Information Please: Routine Supplements And Hypoglycemia In The Newborn

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Information Please: ROUTINE SUPPLEMENTS AND HYPOGLYCEMIA IN THE NEWBORN

Occasionally trends develop in breastfeeding management or hospital policy that interfere with breastfeeding. One such trend is labeling newborns over a certain weight (such as eight pounds) hypoglycemic and ordering routine glucose water supplements.

Hypoglycemia -- or low blood sugar -- often occurs without symptoms in the newborn. However, it may cause jitteriness or shaking, and if severe, convulsions or coma. Several possible causes of hypoglycemia are: a long, difficult labor, toxemia, maternal diabetes, or glucose given to the mother intravenously during labor and delivery. Hypoglycemia in a newborn is defined as blood glucose levels of less than 30 mg/dl in a full-term baby and less than 20 mg/dl in a premature or low-weight gain baby.

Several studies have demonstrated that newborns at risk for hypoglycemia benefit from immediate breastfeeding and continuous contact with mother. Newborns can receive the fluids and calories they need when they are allowed to breastfeed unrestrictedly from birth (typically ten to twelve feedings every twenty-four hours), which is preferable to giving supplements for several reasons.

- Babies who receive artificial topples during the first few weeks of life -- while they are still learning to breastfeed -- are at risk of becoming "nipple confused," causing some babies to refuse the breast or to breastfeed less effectively.

- Supplemental feedings fill up a baby, making him or her less interested in nursing. Less frequent nursings can contribute to newborn jaundice in the baby and painful engorgement in the mother.

- When routine supplements are given in the hospital, the mother receives the unspoken (and incorrect) message that her milk alone is not enough for her baby. Many mothers assume that once home their babies will continue to need supplementary water, often resulting in a quick end to breastfeeding when the baby becomes nipple confused and or the mother's milk supply diminishes.

As Ruth Lawrence, MD. says in her book, Breastfeeding: A Guide for the Medical Profession, "When lactation is going well [supplements are] not needed, and when it is not going well, a bottle may aggravate the problem...Giving a...bottle may confuse a new infant, who may be having trouble sucking at first. Infants who are given water or glucose water in the hospital do less well and usually lose more weight. There is a significant relationship between supplements in the hospital and early discontinuation of breastfeeding."

If hypoglycemia is a serious concern, rather than routinely supplementing all babies who are at risk, doctors on LLLI's Health Advisory Council recommend first using Dextrostix to test their urine at regular intervals during the first tour hours of life. If the glucose levels drop below borderline, a blood glucose test needs to be done. If the results are below 20 mg/dl, the baby needs intravenous fluid and glucose, not glucose supplements by mouth.

It would be wise for a pregnant woman to ask her baby's health-care provider some questions below birth to help breastfeeding get off to a good start.

- Are routine supplements (water or formula a regular part of his or her newborn care? (If so, the mother may request written orders for no supplements and take these orders with her when she gives birth.)

- How is newborn jaundice treated? (In most cases, breastfeeding does not need to be interrupted and supplements will only make the jaundice worse.) For more information, see pp. 286-290 of THE WOMANLY ART OF BREASTFEEDING.

- How does he or she feel about breastfeeding on cue? (Scheduling feedings can decrease a mother's milk supply and result in a slower weight gain in the baby.)

One more question she can add to her list is how the hypoglycemic (or potentially hypoglycemic) baby is treated. By discussing these issues before birth, a mother can avoid any surprises during her baby's early days and help lay the groundwork for breastfeeding to go more smoothly.

REFERENCES

Gentz, J. et al. on the diagnosis of symptomatic neonatal hypoglycemia. Acta Paediatr Scand 1969: 58:449-59.

Lawrence, R. Breastfeeding: A Guide for the Medical Profession. 3rd ed. St. Louis: Mosby: 1989, p. 212.

Mohrbacher, N. and J. Stock. THE BREASTFEEDING ANSWER BOOK. Franklin Park, Illinois: Le Leche League International, 1991. pp. 18-19.

Pagleara, A. et al. Hypoglycemia in infancy and childhood, part I. J Pediatr 1973: 82:365-79.

Smallpiece, V. and P. Davies. Immediate feeding of premature infants undiluted breastmilk. Lancet 1964: 2:1349.

La Leche League International, Inc.

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By Judy Minami

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