Wednesday, March 11, 2009

Blood sugar level in neonate

I've had quite a few mums come to me explaining all about the ordeals they get after having their child in hospital - or one even fighting with the staff even before the babies were born!

It seems like at the moment the buzz word in the neonatal unit is 'glucose'. All the nursing staff seem to have it drummed into them that the new born must be monitored closely for their blood glucose level - to avoid hypoglycaemia.

So I set about trying to find what all the fuss is about.

Hypoglycaemia in the neonate seems to be linked to two important things (well as far as I have found out so far anyway). 1) the development of neurodevelopmental impairment and 2) jaundice/ kernicterus/ hyperbilirubinaemia - if the child has something called Glucose-6-phosphate dehydrogenase (G-6-PD) deficiency.

Hypoglycaemia can be symptomatic and assymptomatic. Thats why the testing in the early hours after birth has to be so consistent. Symptomatic hypoglycaemia can be mild or severe - and as it usually goes in neonates: mild can turn into severe rapidly.

Symptoms of hypoglycaemia can be:
depression of cerebral function: lethargic, hypotonic (limp), poor feeder,weak cry, apnoeic, cyanotic or absent moro reflex
overstimulation of cerebral function: jittery infant with high pitched cry, fixed stare and fisting, abnormal eye movements or convulsions
and excessive sweating: speaks for itself, but may not be present in pre-term infants.

Babies most at risk are:
low birth weight for gestational age
wasted infants,
infants born of a diabetic mother.

Medical limits for glucose in neonate:
>2.0mmol/l (up to 7.0mmol/l): normal
1.5mmol/l -2.0 mmol/l: mild hypoglycaemia
>1.5mmol/l: severe hypoglycaemia VERY DANGEROUS!

SO what is the way of helping the baba naturally?!
1)Easy: go with the feeding of the infant as soon as possible - WITH MILK - meaning colostrum. Which leads me onto the next blog...
2) Keep the child warm. If the child is cold, they burn more energy to keep warm - meaning all the energy that they should have stored up whilst inutero - should be used. If this is all used up, then they can easily go into hypoglycaemia

Don't you think it makes sense in South Africa why the c-section babies (60% of births in SA!!!) are always watched closely - if they were pulled out 'early' - without storing all the fat energy to burn in the first few days - they are going to be low on energy and can easily go into mild hypoglycaemia early on before they can feed enough to get the energy up and live off mum's milk.

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