What is neonatal hypoglycaemia?
Neonatal hypoglycaemia is a common metabolic condition in newborn babies which, if left untreated, can cause long-term brain damage and disability. Hypoglycaemia means low blood glucose or sugar. It becomes dangerous when the newborn’s blood sugar drops below safe levels, such as before the baby has established a regular feeding pattern enabling it to keep its blood glucose up in the first few days of life.
What are the risk factors for neonatal hypoglycaemia?
Until adequate feeding is established all newborn babies are at some risk of hypoglycaemia, which is why it is part of the post-natal midwives’ job to ensure that the baby is receiving enough milk. The baby’s blood sugar is measured by a heel-prick blood test and is carried out routinely in some hospitals but should always be carried out for babies who are known to be at risk.
Those at increased risk include:
- Newborn babies with birthweights below 2.5kg - the standard threshold level below which the baby’s blood glucose must be monitored
- Babies with diabetic mothers
- Babies who are small for dates with intra-uterine growth retardation (IUGR)
Regardless of birthweight or their mother’s state of health, any baby who is not feeding properly could be at risk, for example by:
- Not waking up for feeds
- Not sucking properly
- Demanding feeding very frequently because they are not getting enough food at each feed
Is neonatal hypoglycaemia a medical emergency?
If acted upon quickly, neonatal low blood sugar can be corrected quickly by feeding, either by breastfeeding if that provides enough milk, by expressed breastmilk or formula milk or, if necessary, intravenously by a glucose drip.
In a review of medical negligence claims relating to neonatal hypoglycaemia, NHSLA (the NHS Litigation Authority, now known as NHS Resolution, which represents the NHS in legal claims) found that abnormal feeding behaviour was very closely associated with the condition, both as a cause and as a potential consequence of hypoglycaemia. Maternal concerns about abnormal feeding behaviour were often ignored by health professionals, missing a vital opportunity to take action to prevent hypoglycaemia before permanent damage was done to the infant’s brain.
If neonatal hypoglycaemia is severe or is left untreated, the baby’s condition will deteriorate, demonstrating other signs of illness. Neonatal hypoglycaemia with abnormal clinical signs must be regarded as a medical emergency requiring immediate action to avoid permanent brain damage and severe neurodevelopmental disability. Abnormal signs which are commonly seen with hypoglycaemia include:
- Hypothermia (low body temperature)
- Fitting or jitteriness
- Respiratory (breathing) difficulties
Hypoglycaemia can also occur alongside and in combination with other serious conditions.
My baby has brain damage from hypoglycaemia – do I have a claim?
In its review of 25 neonatal hypoglycaemia claims which succeeded against the NHS over a ten year period at a total cost of over £162 million, NHSLA identified the most common errors in clinical care as:
- Delays in obtaining blood glucose test results
- Delays in taking action on a low blood glucose result
- Delays in referring babies to the paediatrician once concerns have been identified
- Delays in admitting babies who have been diagnosed with clinically significant hypoglycaemia to the neonatal unit (NNU)
- Delayed administration of intravenous glucose on the NNU
- Insufficient glucose being administered to correct the hypoglycaemia
- Delayed attendance by the paediatrician when called by the midwife to review
- Failing to advise the mother properly when the baby is discharged home.
Unlike asphyxial (oxygen deprivation) causes of perinatal brain injury, neurodevelopmental disability from neonatal hypoglycaemia might not be obvious to the parents in the immediate aftermath of the traumatic birth or the infant’s early childhood. Neurodevelopmental disability from avoidable neonatal hypoglycaemia might be disregarded or downplayed until the child grows and the impact of their injury later becomes evident when they struggle to cope at school.
In its review, NHSLA said it was likely that whilst the cases they knew about were those where the parents had identified potential deficits in care, it is likely that others who were harmed have not been notified to NHSLA via the litigation process.
Boyes Turner’s specialist brain injury solicitors are experienced in obtaining compensation for children and teenagers with neurodevelopmental injury from avoidable neonatal hypoglycaemia. We work with experts to ensure that, where liability for the injury is established, the extent of the injury and the impact on the individual’s mobility, cognition, education, work and independence is properly assessed to ensure that our clients are properly compensated. In addition, our special educational needs (SEN) team can help families with children affected by neonatal brain injury secure the educational support that they need for their child within the school that is right for them.
If you are caring for a child who has suffered neurodevelopmental disability from negligent medical care, contact us on 0118 952 7219 or email firstname.lastname@example.org.
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