Neonatal hypoglycaemia

Neonatal hypoglycaemia is a condition where a newborn baby’s blood sugar falls to a very low level, which if not recognised, monitored and treated, can leave the child with permanent brain damage.

We spoke recently with Catherine Bell, a Senior Associate within the clinical negligence department of Brain Injury member law firm, Freeths to find out more about this condition.

What is neonatal hypoglycaemia?

Hypoglycaemia means low glucose levels or low blood sugar. The human body produces insulin to remove glucose from our blood by converting it into glycagen that can be stored in the liver. If the amount of insulin produced is more than is needed or if there is not enough glucose being taken into the body then blood sugar levels will fall. If blood sugar levels fall too low then not enough glucose reaches the brain and other organs which can impair growth and cause cells (including brain cells) to start to die.

Neonatal hypoglycaemia is a condition where a baby’s blood sugar falls to a very low level within the first few days after they are born. Once a baby is born and the umbilical cord has been cut, the baby no longer receives a supply of glucose from their mother so they need to maintain their blood sugar levels through feeds or be given medication to help them do so. As a result it is normal for blood sugar to fall after birth and then return to a normal balance after feeding is established.

If it is normal for blood sugar to fall after birth, why, in some cases, does this cause a risk of brain damage?

If risk factors or symptoms are not recognised and the baby’s blood sugar levels are not monitored and adequately restored then the baby can suffer permanent brain damage leaving them with significant lifelong neurological disabilities, seizures, or global developmental delay. This has life changing consequences for both the child and their family.

Babies whose mothers have diabetes or who develop gestational diabetes in pregnancy are at a higher risk of neonatal hypoglycaemia, particularly where their mother has been taking insulin. It is recommended that these babies be born in hospital and that they are feed within 30 minutes of birth. They should have their blood sugar checked within 2 to 4 hours of birth and may require further monitoring and treatment to top-up glucose levels to ensure that they have stabilised at an appropriate level before the baby is discharged from hospital.

Specific risk factors for neonatal hypoglycaemia also include intra-uterine growth restriction, prematurity, low birth weight (e.g. below 2.5kg), a prolonged labour, mothers who have taken beta-blockers during pregnancy, low temperature or hypothermia, and infection (including sepsis) or respiratory problems after birth (including from meconium aspiration). However, any baby who is not feeding properly, for example a baby who is not waking for feeds, not sucking properly, or who seems to be demanding feeds very frequently, is potentially at risk.

The most accurate way to diagnose hypoglycaemia is with a blood test, usually with a pin prick to the baby’s heel, in the first 24 hours of life or earlier in babies with known risk factors. Medical treatment may be required if blood sugar is tested at below 1.0mmol/l at any time (severe hypoglycaemia), below 2.0mmol/l with symptoms present, or if there is more than one reading of below 2.0mmol/l in a baby with a risk factor for hypoglycaemia.

What are the symptoms of neonatal hypoglycaemia?

Symptoms of hypoglycaemia in a young baby may include:

  • Cyanosis: a bluish skin colour
  • Difficulty breathing
  • Decreased muscle tone
  • Irritability, jitteriness or grunting
  • Very sleepy, pale, floppy or listless appearance
  • Vomiting
  • Tremors, shaking or seizures

These symptoms are extremely serious and require urgent medical attention.

How do doctors treat babies at risk?

If feeding the baby with milk or formula is not sufficient to restore blood sugar levels, then treatment for neonatal hypoglycaemia will involve measures to increase blood sugar by feeding the baby glucose gel, by passing glucose through a nasogastric tube directly into the baby’s stomach or by introducing intravenous glucose through a drip directly in to the blood. If a baby’s blood sugar levels do not respond to treatment then further investigations are likely to be required to identify whether the baby has an underlying medical condition.

When may there be cause for concern about care received?

If there has been a delay in recognising the condition and delays in treating low blood sugar levels whether in hospital or in the community, it may be possible to bring a claim for negligence against the hospital.

Examples of when a claim may arise include:

  • failure to recognise weight loss or other indications of feeding problems that are preventing the baby from taking in sufficient glucose;
  • failure to provide sufficient information to help parent’s recognise feeding or other issues themselves and seek medical advice;
  • failure to diagnose gestational diabetes or other risk factors during pregnancy, so that appropriate precautions can be taken to monitor the baby;
  • failure to commence or conduct appropriate monitoring in a baby with known risk factors;
  • failure to detect or recognise low blood sugar in a baby with known risk factors;
  • failure to treat low blood sugar appropriately and without delay;
  • discharging a baby with risk factors or who exhibits abnormal feeding behaviour too early without insuring that feeding is sufficient to maintain blood glucose or without an adequate assessment that would have detected abnormal neurological signs.

Neonatal hypoglycaemia is thankfully rare and these claims can be very complex, particularly if the baby has an underlying condition, so it is important to seek specialist legal advice from a clinical negligence solicitor who has experience dealing with this type of claim.

In cases where it can be established that negligence has occurred and that this caused the baby to suffer a brain injury as a result of hypoglycaemia, then bringing a claim for compensation can provide resources for care, support in education, therapy, treatment, equipment and suitable accommodation to fully meet their needs, provide them and their families with security and peace of mind for the future.

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How can Brain Injury Group help?

If you have concerns about the care your newborn baby has received, our member law firms will be able to talk to you about the next steps which may be open to you – initial advice is free with no obligation. Visit our “Find a brain injury solicitor” section to find your local member, or email [email protected]. All member law firms have met our strict membership criteria, which ensures they are true specialists in the field of brain injury.

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About Catherine Bell

Catherine Bell is a Senior Associate within the clinical negligence team at Freeths LLP who have offices in Oxford, Leicester, Derby, Nottingham, Milton Keynes and Birmingham.

She specialises in brain injury claims and has considerable experience representing both children and adults who have suffered brain damage as a result of medical treatment including claims involving strokes, hypoxia (lack of oxygen), negligent treatment with drugs or anaesthetic, surgical negligence and birth injuries.

Catherine regularly represents children suffering from cerebral palsy as a result of birth injuries or negligent neonatal care. She also handles a broad range of other clinical negligence claims including obstetric injuries.

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