Newborn Hypoglycemia Nursing Diagnosis and Nursing Care Plan

Hypoglycemia is the most prevalent health issue in newborns. Newborn hypoglycemia occurs when the plasma glucose concentration is less than 30 mg/dL (1.65 mmol/L) in the first 24 hours after birth and less than 45 mg/dL (2.5 mmol/L) subsequently.

Low blood sugar in a newborn baby can occur for various reasons. Thus, hypoglycemia results in significant long-term consequences including neurocognitive damage that causes mental retardation, recurrent seizure activity, developmental problems, and personality disorders. Severe hypoglycemia may also impair cardiovascular function.

Signs and Symptoms of Newborn Hypoglycemia

On their first or second day of existence, infants may be asymptomatic or suffer from fatal central nervous system (CNS) and cardiopulmonary abnormalities. The following are examples of symptoms:

• hypothermia
• Congestive Heart Failure (CHF)
• hypotonia
• apathy and lethargy
• seizures, jitteriness
• poor feeding
• apnea
• lethargy
• cyanosis

Clinical symptoms of the autonomic nervous system stimulation include the following:

• nausea vomiting, and hunger
• anxiety, trembling
• tachycardia
• diaphoresis
• pale face

A clinical presentation of hypoglycorrhachia (a poor glucose concentration in cerebrospinal fluid) or neuroglycopenia (a lack of appropriate glucose in the brain causing changes in neuronal function) usually involves:

• Stroke (hemiplegia, aphasia), numbness or tingling, lightheadedness, loss of memory, and decerebrate or decorticate posturing
• migraine
• seizures
• confusion, staring, changes in behavior, trouble concentrating, and mental confusion.
• communication problem
• coma, ataxia, and somnolence
• visual disturbances such as decreased acuity, and diplopia

Causes of Newborn Hypoglycemia

A variety of factors can cause newborn hypoglycemia, including:

• maternal malnutrition during pregnancy
• poorly controlled mother’s blood sugar during pregnancy which causes excessive production of insulin
• infectious disease (the mother may have taken certain medications during her pregnancy that results in the newborn’s sepsis or severe infections)
• Mother and child have incompatible blood types, which may also cause severe hemolytic disease in the newborn
• liver diseases
• congenital disabilities
• inherited or congenital metabolic disorders or hormone deficiency
• insufficient oxygen at birth
• excessive insulin in the newborn’s blood for several other reasons, such as a pancreatic tumor

Other possible causes of newborn hypoglycemia include, but are not limited to:

• interference with intravenous (IV) fluid administration
  • extravasated, tangled, or spilling peripheral IV

• An insufficient amount of enteral feeding
  • poor sucking abilities
  • vomiting

Risks Factors for Newborn Hypoglycemia

Newborns who are more likely to have hypoglycemia are the following:

• babies born to diabetic mothers
• babies who are small for their gestational age or have growth restrictions
• premature babies, particularly those with low birth weights
• babies born under extreme stress
• babies whose mothers were given certain medications, such as beta-blockers
• babies who are excessively large for their gestational age

The following are high-risk categories that require screening for hypoglycemia in the first hour of life:

• Newborns weighing more than 4 kg or less than 2 kg
• Newborns who are large for gestational age (LGA) and within the 90th percentile, infants who are small for gestational age (SGA) and under the 10th percentile, and infants with intrauterine growth restriction
• Infants born to insulin-dependent moms (1:1000 pregnant women) or gestational diabetes (which affects 2% of pregnant women)
• less than 37 weeks gestation
• Infants suspected of having sepsis or those born to a mother suspected of having chorioamnionitis
• Newborns have hypoglycemic symptoms such as grogginess, tachypnea, hypotonia, poor feeding, apnea, temperature instability, convulsions, and lethargy.

Complications of Newborn Hypoglycemia

• Seizures. As blood glucose levels continue to fall, neuroglycopenic symptoms may develop due to insufficient glucose supply to the neural tissues and brain, resulting in seizures.
• Occipital lobe epilepsy. Significant variations in blood sugar can influence the excitability of nerve cells (neurons), making epilepsy more likely to occur.
• Brain Injury. Hypoglycemia frequently results in a lack of brain fuel, leading to functional brain failure, which can be rectified by increasing plasma glucose concentrations.
• Visual Disturbances. Acute decreases in blood sugar levels of neonates have been linked to diplopia, dimness, impaired vision, and a lack of contrast sensitivity.
• Neurological Symptoms. Since the brain relies on blood glucose as its principal energy source, hypoglycemia impairs its capacity to function normally. Drowsiness, migraine, blurred vision, impaired concentration, and other neurological symptoms may result.
• Death. Severe, sustained hypoglycemia can cause significant central nervous system degeneration and, if untreated, can also lead to death.

Diagnosis of Newborn Hypoglycemia

• Laboratory Test
  • Bedside glucose testing. All symptoms are general and can occur in newborns suffering from hypoglycemia, hypoxia, sepsis, hypocalcemia, or opiate withdrawal. As a result, at-risk neonates require an urgent bedside blood glucose check from a capillary sample, whether or not they exhibit these symptoms. A venous sample confirms deficient levels.
  • Blood Test (Glucagon test). This laboratory test may be performed after 8 to 10 hours of fasting from the previous night.

Treatment for Newborn Hypoglycemia

• IV Treatment. When hypoglycemia occurs regularly, start a 5% or 10% dextrose drip.
• Emergency treatment. Oxygen, an intravenous (IV) line, and monitoring are examples of supportive therapy. Seizures that do not respond to hypoglycemia correction should be treated with adequate anticonvulsants.
• Enteral Feeding. Suppose a neonate’s glucose falls below 50 mg/dL (2.75 mmol/L). In that case, therapy should begin immediately with enteral nutrition or an IV infusion of up to 12.5% D/W, 2 mL/kg over 10 minutes; elevated concentrations of dextrose can be administered using a central catheter if required.
• Inpatient treatment. Newborns with confirmed hypoglycemia not caused by insulin therapy should be admitted to the hospital for careful monitoring and diagnostic testing.
• Surgery. Surgical intervention may be required if an infant is diagnosed with hypoglycemia before three months. Surgical exploration is typically performed on critically ill infants.

Prevention of Newborn Hypoglycemia

• The doctor and the healthcare team should thoroughly observe the patients at risk of newborn hypoglycemia.
• If the infant shows symptoms of low blood glucose, contact the baby’s healthcare practitioner immediately. If indicated, give the baby formula or a dextrose and water mixture.
• The mother should refrain from eating unhealthy foods during pregnancy.
• The mother should go to her doctor for regular consultations.
• Diabetic mothers should keep their blood glucose levels at normal levels during pregnancy.
• Preventive medication (oral or IV glucose) should be given to diabetic mothers’ infants, extremely preterm infants, and infants with respiratory distress.
• Understand why a new medicine or therapy is being provided and how it will benefit the newborn. Also, be aware of the potential adverse effects.
• Inquire whether the newborn’s condition can be addressed in any other way.
• Understand why a test or procedure is advised and what the results may imply.
• Understand what to expect if the newborn does not take the medication or undergoes the test or operation.
• If the newborn has a follow-up appointment, note the date, time, and reason for the visit.
• Learn how to reach the newborn’s healthcare provider after office hours. This is critical if the newborn becomes ill and you have questions or require assistance.

Nursing Diagnosis for Newborn Hypoglycemia

Newborn Hypoglycemia Nursing Care Plan 1

Interrupted Breastfeeding

Nursing Diagnosis: Interrupted Breastfeeding related to the neonate’s current health condition secondary to newborn hypoglycemia as evidenced by poor feeding, infant exhaustion, and inappropriate weight.

Desired Outcome: The mother will learn how to manage the baby’s condition and will be able to prevent being interrupted by breastfeeding despite the neonate’s condition.

Newborn Hypoglycemia Nursing Interventions	Rationale
Evaluate the mother’s perception and comprehension of breastfeeding and the degree of education provided.	Since mothers may only be at a hospital or birthing center for a short period, teaching parents about breastfeeding is critical. Before discharge, it is essential to review the mother’s breastfeeding plans so the patient’s remaining questions may be answered. The more informed a patient is about breastfeeding, the more likely she is to feel at ease with the practice.
Show the patient how to use a portable breast pump. Educate the mother on how to assemble, disassemble, and sterilize the breast pump.	When breastfeeding must be momentarily interrupted, it is necessary to train the mother on how to pump her milk to continue exclusive breastfeeding. Portable breast pumps allow the mother to return to work while still pumping and storing breastmilk for the newborn.
When the mother is breastfeeding, provide her and the newborn with privacy and a peaceful environment.	Rooming-in, as advised for a sick or premature baby, is excellent for breastfeeding since the newborn can be fed with feeding cues. The room should be at a suitable temperature, and the baby should not be exposed to tobacco smoke since it will be dangerous for the newborn.
Provide information to the patient regarding the correct positioning strategies and neonate’s body alignment for breastfeeding.	The side-lying position may allow the mother to relax while breastfeeding. A football hold with the newborn on a pillow may also be beneficial, mainly if the mother had a cesarean delivery. Whatever posture is chosen for breastfeeding, the neonate’s body must be in a chest-to-chest position with the mother, with the head and neck aligned.
Provide emotional support to the mother and accept her choice of whether to discontinue or continue breastfeeding.	The inability to breastfeed can result in reduced milk production, a lack of confidence in parental tasks, a sense of not being a mother, and feelings of guilt, worry, despair, and stress. Furthermore, it has been found that prolactin levels decline faster in mothers unable to breastfeed, which might lead to postpartum depression. Providing emotional comfort may assist the mother in being motivated to express breastmilk despite an interruption in breastfeeding.

Newborn Hypoglycemia Nursing Care Plan 2

Risk for Impaired Parent or Infant Attachment

Nursing Diagnosis: Risk for Impaired Parent or Infant Attachment related to neonate’s current condition, parents’ fear of touching the fragile newborn, anxiousness, and lack of information about bonding techniques secondary to newborn hypoglycemia.

Desired Outcomes:

• The mother will discover and demonstrate strategies to improve the neonate’s behavioral structure.
• The parents will pay frequent visits to the hospital and hold the newborn.
• The parents will be able to have mutually satisfying relationships with their newborn after discharge.

Newborn Hypoglycemia Nursing Interventions	Rationale
Encourage the parents to communicate their thoughts and feelings regarding the newborn and its health condition.	Before good bonding can occur, parents might need some time to process their disappointment that the infant is so tiny or their guilt that they were unable to avoid the illness of the preterm birth. It is a vital nursing role to assist them in expressing their sentiments and developing a more positive attitude about their preterm baby.
Look for mother-baby interactions that require more intervention.	The nurse should observe parent-neonatal interactions that indicate the need for different interventions. Some of these behaviors include ignoring the neonate’s indications of hunger or discomfort, failing to recognize their infant’s communication, avoiding eye contact with the neonate, and addressing the neonate negatively.
Examine parenting actions toward the newborn.	The nurse should observe the parenting practices, including the affection and interest provided to the newborn. Physical contact, stimulation, eye-to-eye contact, and time spent engaging with the newborn are all critical. Adults frequently use high-pitched voices when conversing with newborns.
Recognize and provide the patient with nurturing and protective parenting behaviors by providing positive feedback.	This approach encourages desired behaviors to continue. Since first-time parents may be sensitive to negative remarks, the nurse should congratulate their achievements while politely suggesting areas for improvement.
Encourage parents to interact with their newborns as needed.	Although it is critical to preserve a premature baby’s strength by limiting sensory stimulation and carefully handling the neonate, preterm newborns appear to require the same attention and affection as term neonates.

Newborn Hypoglycemia Nursing Care Plan 3

Risk for Unstable Blood Glucose Levels

Nursing Diagnosis: Risk for Unstable Blood Glucose Levels related to the mother’s condition during pregnancy and premature delivery secondary to newborn hypoglycemia.

Desired Outcomes:

• The neonate’s glucose levels will remain within a safe range.
• The mother will express her comprehension of the neonate’s needs verbally.
• The mother will verbalize her comprehension of plans to avoid or reduce complications of newborn hypoglycemia.

Newborn Hypoglycemia Nursing Interventions	Rationale
Monitor the newborn’s glucose levels frequently.	Every two hours, take blood samples from the neonate’s heel. Any condition that raises energy requirements, like hypoglycemia, challenges the neonate’s already depleted resources even more. Hypoglycemia is plasma glucose levels less than 40 mg/dL in a term infant and less than 30 mg/dL in a preterm infant.
Feed the premature neonate small, frequent meals or snacks.	Since premature babies have a lesser stomach capacity than full-term neonates, they must be fed more often and in tiny portions, maybe as little as one or two milliliters every 2 to 3 hours.
Examine the newborn for signs and symptoms of hypoglycemia.	Tremors, faint cries, fatigue, seizures, and a plasma glucose level less than 40 mg/dL (term) or 30 mg/dL (preterm) are signs of hypoglycemia in the preterm newborn. Monitoring these clinical manifestations can help to avoid severe complications in newborns.
Determine the newborn’s birth weights precisely.	Newborn hypoglycemia is one of the primary causes of neonatal mortality, particularly in preterm and low-birth-weight newborns. A recent study suggests that mortality in neonatal hypoglycemia happens more frequently at moderate to late preterm delivery and is more prevalent at low birth weight.
Organize procedures to allow the neonate as much relaxation as possible.	To counteract hypoglycemia and infection, the newborn may need to relax and preserve energy. To allow this, try to plan procedures, so the neonate can rest as possible. Without a coordinated effort, the neonate may be constantly awakened for interventions.
As directed, administer intravenous glucose.	Intravenous glucose is administered as a 200 mg/kg bolus (dextrose 10% at 2 ml/kg), followed by a continuous dextrose 10% infusion at 5 to 8 mg/kg per minute (80 to 100 ml/kg per day) to sustain blood glucose levels of 40 to 50 mg/dL. Infants receiving intravenous dextrose infusions must be closely monitored, with blood glucose levels measured as often as every hour for the first 12 hours, then less frequently until target blood glucose is attained.

Newborn Hypoglycemia Nursing Care Plan 4

Ineffective Breathing Pattern

Nursing Diagnosis: Ineffective Breathing Pattern related to mother’s premature delivery secondary to newborn hypoglycemia as difficulty breathing normally.

Desired Outcomes:

• The neonate’s respiratory rate and breathing pattern will be within the standard range.
• The newborn will have clean breathing sounds and utilize fewer auxiliary muscles.
• The neonate’s capillary refill will be within the usual range.

Newborn Hypoglycemia Nursing Interventions	Rationale
Examine the use of auxiliary muscles while breathing.	The neonate’s breathing is accompanied by nasal flaring and sternal and subcostal respirations. As the neonate’s distress level grows, he or she may demonstrate seesaw respirations, in which the anterior chest wall tightens, the abdomen protrudes on inhalation, and the sternum rises on exhalation.
Comparatively, auscultate the patient’s breath sounds from both lung areas.	Auscultation may reveal fine rales, and reduced breath sounds due to inadequate air entrance. Increased respiratory discomfort may indicate decreased air exchange.
Examine the newborn’s respiratory rate and breathing rate.	Respiratory distress symptoms appear shortly after birth. However, they may only appear for a short time. Respirations increase to 60 breaths per minute or higher. Rapid breathing or tachypnea is accompanied by grunting sounds. The glottis closing induces expiratory grunting as it tries to boost the pressure in the alveoli during expiration to keep them from collapsing.
Improve the newborn’s hydration and nutrition.	Since the neonate is too fatigued to suck, provide hydration and nutrition by intravenous fluids and glucose or gavage feedings. Feed nutrients by enteral feedings of breast milk combined with high-calorie formula.
As needed and as per the doctor’s recommendation, provide nitric oxide to the patient.	The infusion of nitric oxide, a potent vascular dilator, is another medication that can aid in carrying oxygen to the neonate’s lungs. It promotes pulmonary vasodilation while not affecting systemic vascular function. On ventilation, nitric oxide reaches the alveoli and redirects the pulmonary blood by dilatation of the pulmonary arterioles.

Newborn Hypoglycemia Nursing Care Plan 5

Risk for Infection

Nursing Diagnosis: Risk for Infection related to immature or weakened immune responses secondary to newborn hypoglycemia.

Desired Outcomes:

• The neonate will show no indications of infection.
• The mother will demonstrate how to avoid complications.

Newborn Hypoglycemia Nursing Interventions	Rationale
Execute Apgar scoring one minute and five minutes following birth.	Neonates are examined and evaluated one minute and five minutes after birth using an Apgar score, an assessment tool used as a baseline for newborn evaluation. The pulse rate, breathing effort, muscle strength, reflex irritability, and color of the newborn are all scored 0, 1, and 2.
Ensure that all healthcare staff caring for the newborn, visitors, and mother are infection-free.	Healthcare personnel with infections (especially sore throats, upper respiratory tract infections, or herpes lesions) should be restricted from caring for newborns and mothers until the ailment has cleared entirely. If the mother has an infectious illness, her newborn should be kept from her until there is no longer a risk of infection.
Wear proper PPE and practice good hand hygiene at all times.	Before touching a newborn, healthcare professionals should thoroughly wash their hands and arms up to their elbows with antiseptic soap. Although no evidence that wearing cover gowns or nursery uniforms reduces infections, agency staff are frequently compelled to wear them when directly caring for neonates. When dealing with an unwell newborn, gloves and a face mask are also required.
Examine the area surrounding the umbilical cord.	Examine the cord to ensure it is adequately secured. A bleed could occur if it loosens before thrombosis destroys the umbilical vessels. Make sure the region around the cord is dry and erythema-free.
Examine the newborn’s vital signs.	Following the initial period of hypoglycemia, further gradual declines in cardiac output with bradycardia and systemic hypotension may occur. The neonate exhibits overt shock, as evidenced by pallor, poor capillary perfusion, and edema. These late shock symptoms are symptomatic of severe deterioration and are significantly linked to mortality.
Administer intravenous fluids as directed.	When deciding whether to treat neonatal hypoglycemia, a fluid bolus is the suggested first step (crystalloid). Even though there is less data on neonates to support this intervention, it is still standard clinical practice to treat and closely monitor for symptoms of intravascular volume depletion. Aggressive volume expansion should be considered in term or older preterm newborns. Using a 10% glucose solution with frequent monitoring assures normoglycemia to prevent hypoglycemia.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

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