These are my notes from the State LLLI Conference 1998 in Illinois

Hypoglycemia
Based on information presented by Betty Crase, AAP

Hypoglycemia is a condition that results when there is too rapid a fall in
glucose levels when the usage of glucose in the baby's system exceeds the
production.  While the condition does require attention, the routine
administration of a prophylactic glucose bottle is not recommended.

Definition
Many inconsistencies exist with the definition, detection, prevention and
treatment of hypoglycemia resulting in no standard of care.  The definition
of hypoglycemia depends on the blood levels used to define the condition.
Studies that have examined this condition are using varying levels, ranging
from less than 30mg/dl to less than 47 mg/dl. There is no gold standard or
even standard universal range reflected in the literature.  The detection
methods depend on whether whole blood or the serum or plasma is tested.
While the blood tests are the most reliable in terms of consistency of
results, without a standard definition, the information becomes less useful.
Furthermore, a blood test requires a full blood draw and is much more
costly. This has made the rapid detection tests, Dextrostix and Chemstrips,
more popular.  However, the Dextrostix and Chemstrips are unreliable in the
quality and consistency of their results and the American Academy of
Pediatrics discouraged their use in 1993.  Lastly, the use of arbitrary
weight limits as a risk factor varies from hospital to hospital and there is
no standard of care or recommendation in the literature.

Treatment and Prevention
The treatment for and prevention of hypoglycemia in the newborn, even in
preterm infants, is "to feed undiluted human milk because the fat in human
milk causes a rapid rise in blood sugar.  Symptomatic neo-natal hypoglycemia
is due to delayed or inadequate feeding of human milk." (Smallpeice, 1964).
Colostrum contains 6.4% Lactose, 3% Lipids, 2-3% Protein, totaling 18
calories /ounce.  The standard glucose bottle contains less glucose, 5%, and
no fat or other nutrients which, when taken orally, causes a rapid rise and
then fall in blood sugar levels potentially creating iatrogenic hypoglycemic
shock.  Breastfeeding on demand provides the optimum nutritional composition
to prevent and correct hypoglycemia.  Nursing on demand provides small,
frequent high-protein/fat/calorie meals for the infant, which are the same
recommendations as for the adult.
The incidence of hypoglycemia is increased by two factors that we know of at
this time.  One is the use of maternal glucose IV which transports rapidly
across the placenta and therefore the baby does not need to produce his/her
own.  The incidence of Demerol epidurals also increased the frequency of
hypoglycemia to 37% in 30 women who delivered vaginally and 43% who delivery
by cesarean section from the more classic incidence of 4% (Cole 1994).
Recommendations of the World Health Organization 1997 are:
- No need to routinely check healthy, term infant if breastfed on demand and
nursed within 1 hour of birth
- No routine oral glucose bottles
- If neonate is at risk and is asymptomatic, then give human milk at breast,
or if unable to suckle, give expressed milk.  If still hypoglycemic three
hours later, give IV 10% glucose and continue breastfeeding
- If neonate is sick or symptomatic give IV 10% glucose and continue
breastfeeding
 Please note that there are no recommendations for oral glucose bottles at
all.   The administration of IV glucose can be avoided by encouraging
immediate breastfeeding.  IV administration has the undesirable effect of
being more invasive and can create "Vulnerable Baby Syndrome" in the mother
who might feel that her milk is inadequate or that she has a sickly baby.
Breastfeeding can both prevent as well as treat hypoglycemia because it is
the best nutritionally, making it the substance of choice.

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