Checking blood glucose in newborn babies

What is blood glucose?

One of your baby’s most important sources of energy is sugar, in particular, a type of sugar
called ‘glucose’.

Glucose is carried to every cell in the body by the circulation of blood. Healthy babies keep
themselves well supplied with energy by keeping their blood glucose levels within a normal,
safe range.

Why is blood glucose important to my newborn baby?

A good supply of food energy, particularly glucose, is important for normal activity, growth
and development.

In rare cases, blood glucose levels can fall too low and a baby may become unwell. When a
baby is unwell, the blood glucose level should be checked without delay. The concern is that
long periods of low blood glucose in a sick baby may cause brain damage.

Where do babies get their glucose from?

In the uterus (womb), babies get glucose from their mother through the placenta and
umbilical cord. Some glucose is used immediately as energy and some is stored in
preparation for birth. Newborn babies are able to make glucose from these stores. In this way,
healthy, well-grown babies keep their blood glucose levels normal for the first few days of
life and until they are feeding well.

Once a supply of breastmilk is established (usually by the baby’s third day of life), milk
becomes the main source of sugar for the baby. The lactose sugar in milk is converted to
glucose in the body. In addition to using sugar from milk for activity and growth, your baby
will again store sugar to avoid low blood glucose between feeds.

Why is blood glucose low in some babies?

Another name for low blood glucose is ‘hypoglycemia’. In healthy babies, blood glucose
levels are lowest at 1 hour to 2 hours of age, while the baby gets used to being outside the
womb; in most cases, blood glucose levels will rise after this, using healthy sugar and fat
stores.

Small and preterm babies may not have enough stores to keep the blood glucose level up
without extra feedings.

In babies whose mothers have diabetes, the hormone imbalance makes them unable to use
their glucose stores when they need them and blood sugar may not rise after 1 hour to 2 hours
of life. Babies who are large for their gestational age (or ‘large-for-dates’) may have similar
difficulties.
The low blood glucose level (or ‘hypoglycemia’) commonly found in newborn babies usually
lasts for a few hours or days; once the glucose levels are restored, your baby should not have
hypoglycemia at an older age. Very rarely, low blood sugar can be severe or last a long time,
in which case, special tests are done to look for unusual causes.

Do all babies need blood glucose checks?

Healthy babies born at full term do not need blood glucose checks. They have enough stored
energy to last them until breastfeeding is well-established – usually by the third day of life.

Babies who are not well need blood glucose checks in addition to the tests that are required
for their illness.

Some babies are more likely to have low blood glucose in the first few hours or days of life.
The following babies need routine glucose checks starting at about 2 hours of age:

 preterm babies born more than three weeks before they are due, including babies who
are born at 36 weeks’ gestation or less;
 babies who are small for their gestational age (or ‘small-for-dates’), particularly, if
their growth was poor in the last few weeks of pregnancy;
 babies whose mothers had diabetes during or before pregnancy;
 babies who are large for their gestational age (‘large-for-dates’); and
 babies with rare medical conditions that cause low blood glucose.

How will my baby’s blood glucose be checked?

Blood glucose can be checked with just a few drops of blood, usually taken from your baby’s
heel.

If your baby is in one of the above at-risk groups and is well, blood glucose will be checked
at 2 hours of age and then again before your baby feeds, about three to five times during the
first and second days of life.

What is the normal level of blood glucose in a baby?

Blood glucose is measured in ‘millimoles’ per litre (mmol/L).

Blood glucose levels change with age and are usually lower in newborn babies than in older
children and adults.

When babies are just 1 hour to 2 hours old, the normal level is just under 2 mmol/L, but it
will rise to adult levels (over 3 mmol/L) within two to three days. In babies who need
treatment for low blood glucose or are at risk for low blood glucose, a level over 2.5 mmol/L
is preferred.

Why is low blood glucose dangerous to babies?

If a baby is already sick with low blood glucose, especially if low blood glucose lasts for
several hours, there may be a risk of long-term problems with development or learning.
How can I prevent low blood glucose in my baby?

The most natural and important way to feed your baby and maintain a normal blood glucose
level is early and regular breastfeeding. Talk to your health care provider before you start
using breastmilk substitutes (formula or glucose water).

It is important to know if your baby has one of the risk factors for low blood glucose listed
above. If you have diabetes, good control throughout your pregnancy and during labour is
also important. It is very important not to smoke during pregnancy because babies do not
grow well when exposed to tobacco and its byproducts.

What can be done if my baby has low blood glucose levels?

Your baby should be examined to check that there is no sign of illness and that the cause of
the low glucose level is not serious.

Your baby will need extra feeding if the blood glucose doesn’t rise on its own. The extra
feeds may be given as

1.extra feeds from the breast;

2.extra feeds of expressed breastmilk or formula; or

3.Extra feeds of glucose water (or ‘dextrose water’).

If extra feeds do not raise the blood glucose level, intravenous treatment (through a needle or
‘canula’) will be needed.

For how long might blood glucose checks or additional treatment be

required?

Blood glucose levels in babies usually become normal within 12 hours to 72 hours of birth,
especially once a regular feeding pattern is established. The risk of low blood glucose is
greatest in the first 12 hours of life in large-for-dates and full-term babies, and up to 36 hours
of life in small-for-dates and preterm babies.

It is rare for babies to continue to have difficulty maintaining their blood glucose levels. If
this happens beyond 24 hours, speak with your baby’s doctor.

For more information on your baby’s growth and development, visit

<www.caringforkids.cps.ca>.
REFERENCES

1. Oxford Centre for Evidence-Based Medicine Levels of evidence and grades of

recommendation<www.cebm.net/levels_of_evidence.asp#levels> (Version current at
November 9, 2004).

2. Behrman RE, Kliegman R, Jenson HB. Nelson Textbook of Pediatrics. 16th edn.
Philadelphia: WB Saunders Company; 2000. pp. 533–4.

3. Sinclair JC. Approaches to the definition of neonatal hypoglycemia. Acta Paediatr

Jpn. 1997;39(Suppl 1):S17–20. [PubMed]

4. Srinivasan G, Pildes RS, Cattamanchi G, Voora S, Lilien LD. Plasma glucose values in
normal neonates: A new look. J Pediatr. 1986;109:114–7. [PubMed]

5. Hoseth E, Joergensen A, Ebbesen F, Moeller M. Blood glucose levels in a population of

healthy, breast fed, term infants of appropriate size for gestational age. Arch Dis Child Fetal
Neonatal Ed. 2000;83:F117–9. [PMC free article] [PubMed]

6. Diwakar KK, Sasidhar MV. Plasma glucose levels in term infants who are appropriate size
for gestation and exclusively breast fed. Arch Dis Child Fetal Neonatal Ed. 2002;87:F46–
8. [PMC free article] [PubMed]

7. Nicholl R. What is the normal range of blood glucose concentrations in healthy term
newborns? Arch Dis Child. 2003;88:238–9. [PMC free article] [PubMed]

8. Koivisto M, Blanco-Sequeiros M, Krause U. Neonatal symptomatic and asymptomatic

hypoglycaemia: A follow-up study of 151 children. Dev Med Child Neurol. 1972;14:603–
14. [PubMed]

9. Lucas A, Morley R, Cole TJ. Adverse neurodevelopmental outcome of moderate neonatal

hypoglycaemia. BMJ. 1988;297:1304–8. [PMC free article] [PubMed]

10. Pildes RS, Cornblath M, Warren I, et al. A prospective controlled study of neonatal
hypoglycemia. Pediatrics. 1974;54:5–14. [PubMed]