Protecting Your Baby From Low Blood Glucose

What is low blood glucose?

You have been given this leaflet because your baby is at increased risk of having low blood glucose (also called low blood sugar or hypoglycaemia).

Babies who are small, premature, unwell at birth, or whose mothers are diabetic or have taken certain medication (beta-blockers) may have low blood glucose in the first few hours and days after birth. It is especially important for these babies to keep warm and feed as often as possible in order to maintain normal blood glucose levels.

If your baby is in one of these “at risk” groups, it is recommended that they have some blood tests to check their blood glucose level.

Extremely low blood glucose, if not treated, can cause brain injury resulting in developmental problems. If low blood glucose is identified quickly, it can be treated to avoid harm to your baby.

Blood glucose testing

Your baby’s blood glucose is tested by a heel-prick blood test. A very small amount of blood is needed and it can be done while you are holding your baby in skin-to-skin contact. The first blood test should be done before the second feed (2 to 4 hours after birth) and repeated until the blood glucose levels are stable.

You and your baby will need to stay in hospital for the blood tests.

You will know the result of the test straight away.

How do I avoid low blood glucose for my baby?

• Skin-to-skin contact: Skin-to-skin contact with your baby on your chest helps keep your baby calm, warm and helps establish breastfeeding. During skin-to-skin contact your baby should wear a hat and be kept warm with a blanket or towel.

• Keep your baby warm: Put a hat on your baby for the first few days while they are in the hospital. Keep your baby in skin contact on your chest, covered with a blanket and look into your baby’s eyes to check their wellbeing in this position. Keep your baby warm with blankets if left in a cot.

• Feed as soon as possible after birth: Ask a member of staff to support you with feeding until you are confident. Make sure you know how to tell if breastfeeding is going well, or how much formula to give your baby.

• Feed as often as possible in the first few days: Whenever you notice “feeding cues”, which include rapid eye movements under the eyelids, mouth and tongue movements, body movements, sounds or sucking on a fist, offer your baby a feed. Don’t wait for your baby to cry as this can be a late sign of hunger.

• Feed for as long, or as much, as your baby wants: To ensure your baby gets as much milk as possible.

• Feed as often as baby wants, but do not leave your baby more than 3 hours between feeds: If your baby is not showing any feeding cues yet, hold them skin-to-skin and start to offer a feed about 3 hours after the start of the previous feed.

• Express your milk (colostrum): If you are breastfeeding and your baby struggles to feed, try to give some expressed breast milk.

A member of staff will show you how to hand express your milk, or watch the UNICEF hand expression video (search “UNICEF hand expression”).

If possible, it is good to have a small amount of expressed milk saved in case you need it later, so try to express a little extra breast milk in between feeds. Ask your midwife how to store your expressed milk.

How can I tell if my baby is well?

The following are signs that your baby is well:

Is your baby feeding well?

In the first few days, your baby should feed effectively at least every 3 hours, until blood glucose is stable, and then at least 8 times in 24 hours.

Ask a member of staff how to tell if your baby is attached and feeding effectively at the breast, or how much formula your baby needs. If your baby becomes less interested in feeding than before, this may be a sign they are unwell and you should raise this with a member of staff.

Is your baby warm enough?

Your baby should feel slightly warm to touch, although hands and feet can sometimes feel a little cooler. If you use a thermometer, the temperature should be between 36.5^oC and 37.5^oC inclusive.

Is your baby alert and responding to you?

When your baby is awake, they will look at you and pay attention to your voice and gestures. If you try to wake your baby, they should respond to you in some way.

Is your baby’s muscle tone normal?

A sleeping baby is very relaxed, but should still have some muscle tone in their body, arms and legs and should respond to your touch.

If your baby feels completely floppy, with no muscle tone when you lift their arms or legs, or if your baby is making strong repeated jerky movements, this is a sign they may be unwell. It can be normal to make brief, light, jerky movements. Ask a member of the team if you are not sure about your baby’s movements.

Is your baby’s colour normal?

A baby’s breathing can be quite irregular, sometimes pausing for a few seconds and then breathing very fast for a few seconds. If you notice your baby is breathing very fast for a continuous period (more than 60 breaths per minute), or seems to be struggling to breathe with very deep chest movements, nostrils flaring or making noises with each breath out, this is not normal.

Who should I call if I am worried?

If you are in the hospital, inform any member of the clinical staff.

At home

• Call your community midwife and ask for an urgent visit or advice.
• Out of hours: Contact Ward 22 on 01642 382722 or NHS 111
• If you are very worried, take your baby to your nearest Paediatric A&E or dial 999.

What happens if your baby’s blood glucose is low?

If the blood glucose test result is low, your baby should feed as soon as possible and provide skin-to-skin contact. If the level is very low, the neonatal team may advise urgent treatment to raise the blood glucose and this could require immediate transfer to the Special Care Baby Unit.

Another blood glucose test will be done before the next feed or within 2 to 4 hours.

If you are breastfeeding and your baby does not breastfeed straight away, a member of staff will review your baby to work out why. If they are happy that your baby is well, they will support you to hand express your milk and give it by oral syringe/finger/cup/spoon.

If your baby has not breastfed, and you have been unable to express any of your milk, you will be advised to offer infant formula.

The team may prescribe a dose of dextrose (sugar) gel as part of the feeding plan because this can be an effective way to bring your baby’s glucose level up.

If you are breastfeeding and advised to give some infant formula, this is most likely to be for a few feeds only.

You should continue to offer breastfeeds and try to express milk as often as possible to ensure your milk supply is stimulated.

Very occasionally, if babies are too sleepy or unwell to feed, or if the blood glucose is still low after feeding, your baby may need to go to the Special Care Baby Unit. Staff will explain any treatment that might be needed. In most cases, low blood glucose quickly improves within 24 to 48 hours and your baby will have no further problems.

Going home with your baby

It is recommended that your baby stays in hospital for 24 hours after birth. After that, if your baby’s blood glucose is stable and feeding is going well, you will be able to go home.

Before you go home, make sure you know how to tell if your baby is getting enough milk. A member of staff will explain the normal pattern of changes in the colour of dirty nappies and number of wet / dirty nappies.

For further information, if you are breastfeeding see ‘How you and your midwife can recognise that your baby is feeding well’ (Search ‘UNICEF Baby Friendly assessment tool’).

There is no need to continue to wake your baby to feed every 2 to 3 hours as long as they have had at least 8 feeds over 24 hours, unless this has been recommended for a particular reason. You can now start to feed your baby responsively. Your midwife will explain this.

If you are bottle feeding, make sure you are not overfeeding your baby. Offer the bottle when your baby shows feeding cues and observe for signs that they want a break. Don’t necessarily expect your baby to finish a bottle, let them take as much milk as they want.

Once you are home, no special care is needed. As with all new-born babies, you should continue to look for signs that your baby is well, and seek medical advice if you are worried at all about your baby.

Comments, concerns, compliments or complaints

Patient Experience Team (PET)

We are continually trying to improve the services we provide. We want to know what we’re doing well or if there’s anything which we can improve, that’s why the Patient Experience Team (PET) is here to help. Our Patient Experience Team is here to try to resolve your concerns as quickly as possible. The office is based on the ground floor at the University Hospital of North Tees if you wish to discuss concerns in person. If you would like to contact or request a copy of our PET leaflet, please contact:

Telephone: 01642 624719

Freephone: 0800 092 0084

Opening hours: Monday to Friday, 9:30am to 4:00pm

Email: [email protected]

Out of hours

Out of hours if you wish to speak to a senior member of Trust staff, please contact the hospital switchboard who will bleep the appropriate person.

Telephone: 01642 617617

Data protection and use of patient information

The Trust has developed Data Protection policies in accordance with Data Protection Legislation (UK General Data Protection Regulations and Data Protection Act 2018) and the Freedom of Information Act 2000. All of our staff respect these policies and confidentiality is adhered to at all times. If you require further information on how we process your information please see our Privacy Notices.

Telephone: 01642 383551

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Leaflet feedback

This leaflet has been produced in partnership with patients and carers. All patient leaflets are regularly reviewed, and any suggestions you have as to how it may be improved are extremely valuable. Please write to the Clinical Governance team, North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, TS19 8PE or:

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