In response to the request for references regarding hypoglycemia and
breastfeeding: Midrs Midwifery digest June, 1996 Vol 6, no 2 page 220 to 222
and also in Midrs December 1996 6:2 page 382 -386. These articles are a good
starting point and have additional references.

The following points about neonatal hypoglycemia are worth noting.

All babies drop their blood sugar in the first hour or two after birth and
then it rises to normal levels as the child adapts to extra uterine life.
Healthy neonates have a unique glucose metabolism compared to older babies
and adults. They are able to utilise ketones and their brown fat for energy
stores. As a result they are able to maintain their blood glucose levels
with minimal intervention. The colostrum, the brown fat, the liqour - must
all be part of a unique plan. Nature or the man upstairs of you like knows
how to do things!

Most of the portable blood glucose monitoring devices (if not all) are
unsuitable for monitoring neonatal blood glucose. The under-read horribly
which has everyone rushing for the formula. One needs an accurate lab
reading.

I am aware of hospital policies (in Australia) that do not intervene if a
healthy babe has not breastfed until the first 10 hours are up. Only then is
the blood glucose checked. If is is below 2mmol/l then intervention is
commenced. Fist stop some hand expressed colostrum from mother if possible.
This often does the trick. and you can keep doing it and checking the blood
glucose until babe is ready to feed. (usually every 3 hrs) One would only
resort to a comp feed if the blood glucose was in the region of less than
1 mmol/l or the babes was showing signs of hypoglycemia.


Hypoglycemia occurs in the neonate due to sepsis, illness, shock, poor
temperature control (babe allowed to get cold), asphyxia, diabetic
mother, low birth weight infant ( no brown fat). I think what I am trying to
emphasise is that the healthy babe is really equipped to deal with the
normal variations that we see in breastfeeding patterns in the ist 24 -
48hrs. Survival of the fittest etc.


Regards

Mandy O'Reilly

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