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What is low blood glucose?
You have been given this leaflet because your baby is at increased risk of having low blood glucose (also called low blood sugar or hypoglycaemia). Babies who are small, premature, unwell at birth, or whose mothers are diabetic or
have taken certain medication (beta-blockers), may have low blood glucose in the first few hours and days after birth, and it is especially important for these babies to keep warm and feed as often as possible to maintain normal blood glucose levels. If your baby is in one of these 鈥渁t risk鈥� groups, it is recommended that 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鈥檚 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 in skin-toskin contact. The first blood test should be done before the second feed (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 straight away.
How to avoid low blood glucose
鈥� Skin-to-skin contact
Skin-to-skin contact with your baby on your chest helps keep your baby calm and warm and helps establish breastfeeding. Lie in a position where your head and shoulders are raised (not flat on your back). Have baby in a position where you can look into their eyes and you can check that baby is well in this position.
鈥� Keep your baby warm
During skin-to-skin contact your baby should wear a hat and be kept warm with a blanket or towel. Once you go home from hospital your baby will no longer need to wear a hat indoors. If your baby is in a cot keep baby warm with blankets.
鈥� 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 how much formula to give your baby.
鈥� Feed as often as possible in the first few days
Whenever you notice 鈥渇eeding cues鈥� which include rapid eye movements under the eyelids, mouth and tongue movements, body movements and sounds, sucking on fist, offer your baby a feed. Don鈥檛 wait for your baby to cry 鈥� this can be a late sign of hunger.
鈥� Feed for as long, or as much, as your baby wants.
To ensure your baby gets as much milk as possible. Feed as often as baby wants, but do not leave your baby more than 3 hours between feeds. If your baby is not showing any feeding cues yet, hold him/her skin-to-skin and start to offer a feed about 3 hours after the start of the previous feed. Your midwife will talk toyou about when you can move to responsive feeding.
鈥� 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 watch the UNICEF hand expression video (Hand expression video - BabyFriendly Initiative (unicef.org.uk)). 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 breast milk in between feeds. Ask your midwife how to store your聽 expressed milk.
Don鈥檛 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 he / she is well, but 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 parents鈥� instincts are often correct.
The following are signs that your baby is well:
鈥� Is your baby feeding well?
In the first few days your baby should feed effectively at least every 3 hours, until 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, or how much formula he / she needs. 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.
鈥� 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 36.5c鈦� and 37.5 c inclusive.聽
鈥� Is your baby alert and responding to you?
When your baby is awake, he/she 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.
鈥� Is your baby鈥檚 muscle tone normal?
A sleeping baby is very relaxed but should still have some muscle tone in their body, arms and legs and should 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鈥檚 movements.
鈥� Is your baby鈥檚 colour normal?
Look at the colour of the lips and tongue 鈥� they should be pink.
鈥� Is your baby breathing easily?
Babies鈥� 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) seems to be struggling to breathe with very deep chest movements, nostrils flaring or making noises with each breath out 鈥� this is not normal.
Who to call if you are worried
鈥� In hospital, inform any member of the clinical staff.
鈥� At home, call you GP or community midwife (office hours)
鈥� Out of hours, call NHS 111or attend an out of hours GP service.
鈥� If you are really worried, take your baby to your nearest A&E or dial 999.
What happens if your baby鈥檚 blood glucose is low?
鈥� If the blood glucose test result is low, your baby should feed as soon as possible and be kept warm 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.
鈥� If your baby has no other symptoms and is well the midwife will consider giving your baby a small dose of oral dextrose (glucose) gel as part of the feeding plan because this can be an effective way to bring your baby鈥檚 glucose level up.
鈥� If you are breastfeeding and advised to give some infant formula, this is mostlikely 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. Another blood glucose test will be done before the next feed or within 2-4 hours. If 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, you can be supported to hand express your milk and give it to your baby. If your
baby has not breastfed, and you have been unable to express any of your milk, you may be advised to offer infant formula. Very occasionally, if babies are too sleepy or unwell to feed, or if the blood glucose is still low after feeding, he / she may need to go to the Neonatal 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 your baby
It is recommended that your baby stays in hospital for 24 hours after birth. After that, if your baby鈥檚 blood glucose is stable and he / she is 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. It is important to make sure that your baby feeds well at least 8 times every 24 hours and most babies feed more often than this. There is no need to continue waking your baby to feed every 2鈥�3 hours as long as baby has had at least 8 feeds over 24 hours, unless this has been recommended for a particular reason. You can now start to feed your baby responsively. This means feeding you baby when they display
feeding cues / signs of hunger, as well as feeding when your breasts feel full, your baby is distressed or in need of comfort or to comfort and relax yourself. You cannot overfeed a breastfed baby.If you are bottle feeding, offer the bottle by the paced feeding method (this will be explained / demonstrated to you) when baby shows feeding cues and observe for signs that baby wants a break or has had enough. Don鈥檛 expect your baby to finish a bottle 鈥� let baby take as much milk as he/she wants. Once you are home, no special care is needed. As with all newborn babies, you
should continue to look for signs that your baby is well and seek medical advice if you are worried at all about your baby. Our Maternity & Neonatal Information Leaflets for parents and service users are reviewed regularly by parents
and service users.聽