The definition of hypoglycemia is a blood sugar less than 40 mg/dl.  This is
in a term infant.  In a premature infant the cutoff level is 30 mg/dl.
These are the accepted numbers that most hospitals and physicians use.
In our hospital breastfeeding in the delivery area is encouraged.  It is
unusual to see hypoglycemia after being breastfed in the delivery room.
However, if for whatever reason, it does go below 40, first we find out if
mom is willing and able to feed.  If not, we finger feed formula (not more
than 30 cc, so as not to suppress child's own hunger) and then try to get
baby with mom as soon as possible.  We also ask mom's permission to use
formula because some moms prefer glucose water, which works just as well to
immediately raise the blood sugar, which is the main goal anyway.  For the
greater than 4 kilo infants of diabetic mothers, if their blood sugars go
below 40 twice, I will put IVs in and give enough D10 per hour to keep the
blood sugar at 40 and above.  The baby is then kept with mom as much as
possible and told to keep the baby at the breast as much as possible.  As
long as the baby has an IV and the blood sugar is stable there is no need to
supplement.  The baby can just breastfeed.  I've used this technique many
times and have had good success with it.  Usually you can begin weaning the
IV fluid within 2 days after starting it and the baby does very well.  I'd
be interested to hear what other people have seen done in their hospitals to
manage this problem.


Terry Lynn Dise, MD
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