Feed as often as baby wants, but do not leave your baby more than 3 hours between feeds
If your baby is not showing any feeding cues yet, hold him/her skin-to-skin and start to offer a feed about 3 hours after the start of the previous feed.
Express your milk (colostrum)
If you are breastfeeding and your baby struggles to feed, try to give some expressed breast milk. A member of staff will show you how to hand express your milk or watch the UNICEF hand expression video (search “UNICEF hand expression).
Don’t hesitate to tell staff if you are worried about your baby
If your baby appears to be unwell, this could be a sign that they have low blood glucose. As well as doing blood tests, staff will observe your baby to check he / she is well, but your observations are also important. You are with your baby all the time, so it is important that you tell staff if you are worried that there is something wrong with your baby.
The following are signs that your baby is feeding well:
Is your baby feeding well?
In the first few days your baby should feed effectively at least every 3 hours, until blood glucose is stable, and then at least 8 times in 24 hours. Ask a member of staff how to tell if your baby is attached and feeding effectively at the breast, or how much milk to give if formula feeding. If your baby becomes less interested in feeding than before, this may be a sign they are unwell and you should raise this with a member of staff.
Is your baby warm enough?
Your baby should feel slightly warm to touch, although hands and feet can sometimes feel a little cooler. You should test the temperature using the back of your hand on the trunk of the tummy or back of the neck. If they feel cool here despite being in a warm environment, then you should have this checked. However, if they feel sweaty, they may actually be too hot so remove covers appropriately. If you use a thermometer the temperature should be between 36.50C and 37.50C inclusive.
Is your baby alert and responding to you?
When your baby is awake, he/she will look at you and pay attention to your voice and gestures. If you try to wake your baby, they should respond to you in some way.
Is your baby’s muscle tone normal?
A sleeping baby is very relaxed but should still have some muscle tone in their body, arms and legs and should respond to your touch. If your baby feels completely floppy, with no muscle tone when you lift their arms or legs, or if your baby is making strong repeated jerky movements, this may be a sign they are unwell. It can be normal to make brief, light, jerky movements in response to noise or touch. Ask a member of the team if you are not sure about your baby’s movements.
Is your baby’s colour normal?
Look at the colour of the lips and tongue – they should be pink.
Is your baby breathing easily?
Babies’ breathing can be quite irregular, sometimes pausing for a few seconds and then breathing very fast for a few seconds. If, however, you notice your baby is breathing very fast for a continuous period (more than 60 breaths per minute) or seems to be struggling to breathe with very deep chest movements, nostrils flaring or making noises with each breath out – this is not normal.
Whom to call if you are worried
- In hospital, inform any member of the clinical staff.
- At home, call your community midwife and ask for an urgent visit or advice.
- Out of hours, call NHS 111
- If you are worried, take your baby to your nearest A&E department or dial 999.
What happens if your babies blood glucose
If the blood glucose test result is low then the staff may take a further blood sample again from the heel but into a small tube. This sample can then be tested on a machine that will give us a second and more detailed and accurate result.
In the meantime, staff will give your baby some dextrose gel rubbed on to the inside of their cheeks, as this is an effective way to bring your baby’s blood sugar level back up.
You should provide skin to skin contact and feed your baby as soon as possible.
If you are breastfeeding and your baby does not breastfeed straight away, a member of staff will review your baby to work out why. If he / she is happy that your baby is well, he / she will support you to hand express your milk and give it by oral syringe / finger / cup.
If your baby has not breastfed, and you have been unable to hand express or provide colostrum collected antenatally, you may be advised to offer infant formula, if there is a clinical need to do so. If you are breastfeeding and advised to give some infant formula, this is most likely to be for one or a few feeds only. You should continue to offer breastfeeds and try to express milk as often as possible to ensure your milk supply is stimulated.
Your baby’s blood glucose will be tested again before the next feed, or earlier if there is any concern.
Very occasionally, if babies are too sleepy or unwell to feed, or if the blood glucose remains low prior to the next feed, he / she may need to go to the Neonatal Unit / Special Care Baby Unit. Staff will explain any treatment that might be needed. In most cases, low blood glucose quickly improves within 24-48 hours and your baby will have no further problems.
Going home with your baby
Before you go home, make sure you know how to tell if your baby is getting enough milk. A member of staff will explain the normal pattern of changes in the colour of dirty nappies and the number of wet / dirty nappies, which can help you assess this. For further information, make sure you also watch the postnatal information video and refer to the leaflets within your postnatal pack. If you are breastfeeding then the “how can I tell my breastfeeding is going well?” sheet in your pack can be particularly useful.
Unless it has been recommended to stick to a specific feeding plan then you can now begin to feed your baby responsively. This includes observing for your baby’s feeding cues and feeding appropriately alongside your own needs to feed baby too. You should ensure your baby feeds at least 8-12 times in 24 hours. If you have any feeding concerns, you should contact your midwife for advice.
If you are bottle feeding, make sure you are not over feeding your baby. Offer the bottle when he / she shows feeding cues and observe for signs that he/she wants a break. Don’t necessarily expect your baby to finish a bottle – let him / her take as much milk as he / she wants.
Once you are home, no special care is needed. As with all newborn babies, you should continue to look for signs that your baby is well and seek medical advice if you are worried at all about your baby.
A Framework for Practice. British Association of Perinatal Medicine, 2017.
This leaflet was produced by the Infant Feeding Coordinator’s, at Hull and East Yorkshire Hospitals NHS Trust and will be reviewed in March 2018
Ref: (Supplied by Clinical Governance Directorate Ratification group)
Should you require further advice regarding the issues contained in this leaflet, please do not hesitate to contact the Infant Feeding Coordinator on tel. no. 01482 607838. Please leave an answer phone message with your name and contact number and we will get back to you.
General Advice and Consent
Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.
Consent to treatment
Before any doctor, nurse or therapist examines or treats your child, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to your child. You should always ask them more questions if you do not understand or if you want more information.
The information you receive should be about your child’s condition, the alternatives available for your child, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:
- you must be able to give your consent
- you must be given enough information to enable you to make a decision
- you must be acting under your own free will and not under the strong influence of another person
Information about your child
We collect and use your child’s information to provide your child with care and treatment. As part of your child’s care, information about your child will be shared between members of a healthcare team, some of whom you may not meet. Your child’s information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.
We may pass on relevant information to other health organisations that provide your child with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your child’s doctor, or the person caring for your child.
Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about your child. For further information visit the following page: Confidential Information about You.
If you need information about your child’s (or a child you care for) health and wellbeing and their care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.
Your newborn baby’s NHS number
An NHS number is allocated to everyone whose birth is registered with a Registrar of Births and Deaths in England and Wales. You already have an NHS number and your baby will be assigned an NHS number soon after birth. Your NHS number is unique to you and provides a reliable means of linking you to the medical and administrative information we hold about you. NHS numbers are allocated on a random basis and, in themselves, provide no information about the people to whom they relate.