Late-Onset Hypoglycemia in Term Newborns With Poor Breastfeeding

Brain injury as a result of significant neonatal hypoglycemia has been recognized for many years. Recently, several case reports from around the world have documented that neonatal hypoglycemia in term infants can result from inadequate intake related to breastfeeding.¹ Clinical manifestations can vary from no symptoms, to hypotonia and lethargy, to seizures.² The blood glucose level and duration of hypoglycemia that lead to neurodevelopmental sequelae have not been established.³ For many years, it was thought that hypoglycemic brain injury was localized to the occipital lobes; however, more recent research has shown that the damage can occur anywhere in the brain.^4,5 There have been minimal follow-up data in this patient population to determine long-term prognosis.⁶ We report a cohort of 11 term neonates who were admitted to the Cincinnati Children’s Hospital Medical Center (CCHMC) NICU for treatment of hypoglycemia that was not due to endocrinopathies, sepsis, hypoxic-ischemic encephalopathy, or maternal medical problems such as diabetes. All of the infants were discharged from their birth hospitals and within a few days were admitted to the NICU with hypoglycemia.