Hypoglycemia – Newborn Complications (Nursing)

by Jacquelyn McMillian-Bohler

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    00:01 Now, let's talk about hypoglycemia.

    00:04 So risk factors for neonatal hypoglycemia include a birthing person who has diabetes.

    00:11 So again, Type 1, Type 2, or gestational diabetes should already be an alarm bell that we need to monitor blood glucose for the newborn immediately after birth.

    00:21 Babies that are large for gestational age.

    00:24 ding, ding, ding exactly right, because one of the reasons why the baby may be large for gestational age is because the birthing person has diabetes.

    00:33 A baby that is small for gestational age, because diabetics can also have babies that are SGA.

    00:39 And babies that are SGA may also have issues with having enough fat stores to stay warm, which could then cause hypoglycemia.

    00:48 Putting all this together.

    00:50 Preterm infants, because they have immature systems across the board and an ability to maintain glucose takes maturity.

    00:59 Hypothermic infants.

    01:00 So infants who are cold may also experience hypoglycemia.

    01:04 And this may just be a part of normal transition.

    01:07 Not that it's normal to be hypoglycemic, but this means that a baby could not have any risk factors at all, and still experience hypoglycemia.

    01:16 Symptoms of hypoglycemia include: hypothermia, being cold; lethargy, where the baby is not particularly active; hypotonia where the baby's flaccid.

    01:27 Remember, we want the baby to look like they're trying to lift some weights in a squat frog, right? So when the baby's flaccid like this, hypoglycemia may be the reason.

    01:37 Poor feeding because infants that have hypoglycemia don't really feel like eating very much, even though that's something they need.

    01:45 An infant experiencing hypoglycemia may also appear jittery.

    01:50 It's important to differentiate jitteriness from a Moro reflex.

    01:55 So a Moro reflex, also called the startle reflex will usually be a quick jerky movement that ends.

    02:02 Jittery tends to go on. It tends to last.

    02:05 And it's not usually in response to any sort of stimuli.

    02:09 It can be, but not usually.

    02:12 The baby may also be tachypnic or experience some episodes of respiratory distress.

    02:17 So looking for rapid breathing, nasal flaring, chest retractions, any of those things.

    02:24 Remember, they go together.

    02:26 And also any seizure activity.

    02:28 So if a baby is hypoglycemic, they may have a seizure.

    02:32 So one of the things that you're going to do postictal will be to check blood sugar.

    02:37 In terms of assessment, we want to check all the vitals.

    02:42 So that's respiratory, heart rate, blood pressure, everything.

    02:47 We also want to check the labs.

    02:49 We've discussed blood glucose assessment, but we also may need to check the baby for sepsis.

    02:55 Treatment for neonatal hypoglycemia will depend on two things.

    02:59 First, the blood glucose level.

    03:01 And second, the newborns ability to eat or feed.

    03:05 The exact values for treatment levels is going to vary by facility to facility.

    03:10 So make sure you know the protocols when you step into that newborn nursery.

    03:14 But in general, we'll start with feeding the infant.

    03:17 So getting the baby to the breast, or giving the baby a bottle is going to be a frontline treatment.

    03:23 And then if that's not effective, we'll move on to dextrose gel.

    03:27 And if that's not effective, then we'll move on to IV glucose as a way to get that glucose into the body as quickly as possible.

    03:36 While we're supporting the baby's blood glucose, we don't want to neglect any of the other systems.

    03:41 Remember, these things happen together.

    03:44 So we want to monitor for the need for respiratory support.

    03:47 So this can include the nasal cannula or the Neopuff depending on what's needed.

    03:53 Prevention of neonatal hypoglycemia is also an important thing to consider.

    03:58 Since all babies are at risk for hypoglycemia.

    04:00 This is something that all nurses should do for every baby.

    04:04 Making sure that we provide thermoregulation support.

    04:07 So that means watching out for those four areas of heat loss and making sure the baby stays warm.

    04:13 We also want to make sure that baby feeds within the first hour of life.

    04:17 Why? Because that helps to maintain the blood sugar.

    04:21 And finally making sure that skin to skin is initiated.

    04:24 I cannot stress enough how important that it is that we get the baby to skin.

    04:30 Whether it's the birthing person or someone else that golden hour is truly a golden thing.

    About the Lecture

    The lecture Hypoglycemia – Newborn Complications (Nursing) by Jacquelyn McMillian-Bohler is from the course Newborn Complications (Nursing).

    Included Quiz Questions

    1. LGA
    2. SGA
    3. Hypothermia
    4. AGA
    5. MGA
    1. Dextrose gel
    2. IV glucose
    3. Feed the newborn
    4. Bathing
    5. Normal saline bolus

    Author of lecture Hypoglycemia – Newborn Complications (Nursing)

     Jacquelyn McMillian-Bohler

    Jacquelyn McMillian-Bohler

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