Protecting your baby from low blood glucose

What is low blood glucose?

Babies who are small, premature, unwell at birth, or whose mothers are diabetic or have taken certain medication (such as beta-blockers), are more at risk of a low blood glucose in the first few hours and days after birth. Therefore, 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 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 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 (no later than 2-4 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 within a few minutes

How to avoid low blood glucose

Safe skin to skin contact – Skin to skin contact with your baby on your chest helps keeps baby calm, warm and helps establish breastfeeding. During skin to skin contact ensure your baby’s nose and mouth is clear and their airway open.

Keep baby warm – Place a hat on your baby whilst they remain ‘at risk’. During skin to skin contact place a warm towel or blanket over you both. If baby is placed in a cot, ensure they are kept warm with blankets or towels, ensuring they do not cover baby’s face.

Feed as soon as possible after birth – Ask a member of staff to support you with feeding until you are confident and make sure you know how to tell if breastfeeding is going well, or if you are formula feeding how much milk to give.

Feed as often as possible in the first few days – Whenever you notice ‘feeding cues’ which include rooting or sucking on fingers, baby opening their mouth or turning their head, offer a feed. Don’t wait for your baby to cry—this can be a late sign of hunger.

Feed for as long, or as much, as your baby wants but do not leave your baby more than 3 hours between feeds whilst your baby remains ‘at risk’ – This ensures your baby gets as much milk as possible. 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 you can watch the UNICEF hand expressing 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 breastmilk in between feeds. Ask your midwife how to store your expressed milk.

Don’t hesitate to tell staff if you are worried about your baby – If your baby appears to be unwell, this could be a sign that they have low blood glucose. As well as doing blood tests, staff will observe your baby to check they are well however your observations are also important, as you are with your baby all
the time so know your baby best. It is important that you tell staff if you are worried that there is something wrong with your baby, as parent’s instincts are often correct.

The following are signs that your baby is well:

Is your baby feeding well? – In the first few days your baby should be encouraged to feed effectively at least every 3 hours, until the 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 (remember breastfeeding
should not be painful) or how much milk they should be consuming if they are formula feeding. 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.

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 will still have some muscle tone in their body, arms and legs and will 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? – Look at the colour of the lips and tongue – they should be pink.

Is your baby breathing easily? – Babies’ 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 to call if you are worried

In 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, call NHS 111 or contact the Maternity unit (the number will be on the front of your handheld postnatal notes).
If you are really worried, take your baby to your nearest A&E or dial 999.

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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, ideally in 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 Neonatal Unit.

Depending on the blood glucose result, 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.
Another blood glucose test will be done before the next feed or within 2-4 hours.
lf 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 baby has not breastfed, and you have been unable to express any of your milk, you will be advised to offer infant formula.
If you are breastfeeding and advised to give some infant formula, this is most likely to be for one or 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, they may need to go to the Neonatal Unit / Special Care Baby Unit. Staff will explain any treatment that might be needed. In most cases, low blood glucose quickly improves within 24-48 hours and your baby will have no further problems.

Going home with 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 they are feeding 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, search ‘UNICEF Baby Friendly assessment tool’.
It is important to make sure that your baby feeds well at least 8-10 times in 24 hours however most babies feed more often than this.
There is no need to continue waking your baby to feed every 2-3 hours, as long as they have had at least 8-10 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 they show feeding cues and observe for signs that they wants a break. Don’t necessarily expect your baby to finish a bottle – let them take as much milk as they wants.
Once you are home, no special care is needed. As with all newborn babies, you should continue to look for signs.