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Hypoglycemia
A study found that hypervigilance and fear of hypoglycemia may lead parents to hesitate to leave their child in care. A recent study found that 44% of parents affected their decision to enroll their child in school or daycare due to T1D (Commissariat et al., 2019).
When the umbilical cord is clamped, the newborn’s glucose supply is cut off. If neonates are under significant physiological stress, they may experience hypoglycemia because of insufficient gluconeogenesis or increased utilization of glycogen stores (Althoff et al., p. 39, 2023).
In the case of children:
As a nurse, I am responsible for educating patients and caregivers about the early detection of hypoglycemic symptoms such as sweating, tachycardia, tremor, palpitations, nervousness, hunger, pallor, confusion, lethargy, unusual behavior, irritability, seizures, and coma (Gartley, 2023).
Caregivers should create a daily backpack checklist for necessary supplies, including a blood sugar meter, ketone testing supplies, insulin, syringes or pens, antiseptic wipes, water, and fast-acting carbs like glucose tablets. Additionally, create a “hypo” box with the child’s name for school office emergencies (Managing Diabetes at School, 2022).
Ensure your child wears a medical ID daily, tests blood sugar regularly, knows when to seek help, and knows who to contact for low blood sugar (Managing Diabetes at School, 2022).
Neonate case
I will educate the parent or caregiver about hypoglycemia signs and symptoms, or low blood sugar, which can show up in babies in many ways. Irritability: This is a common sign that a baby is in pain. It’s possible for babies to be fussier or more restless when their blood sugar is low. Muscle twitches, jitteriness, and tremors are all bodily signs that you might have low blood sugar. Low blood sugar can make babies’ muscles move on their own (Hypoglycemia in a Newborn Baby – Health Encyclopedia – University of Rochester Medical Center, n.d.).
Not eating enough: Babies whose blood sugar is low may have trouble eating. They might not want to eat as much or might not be able to eat as well. Lethargy: Babies with low blood sugar may become very sleepy or unresponsive. This is because the brain isn’t getting enough glucose to work properly (Hypoglycemia in a Newborn Baby – Health Encyclopedia – University of Rochester Medical Center, n.d.).
Seizures: Infants can have seizures when their blood sugar is very low. This is a medical issue that needs help right away. These signs might mean you have hypoglycemia, but they could also mean you have another health problem. So, if a baby shows these symptoms, it’s important to get them medical help (Hypoglycemia in a Newborn Baby – Health Encyclopedia – University of Rochester Medical Center, n.d.).
As a nurse, I will educate the caregiver about skin-to-skin contact, it will promote breastfeeding and thermoregulation to stabilize blood sugar levels and prevent hypoglycemia in the newborn (Althoff et al., 2023).
Young children with type 1 diabetes face unique challenges in managing their condition, including managing glucose levels, anxiety, depression, stress, and distress. Parents also experience emotional burdens, including worries about hypoglycemia, future complications, and the impact on their child’s quality of life (Commissariat et al., 2019).
Refereces
Commissariat, P., Harrington, K. R., Whitehouse, A. L., Miller, K. M., Hilliard, M. E., Van Name, M., DeSalvo, D. J., Tamborlane, W. V., Anderson, B. J., DiMeglio, L. A., & Laffel, L. M. (2019). “I’m essentially his pancreas”: Parent perceptions of diabetes burden and opportunities to reduce burden in the care of children <8 years old with type 1 diabetes. Pediatric Diabetes, 21(2), 377–383. https://doi.org/10.1111/pedi.12956Links to an external site.
Gartley, C. E. (2023). Hypoglycemia and the Rule of 15: American Nurse. https://www.myamericannurse.com/hypoglycemia-and-the-rule-of-15/Links to an external site.
Hypoglycemia in a newborn baby – Health Encyclopedia – University of Rochester Medical Center. (n.d.). https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=90&contentid=p01961Links to an external site.
Managing diabetes at school. (2022, June 20). Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/library/features/managing-diabetes-at-school.htmlLinks to an external site.
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Hyperbilirubinemia
Hyperbilirubinemia is an elevation of bilirubin in the blood which causes the newborn to have yellowing of the skin and eyes, called jaundice. This can be broken up into two categories. Physiologic jaundice is common and caused by an immature liver. This appears 24-72 hours after birth. The jaundice should go away within 10 days of birth. Pathologic jaundice is present before the newborn is 24 hours old and is caused by an underlying disease such as infection of blood group incompatibility. This type of jaundice is present even after the newborn is two weeks old and does require treatment (Assessment Technologies Institute (ATI), 2023).
Some signs and symptoms of hyperbilirubinemia are yellowing of the skin and eyes, dark urine, pale stool, and the newborn may not want to eat as well or as often (National Health Service (NHS), 2022).
Excess bilirubin is excreted through stools (ATI, 2023). If the newborn is not eating enough and/or having 6-8 wet diapers throughout the day, you should notify the nurse. If the newborn is not eating enough, he will not clear the excess bilirubin, which in turn will not allow the jaundice to clear. The newborn may also be very sleepy (NHS, 2022). If you are unable to arouse your baby, notify the nurse.
Assessment Technologies Institute (2023). Maternal Newborn (edition).
National Health Service. (2022, February 3). Symptoms of newborn jaundice. Newborn jaundice. https://www.nhs.uk/conditions/jaundice-newborn/symptoms/Links to an external site.
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