At risk means many different things.  A premature baby may not be able to
mobilize other sources of nutrients the way a full term baby can usually, so
that there is more urgency to treat that baby.  A large for gestational age
baby, if he is overproducing insulin also might not be able to mobilize
other energy sources.  But the overproducing of insulin comes from poorly
controlled maternal diabetes, and if the mother is well controlled, there
shouldn't be a problem.

Again, why give formula first if the baby is symptomatic?  I feel this is
dangerous.  What if he has a seizure before the ABM has a chance to be
effective?  He might aspirate on top of everything else.  Symptomatic, that
means IV and rapid and *reliable* correction of the blood sugar as far as I
can see.  In fact, I would be surprised that most paediatricians would treat
symptomatic hypoglycemia with formula only and wait to see what happens.
Truthfully, I feel this is a very risky approach. The IV.

As far as the asymptomatic baby is concerned, feed the baby, absolutely.
And that means breastfeeding.  That will increase the sugar.  If you use a
lactation aid to supplement sugar water at the breast (and I would not use
10%, but rather 5%, it'll be alright).  In that case the baby gets both.
Where does it say it doesn't work?  It's always worked for me.

Jack Newman, MD, FRCPC

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