Early neonatal hypoglycemia in exclusively breastfed babies in a developing country - India

Neonatal hypoglycemia has been a cause for concern due to increasingly frequent reports of long-term sequelae, leading to undue concern and inadvertent administration of formula feeds. Though hypoglycemia is usually encountered only in neonates with classical risk factors, hypoglycemia is also rarely seen even in babies with no known risk factors. These babies may present only with sequelae in later childhood.

This is a hospital-based observational, prospective study. We included 299 exclusively breastfed neonates who were shifted to mother's side with no congenital malformation or need for neonatal intensive care unit (NICU) admission. The neonates were studied in two groups: " At Risk" and "No Risk." The "At Risk" group included babies with known risk factors like low birth weight, late preterm (34-36 weeks), small for gestational age (birth weight <10^th centile), infant of a diabetic mother, or large for gestational age (birth weight >90^th centile). Hypoglycemia was the primary outcome measured independent of feeding time for both groups. For the "At Risk" group, monitoring was done at 0, 1, 2, 3, 4, 12, 24 plus 48 h. For the "Not At Risk" group, it was done at 12 and 24 h of life. The factors associated with both groups were studies as the secondary outcome.

Out of 299 exclusively breastfed neonates, 13% were hypoglycemic. 27.06% were hypoglycemic in the "At Risk" group. In the "At Risk" group, low birth weight and primiparity were significant risk factors. The incidence of hypoglycemia in the "No Risk" group was 1.80%. Breast problems and breastfeeding problems, low education status of mother, young age, and primiparity were significant risk factors in the "No Risk" group.