What is the treatment for a 2-day-old baby with poor suckling and hypoglycemia (Random Blood Sugar (RBS) of 78 mg/dl)?

From the Guidelines

For a 2-day-old baby with poor suckling and a blood glucose level of 78 mg/dL, immediate intervention with glucose treatment is not required as this glucose level is above the threshold for hypoglycemia (<70 mg/dL) as per the standards of care in diabetes-2023 1. The primary approach should be to encourage frequent breastfeeding every 2-3 hours or formula feeding if breastfeeding is not possible. Ensure proper latching technique and consider consulting a lactation specialist if suckling difficulties persist. Monitor the baby's blood glucose levels before feeds, aiming to maintain levels above 54 mg/dL, which is the threshold for level 2 hypoglycemia as defined in the study 1. If the baby continues to have poor suckling but maintains normal glucose levels, consider feeding expressed breast milk or formula via alternative methods such as cup feeding, finger feeding, or in some cases a nasogastric tube. Some key points to consider in the management of this baby include:

• Poor suckling in a newborn can be due to prematurity, jaundice, infection, or neurological issues, so further evaluation may be necessary if the problem persists.
• Dehydration and weight loss should be monitored closely, with a goal of limiting weight loss to less than 10% of birth weight.
• The current glucose level of 78 mg/dL is reassuring, but continued monitoring is important due to the poor suckling, which could potentially lead to hypoglycemia if feeding intake remains inadequate, and according to the study 1, glucose levels <70 mg/dL should be treated with approximately 15–20 g of glucose. It is essential to note that the baby's glucose level is currently not in the hypoglycemic range, and therefore, treatment with glucose is not necessary at this time, but rather addressing the poor suckling and ensuring adequate nutrition is the priority.

From the FDA Drug Label

When administered intravenously this solution restores blood glucose levels in hypoglycemia and provides a source of carbohydrate calories. The baby's RBS is 78 mg/dl, which may be considered low for a 2-day-old baby, but the treatment for poor suckling with this RBS level is not directly stated in the label.

• The label does mention that dextrose injection restores blood glucose levels in hypoglycemia.
• However, the label does not provide a specific treatment guideline for a 2-day-old baby with poor suckling and RBS 78 mg/dl. Given the information, a conservative clinical decision would be to consider the baby's RBS level and poor suckling, but the FDA label does not provide direct guidance for this specific scenario 2.

From the Research

Treatment for Poor Suckling with Low Blood Sugar in a 2-Day-Old Baby

• The baby's condition with poor suckling and a blood sugar level of 78 mg/dl requires immediate attention to prevent further complications.
• According to the study 3, dextrose 10% (D10) may be as effective as dextrose 50% (D50) in resolving symptoms and correcting hypoglycemia, with fewer adverse events.
• However, the study 3 also notes that the desired effect of D10 may take several minutes longer to achieve, and there may be a greater need for subsequent doses.

Feeding Problems in Infants with Congenital Hyperinsulinism

• The study 4 discusses the use of continuous intragastric dextrose (IGD) as a therapeutic option for refractory hypoglycemia in congenital hyperinsulinism.
• The study 4 found that IGD was well-tolerated, with no change in weight-for-length or body mass index Z-scores over a median follow-up of nearly 1 year.
• However, the study 4 does not provide direct guidance on the treatment of poor suckling with low blood sugar in a 2-day-old baby.

Blood Glucose Levels Following Gastrostomy Tube Insertion

• The study 5 investigated variations in blood glucose levels following gastrostomy tube insertion in a pediatric population.
• The study 5 found that hyperglycemia was common, especially in the group that received glucagon, and hypoglycemia rarely occurred.
• However, the study 5 does not provide direct guidance on the treatment of poor suckling with low blood sugar in a 2-day-old baby.

Glycemic Control During Enteral Tube Feeding

• The study 6 assessed glycemic control in patients with diabetes during enteral tube feeding.
• The study 6 found that despite adequate adherence to guidelines, the target glycemic range was achieved in only 40% of cases.
• The study 6 emphasizes the importance of early involvement of the diabetes inpatient specialist nurse and proactive dose up-titration of insulin to improve glycemic control.

Effects of Glucose Therapy Agents on Enteral Tube Flow

• The study 7 determined the effect of glucose therapy agents (apple juice, orange juice, and cola) on enteral tube flow and patency.
• The study 7 found that apple juice and cola had higher average flow rates than orange juice, and polyethylene tubes had higher average flow rates than silicone tubes.
• However, the study 7 does not provide direct guidance on the treatment of poor suckling with low blood sugar in a 2-day-old baby.