Jane Hawdon's work focuses on hypoglycaemia and feeding; I promised
to post some refs.  Some of her work, and that of her colleagues,
informed the WHO guidelines. I have heard her speak, and she
emphasises that infants at risk of developing hypoglycaemia show
neurological signs of this - so watching the baby, not the clock, is
essential. She makes a distinction between the term baby and the
pre-term.
HWN, UK

Neonatal hypoglycaemia--blood glucose monitoring and baby feeding.

Hawdon JM ; Platt MP ; Aynsley-Green A

Midwifery, 9(1):3-6 1993 Mar
Abstract
Recent concerns regarding neurological sequelae of neonatal
hypoglycaemia have raised the question of whether demand breast
feeding may increase the risks of neonatal hypoglycaemia and
neurological handicap. In this review article neonatal hypoglycaemia
is defined, monitoring of babies for this condition is discussed and
implications for baby feeding practices are stated.



Hypoglycaemia and the neonatal brain.

Hawdon JM

Eur J Pediatr, 158 Suppl 1(-HD-):S9-S12 1999 Dec
Abstract
There has been much controversy and confusion regarding potential
damage caused to the neonatal brain by low blood glucose levels.
Previous studies of outcome after neonatal hypoglycaemia are flawed
by many factors including retrospective data collection and inability
to control for co-existing clinical complications. There is no doubt
that hypoglycaemic brain damage does occur but the severity and
duration of low blood glucose levels required to cause lasting harm
varies between subjects and is related to the ability of each baby to
mount a protective response such as the production of ketone bodies
which are alternative cerebral fuels. Evidence from studies of humans
and other animals suggests that cortical damage and long-term
sequelae occur after prolonged hypoglycaemia sufficiently severe to
cause neurological signs. CONCLUSION: Prolonged hypoglycaemia should
be avoided by close clinical observation of vulnerable infants whilst
avoiding excessively invasive management in populations of neonates
which may jeopardize the successful establishment of breast feeding.

Patterns of metabolic adaptation for preterm and term infants in the
first neonatal week.

Hawdon JM ; Ward Platt MP ; Aynsley-Green A

Arch Dis Child, 67(4 Spec No):357-65 1992 Apr
Abstract
There have been few comprehensive accounts of the relationships
between glucose and other metabolic fuels during the first postnatal
week, especially in the context of modern feeding practises. A cross
sectional study was performed of 156 term infants and 62 preterm
infants to establish the normal ranges and interrelationships of
blood glucose and intermediary metabolites in the first postnatal
week, and to compare these with those of 52 older children. Blood
glucose concentrations varied more for preterm than for term infants
(1.5-12.2 mmol/l v 1.5-6.2 mmol/l), and preterm infants had low
ketone body concentrations, even at low blood glucose concentrations.
Breast feeding of term infants and enteral feeding of preterm infants
appeared to enhance ketogenic ability. Term infants had lower prefeed
blood glucose concentrations than children but, like children,
appeared to be capable of producing ketone bodies. This study
demonstrates that neonatal blood glucose concentrations should be
considered in the context of availability of other metabolic fuels,
and that the preterm infant has a limited ability to mobilise
alternative fuels.

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