What Is Neonatal Hypoglycaemia?
In normal healthy people low blood sugar is extremely uncommon as the body is very good at keeping glucose levels constant in all but the most severe conditions. However, this is not so in the newborn, when the baby has to adapt to a fluctuating supply of glucose (from feeding) rather than a continuous supply from the mother via the placenta. Most healthy babies will adjust to this change without any problems but there are certain babies who are at risk of developing dangerously low blood sugar levels, which if undetected and/or treated can lead to serious brain damage. This condition is known as neonatal hypoglycaemia These babies should have their blood sugar levels closely monitored during the first few days of life.
Risk factors are:-
- Prematurity
- Illness
- Small for gestational age
- Hypothermia
- Asphyxia at birth
- Diabetic mother
There is much debate about what constitutes normal blood sugar in the newborn as levels naturally fluctuate during this period but there appears to be a consensus that there is little to be gained from screening all newborns. However, the general view seems to be that blood sugar levels should be maintained at 2.6mmol/l or above.
The clinical signs and symptoms can be quite difficult to recognise as they are often subtle and vary from one infant to another. However this condition should be considered if a baby has some or all of the following:-
- Lethargy
- Listlessness
- Poor feeding
- Jitteriness
- Trembling
- Difficulty maintaining normal body temperature
Medical Negligence Case: Undetected Neonatal Hypoglycaemia
Eddie Jones recently negotiated a structured settlement of £4.5 million for a 9-year-old boy who had sustained extensive brain damage soon after birth due to severe low blood sugar.
RC was born at 36 weeks gestation with a birth weight of 1.95kg, well below the average for a baby of that degree of prematurity. Despite this he was in good condition at birth with high apgar scores. His blood sugar was checked soon after birth and again the following morning. On both occasions it was within the normal range (ie 2.6 mmol/l or above). However, it was not checked again for the next 46 hours despite both prematurity and low birth weight both being risk factors for hypoglycaemia. Although initially RC was feeding well he gradually became increasingly lethargic and reluctant to feed and on several occasions had to be tube fed. The midwives became concerned and transferred him to the Special Baby Care Unit where eventually his blood sugar level was checked again and found to be so low it was unrecordable. By this time RC had sustained irreversible brain damage. RC now has severe learning difficulties, behavioural problems and visual impairment and he will require 24-hour care for the rest of his life. The settlement was agreed after long negotiations with the NHS Trust who eventually confirmed that liability would not be disputed.
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