Hypoglycemia – Newborn Complications (Nursing)

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.