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Your guide to neonatal hypoglycaemia

Newborn baby - Neonatal Hypoglycaemia

Neonatal hypoglycaemia (low blood sugar) is always a risk in new born babies and cannot be entirely prevented.  As it can cause devastating and irreversible brain damage, the doctor, midwife or neonatal nurse should monitor the newborn frequently for signs of low blood sugar.

Some babies are at greater risk and so doctors should be alert to:

  • Babies who were premature and have a low birth weight
  • Babies who aresmall or growth restricted
  • Mothers who are diabetic or developed gestational diabetes (glucose intolerance) during pregnancy.

A doctor, midwife or neonatal nurse should also know that the absence of symptoms does not mean that a baby does not have hypoglycaemia.

Reaching a decision to claim for clinical negligence is never easy

Health professionals have a ‘duty of care’ to you and your baby, which should not fall below an expected standard of appropriate care and treatment. We recognise that any claim arising from complications during or after childbirth requires the highest degree of sensitivity, understanding and expert guidance to help you whilst we conduct your case.

Our dedicated team of specialist solicitors has many years of experience in successfully resolving clinical negligence cases. We can help you find out why the system failed to provide the appropriate care at the right time and, crucially, obtain compensation to ensure that the financial needs of your child’s future care and treatment will be properly met.

Neonatal Hypoglycaemia Figures

  • Between one and three in every 1,000 babies born in the UK are affected by neonatal hypoglycaemia. 
  • An estimated 60 negligence claims for babies who suffered brain damage and other complications were caused by a failure to monitor for neonatal hypoglycaemia.       
  • 79 negligence claims for untreated neonatal hypoglycaemia were received by the NHS  

      Litigation Authority in a ten year period up to 2012.                               ( NHS UK, 2012)                                                                                   

What is neonatal hypoglycaemia?

Neonatal hypoglycaemia is caused by low blood sugar or glucose levels, which can arise in the immediate hours and days following a baby’s birth.

What’s the cause?

During pregnancy, a baby receives a continuous supply of glucose from the placenta attached to the lining of the mother’s womb.

While normal healthy adults are very efficient at keeping glucose levels constant, in the immediate period following birth, a baby has to adjust from receiving a continuous supply of glucose to, instead, becoming dependent upon obtaining the necessary level of blood sugar from the mother’s milk or formula milk to top up the glucose produced by the liver.

Most healthy babies adjust to the changed conditions without any problems but others are at risk of developing dangerously low blood sugar levels.

Why do a baby’s glucose levels drop?

Glucose (blood sugar) levels can drop if:

  • Blood contains too much insulin which regulates the glucose level.
  • Not enough glucose is produced
  • More glucose is being used than is being produced
  • Baby not able to feed enough to keep glucose level up.

Other common risk factors

Low blood sugar levels are also more likely because of:

  • Premature birth
  • Low birth weight
  • Smaller in size or growth restricted
  • Birth infection
  • Oxygen needed after delivery
  • Diabetes ( baby is larger than normal)

Other frequently associated conditions  

  • Mother is diabetic or developed gestational diabetes (glucose intolerance) during pregnancy
  • Mother produces too much insulin
  • Poor maternal nutrition during pregnancy
  • Hemolytic (HDN) disease - blood disorder caused by an ‘incompatibility’ between the baby’s blood type and the mother’s blood type. The mother’s antibodies attack the developing baby's red blood cells. 
  • Congenital metabolic diseases - an inherited defect (usually a missing or inadequate enzyme) results in an abnormal metabolism
  • Baby was distressed during birth
  • Cold stress
  • Liver disease.

Symptoms of neonatal hypoglycaemia

Although the symptoms are often quite difficult to recognise and can vary from one baby to another, the more obvious and common symptoms of neonatal hypoglycaemia are:

  • Poor feeding or vomiting
  • Breathing problems, such as pauses, rapid breathing, or  grunting sound   
  • Tiredness, lack of energy
  • Loose or drooping muscles
  • Irritability
  • Agitated, nervous or trembling
  • Difficulty in maintaining normal body temperature
  • Pale or bluish skin

If no symptoms show

Babies with low blood sugar may not display any symptoms at all but this does not mean that neonatal hypoglycaemia is not present.

A baby who shows no symptoms but has one or more risk factors known to cause a low blood sugar level must also be tested for the condition by the hospital natal staff.

Testing for neonatal hypoglycaemia

A doctor and hospital natal staff would be expected to recognise high risk pregnancies and the symptoms of low blood sugar levels in a newborn baby.

While levels will naturally fluctuate as the baby adjusts following birth, the general clinical guideline is that testing should be carried out to ensure the baby maintains its blood sugar levels above the recommended level.

Prevention and treatment are relatively simple and easy:

  • Newborn babies at risk of hypoglycaemia should be monitored using a heel prick blood test every few hours. Blood sugar levels below 50 mg/dL (milligrams/decilitre) will need treatment.
  • Blood tests should continue until the baby's glucose level stays normal for about 12 to 24 hours.

Other possible tests:

  • Screening for metabolic disorders
  • Urine tests

Treating neonatal hypoglycaemia

Treatment for a low blood sugar level can be as simple as early feeding with glucose water, which will raise the blood sugar in otherwise normal babies. Some babies might need to receive an intravenous glucose solution.

The blood sugar level should be carefully and frequently monitored until levels have stabilised and the treatment can be discontinued.

Treatment may depend on the following considerations:

  • Overall health
  • Tolerance to specific treatments
  • Extent of disease
  • Expectations for how disease will progress

What happens if neonatal hypoglycaemia is not detected or treated?

Failure by a doctor, midwife, natal nurse or another clinician to detect and treat hypoglycaemia can lead to serious, irreversible brain damage.

Further serious harm with life-long implications includes:

  • Neurologic damage resulting in problems with mental abilities
  • Recurring seizures
  • Delay in normal development
  • Personality disorders
  • Severe hypoglycaemia may impair cardiovascular function

How Your Legal Friend can help you

As experienced clinical negligence specialists, we know that identifying why complications have arisen may not be straight forward. In some cases, failure to treat hypoglycaemia in a newborn baby was the result of insufficient emphasis placed on breast feeding by midwives attending first time mothers.

From our first conversation and throughout the case, our experienced medical negligence specialists will ensure that the interests of you and your child are put first, whilst we support and guide you through your claim.

Our dedicated team has many years of experience in successfully resolving medical negligence claims. We can help you find out why the system failed to provide the appropriate care at the right time and, crucially, obtain compensation to ensure that your child’s future financial needs are met.