As I mentioned before, I agree with Dr. Aziz that only if the blood
sugars are high during pregnancy is there a risk of hypoglycemia in the
baby.  Babies should go straight to the breast after delivery,
preferably "self attaching" to the breast.  If they can do that, they
are certainly not hypoglycemic.  If they start nursing, and getting milk
(open--pause--close type of suck), they should be alright.  Dr. Larry
Gartner has mentioned that he is convinced that even a little bit of
colostrum seems to have an anti-hypoglycemic action far out of
proportion to the amount of colostrum the baby gets.  I am not sure how
he decided this, but I think there is something to this.  Very hard to
prove, obviously.

If the baby latches on, but does not actually get milk, he can be
supplemented with a nursing supplementer and sugar water (if there is
truly a concern), because if the baby nurses well with it, he will also
get some colostrum.  Furthermore, oral glucose is not like an IV push of
glucose.  There is very little chance of rebound hypoglycemia, as there
is with an IV push.  Indeed, oral glucose, because it is absorbed
relatively slowly, compared to an IV, is more like a steady infusion of
glucose.

If the baby does not latch on, and there is concern, the baby can be
finger fed or cup fed, though I think the former is better.  There is
usually no need for formula

If the baby has a rapidly dropping sugar, I think an IV infusion should
then be used, and nursing continued and encouraged.

What I think needs be done, is individualized care.  An "institutional"
approach, "one size fits all sizes", is not right.

Jack Newman, MD, FRCPC