The American Academy of Pediatrics, the Academy of Breastfeeding Medicine, the Canadian Paediatric Society and other major health organizations recommend newborn hypoglycemia screening based on risk factors, the most common being birth parent with diabetes, preterm birth, and small or large for gestational age (SGA, LGA). Studies on the neurocognitive outcomes among newborns exposed to transient (not severe or prolonged) hypoglycemia are mixed, with a most recent large study showing no negative neurocognitive outcomes at later ages.
According to the authors of this week’s study, there are downsides to newborn hypoglycemia screening including a delay in breastfeeding while waiting for test results, infant pain, and parental anxiety about feeding inadequacy. Although it has been assumed that newborn hypoglycemia screening has a negative impact on exclusive breastfeeding rates, the evidence has not been strong, so the authors of this study sought to compare exclusive breastfeeding rates at 24 hours in unscreened newborns with those of euglycemic newborns screened for hypoglycemia.
This is a retrospective cohort study of 10,965 healthy newborns between Feb 2018 and June 2018 at Hospital Montfort in Ottawa. The hospital performed routine hypoglycemia screening among infants of diabetic birthing parents, LGA, SGA, and infants with clinical signs such as jitteriness. ‘Inadequate breastfeeding’ was also considered a risk factor for hypoglycemia. The study compared exclusive breastfeeding rates at 24 hours among newborns who underwent hypoglycemia screening vs those who didn’t, and excluded all newborns who were diagnosed with hypoglycemia and treated.
The researchers found, as expected, that the newborns who underwent hypoglycemia screening were more likely to have a birthing parent with diabetes, to be premature, LGA or SGA, as compared to those who did not undergo screening.
Despite having normal blood sugars, 28.6% of screened newborns were exclusively breastfeeding at 24 hours as compared to 42.8% of unscreened newborns.
What else? See the question!
Jennie Howland
This is interesting. We offer glucose gel for hypoglycemia but some parents choose formula instead. Perhaps when informing parents why we are doing glucose screening we could also discuss treatments at that time. In addition we are starting a human milk program to offer more treatment options for hypoglycemia. In our hospital there is still a perception from some parents that the infant is suffering and hungry or not getting adequate intake and this pushes them to choose to supplement. Our nursing staff is still on a spectrum of development with discussing these parental fears.
IABLE
Actually, this study was about how just screening without the treatment increases the risk of formula supplementation. They removed the infants who needed treatment for hypoglycemia. Infants who were screened and found to have normal blood sugars were more likely to receive formula.
Jennifer Rose
I work in a small level 1 hospital as a lactation consultant. I find that parents of babies being screened for hypoglycemia are more anxious about feedings at breast even if glucose has been wnl. Nurses are apt to push formula supplementation if babies have received a couple of doses of glucose gel, even when other infant behaviors and conditions are normal. Both nurses and providers are apt to push for formula supplementation before using an IV glucose to treat. Feedings just become timed and more stressful when we are monitoring glucose levels. I wish the parameters could be eased a little, especially for LGA and SGA when gestational diabetes screen was negative in pregnancy and there are no other concerns.
AnneMarie Sandoval
Thank you for doing this study. Looking forward to more to come.