A certain subset of babies will have their blood sugars checked repeatedly after delivery — some for the next 12 hours after delivery and others for the next 24 hours after delivery.

• LGA/Maternal GDM – for the next 12 hours
• SGA/Preterm – for the next 24 hours

The difference lies in the reasoning behind the monitoring. Large for gestational age infants or those born to mothers with gestational diabetes mellitus will have hyperinsulinemia secondary to (maternal hyperglycemia -> fetal hyperglycemia). After delivery, the maternal glucose supply is removed resulting in a transient hypoglycemia in the infant made worse by existing levels of circulating fetal insulin. The half life of insulin is short and this brand of hypoglycemia resolves as insulin levels fall and feedings normalize (12 hour monitoring).

In the case of a small for gestational age infant or preterm infant, inadequate glycogen stores and impaired glucose production via impaired hepatic glycogen mobilization results in a transient hypoglycemia. Birth is also stressful for the infant and energy demand/metabolism is increased in the period after birth. For that reason, these infants may struggle to maintain normoglycemia for an extended period of time even after feedings have normalized (24 hour monitoring).

And of course…. once can never forget the life-saving consideration of sepsis in their diagnosis of a neonate presenting with unexplained hypoglycemia.

“Instead of hating, my heart cries mercy! Mercy on me! Mercy on me! Mercy on me! It calls out to love in an attempt to save myself. I don’t want to be one of those people who live their lives with boils, septic wounds and broken bones bleeding inside.”

Phindiwe Nkosi in Behind the Hospital