Protecting your Baby from Low Blood Glucose

  • Reference Number: HEY-1049/2019
  • Departments: Maternity Services

Introduction

This leaflet has been produced to give you general information about protecting your baby from low blood glucose. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team caring for your child, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

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 hypoglycemia).

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. 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 and 4 hours of age.  This is usually prior to the second feed. It will be repeated prior to feeds until blood sugar levels are stable.
  • You and your baby will need to stay in hospital for the blood tests.
  • You will know the result of the test straight away.
  • If your babies blood sugar is low at the time of testing the staff will inform you and then support you to ensure it rises.  In most instances this will only require providing a further feed to your baby and then a further test to ensure this has raised the blood glucose level.
  • Very occasionally, if babies are too sleepy or unwell to feed, or if the blood glucose is still low after feeding, 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 and 48 hours and your baby will have no further problems.

How to avoid low blood sugars

Antenatal hand expression

If you are reading this leaflet before your baby is born because it has already been identified that your baby may be at risk of low blood glucose, you may want to consider expressing some breast milk before your baby is born. This can be beneficial to supporting your baby’s blood glucose level regardless of whether you plan to breastfeed your baby or not. This is because it is thought that breast milk helps to activate the baby’s response mechanisms which supports them when their blood sugars’ drops.

Research shows that if there are no other risk factors, expressing breast milk from 36 weeks in to your pregnancy should be safe for you and your baby.

You will be shown how to hand express your milk and provided with syringes in which to collect it.  The milk can then be labelled and stored in your own freezer ready to bring in when baby is born.

If you are interested in doing this please see your Midwife for further support and information.

Skin-to-skin contact

Skin-to-skin contact with your baby on your chest helps keep your baby calm and warm and helps to encourage your baby’s natural instincts to feed.  During initial skin-to-skin contact, your baby should wear a hat and be kept warm with a blanket or towel.

Keep your baby warm

Put a hat on your baby until they are able to maintain their own temperature effectively and then remove. Your Midwife will be able to guide you with this.

Keep your baby in skin contact on your chest covered with a blanket and look into you babies eyes to check their well-being in this position, or keep warm with blankets if left in a cot.

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.

This will 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 your baby 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”).

If your baby has not breastfed, and you have been unable to express any of your milk, the team may prescribe a dose of dextrose gel (sugar) or you may be advised to offer infant formula to support raising the blood sugar.

If you are 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.

Do not 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 that the baby is well, but your observations are also important, as you are with your baby all the time it is important that you tell staff if you are worried that there is something wrong with your baby.

The following are signs your baby is well

Is your baby feeding well?

In the first 24 hours you should aim to feed your baby at least every three hours.  If you are breastfeeding it may be that some of these feeds are given as expressed breast milk if your baby does not achieve latching and feeding effectively, this is ok.  Ensure you get support with your chosen method of feeding to ensure that you know how to feed your baby effectively.

Once over the first 24 hours continue to feed your baby regularly until they are waking and showing cues to feed regularly themselves. When they are doing this you can feed your baby responsively in line with their cues, aiming for at least 8 to 12 feeds in 24 hours

If you notice your baby has become less interested in feeding than before this may be a sign they are unwell and you should seek advice.

Is your baby warm enough?

Babies hand and feet can often feel quite cool to touch and this can be normal.  However, if you place the back of your hand on the back of your baby’s neck or the trunk of their tummy they should feel slightly warm to touch. If you check your baby’s temperature by using a thermometer the temperature should be between 36.5 degrees and 37.5 degrees.

Is your baby responding to you?

When your baby is awake, the baby will look at you and pay attention to your voice and gestures.  If you try to wake your baby, the baby should respond to you in some way.

Is your baby’s muscle tone normal?

A sleeping baby is very relaxed, but will still have some muscle tone in their body, arms and legs and will respond to your touch.  If your baby feels completely floppy, with no muscle tone when you lift their arms or legs ensure you seek advice.

It is normal for your baby to make jerky movements in response to noise or movement.  However, if your baby is making strong repeated jerking movements in between this, it may again be a sign your baby is unwell and you should seek advice.

Is your baby’s colour normal?

Look at the colour of your baby’s lips and tongue they should be pink.  If they are bluish or pale in colour this is not normal and should be checked

Is your baby breathing normal?

Babies breathing can be quite irregular, sometimes pausing for a few seconds and then breathing very fast for a few seconds.  If you notice your baby is breathing very fast for 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 and needs checking.

Going home with your baby

It is recommended that your baby stays in hospital for at least 24 hours after birth. After that, if your baby’s blood glucose is stable and they are feeding well, you will be able to go home.

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 wet and dirty nappies and the changing colour of baby’s stools. For further information, if you are breastfeeding, see ‘How you and your midwife can recognise that your baby is feeding well’ (Search ‘UNICEF Baby friendly assessment tool’).

It is important to make sure that your baby feeds well at least 8 times every 24 hours. However, there is no need to continue waking your baby to feed every 2 to 3 hours as long as they have at least this number of feeds, unless this has been recommended for a particular reason. Instead you can now start to feed your baby responsively. Your midwife will explain this t o you.

If you are bottle feeding, make sure you are not over-feeding your baby. Offer the bottle when they show feeding cues and observe for signs that they want a break. Do not necessarily expect your baby to finish a bottle – let them take as much milk as they want.

Once you are home, no special care is needed, however 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.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Infant Feeding Coordinators on (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 themeselves, provide no information about the people to whom they relate.