ISSN: 2469-5769

Patel et al. Int J Pediatr Res 2020, 6:066

DOI: 10.23937/2469-5769/1510066
Volume 6 | Issue 2
International Journal of Open Access

Pediatric Research
Original Research

Hypoglycemia in Exclusively Breastfed High-Risk Neonates

- A Hospital-Based Study
Parth Patel*, Palash R Gogoi, Santanu Deb, Prasenjit Paul, Sabrina Yesmin, Lima Sangla
Jamir and Pramod Paharia Check for
updates

Department of Pediatrics, Nazareth Hospital, Shillong, Meghalaya, India

*Corresponding author: Dr. Parth Patel, Department of Pediatrics, Room no. 1, Above Private B, Nazareth Hospital,
Laitumkhrah, Shillong, Meghalaya - 793003, India

Abstract Conclusion: We conclude that the incidence of asymptom-

atic hypoglycemia is fairly common in high-risk neonates.
Background: Hypoglycemia is one of the commonest met- Strict monitoring and a close watch are therefore necessary
abolic problems in contemporary neonatal medicine. In the to detect hypoglycemia and institute measures to prevent
majority of healthy neonates, the frequently observed low progression to symptomatic hypoglycemia and sequelae
blood glucose concentrations are not related to any signif- later on in life.
icant problem and merely reflect normal processes of met-
abolic adaptation to extrauterine life. However, when low Keywords
blood glucose levels are prolonged or recurrent, they may
Hypoglycemia, Newborns, Incidence, Risk factors
result in acute systemic effects and may result in neurologic
sequelae.
Aims and Objectives: To find out the incidence of hypo- Introduction
glycemia in exclusively breastfed high-risk newborns and to
study associated risk factors like gender, gestational age,
Hypoglycemia is one of the commonest metabolic
birth weight, time of onset of the development of hypogly- problems in contemporary neonatal medicine. In the
cemia majority of healthy neonates, the frequently observed
Methodology: This Descriptive Cross-sectional study of low blood glucose concentrations are not related to any
neonates enrolled 75 exclusively breastfed high-risk neo- significant problem and merely reflect normal process-
nates (low birth weight, late preterms, small-for-gestation, es of metabolic adaptation to extrauterine life. How-
large-for-gestation, infant of diabetic mother and macro- ever, when low blood glucose levels are prolonged or
somic), who did not require admission to neonatal intensive
care unit and were kept in postnatal wards with mother. Hy-
recurrent, they may result in acute systemic effects and
poglycemia was defined as blood glucose < 40 mg/dl. Blood neurologic sequelae [1]. The fetus in utero is entirely de-
glucose was monitored until 72 hours of life (at 2, 6, 12, 24, pendent on the mother for glucose. At the time of birth,
48, 72 hrs of life). the neonate must abruptly switch from having a con-
Results: The incidence of hypoglycemia in newborns with tinuous supply of glucose from the maternal blood in
risk factors was 20% (15 of 75 neonates). All were asymp- fetal life to maintaining its own supply of glucose during
tomatic. The incidence of hypoglycemia in SGA neonate periods of fasting, and when feedings are interspersed
was 37.5% (6/16), in LGA neonate was 18% (2/11), in
Macrosomic neonates 20% (2/10), in LBW neonates 24% intermittently [2]. Postnatal hypoglycemia in newborn
(9/38), in IDM was 14% (4/25) and in late preterm was 14% infants remains an important clinical problem and pro-
(2/12).In the present study, most of the neonates had hypo- longed periods of hypoglycemia may be associated with
glycemia within 24 hours of life and none of the neonates poor neurodevelopmental outcomes. Since prolonged
were hypoglycemic after 48 hours of life.
periods of low plasma glucose are associated with in-
creased risk of neurodevelopmental impairment, it is

Citation: Patel P, Gogoi PR, Deb S, Paul P, Yesmin S, et al. (2020) Hypoglycemia in Exclusively Breast-
fed High-Risk Neonates - A Hospital-Based Study. Int J Pediatr Res 6:066. doi.org/10.23937/2469-
5769/1510066
Accepted: July 14, 2020: Published: July 16, 2020
Copyright: © 2020 Patel P, et al. This is an open-access article distributed under the terms of the
Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction
in any medium, provided the original author and source are credited.

Patel et al. Int J Pediatr Res 2020, 6:066 • Page 1 of 7 •

DOI: 10.23937/2469-5769/1510066 ISSN: 2469-5769

an important priority to prevent hypoglycemia in new- al age (SGA) infants (birth weight less or equal to the
born infants [3]. Certain risk groups, including small for 10th percentile for gestational age), large for gestation-
gestational age infants, preterm infants, and infants of al age (LGA) infants (birth weight more or equal to the
diabetic mothers, are at high risk of hypoglycaemia [4]. 90th percentile for gestational age), low-birth-weight ba-
Prevention, early diagnosis, and prompt treatment are bies (birth weight less than 2500 g), macrosomic infants
important for high-risk infants who develop hypogly- (birth weight more than 4000 g), infant of a diabetic
cemia, to minimize the severity and duration of hypo- mother (IDM) (maternal type 1 or type 2 diabetes melli-
glycaemic episodes, which are associated with adverse tus or gestational diabetes mellitus), late preterm infant
outcomes [5]. This study aimed to find out the incidence (LPI) (a premature infant born between 34-36 6/7 gesta-
of hypoglycemia in exclusively breastfed, high-risk new- tional week). The birth weight percentiles were adopted
borns, and to study associated risk factors like gender, from the Lubchenco chart [6]. Newborns with a major
gestational age, birth weight, time of onset of the devel- congenital malformation in whom breastfeeding cannot
opment of hypoglycemia. be initiated, who required I.V. fluid, in whom exclusive
Materials and Methods breastfeeding cannot be continued or contraindicated
were excluded. The detailed history of the enrolled ba-
This Cross-sectional, descriptive hospital-based study bies was taken which included various maternal risk fac-
was carried out in the Postnatal ward of Nazareth hospi- tors like GDM, PIH, twin pregnancy, etc, and neonatal
tal, Shillong from 15th January 2019 to 14th July 2019. A risk factors like prematurity, LBW, SGA, etc.
total of 75 newborns were included in the study. Ethical
clearance for conducting the study was obtained from Capillary blood samples were taken after warming
the institutional ethics committee. We included all high- the heels of the babies. Blood glucose concentration
risk healthy newborns who were exclusively breastfed was determined by using the glucometer and test strips
after obtaining informed consent from the mother. (SD CodeFree, SD BIOSENSOR). Capillary blood sugar
The high-risk group was defined as small for gestation- was checked with a portable glucometer at 2 hours, 6

Table 1: Demographic data of the enrolled neonates and their mothers.

N = 75 Number of cases Percentage of cases

Sex Male 33 44%
Female 42 56%
Residence Urban 41 54.7%
Rural 34 45.3%
Religion Hindu 21 28.0%
Christian 51 68.0%
Muslim 3 4.0%
Other 0 0.0%
Antenatal History Booked 46 61.3%
Unbooked 29 38.7%
Obstetric History Primigravida 19 25.3%
Multigravida 56 74.7%
Maternal Age < 30 Years 31 41%
> 30 Years 44 59%
Maternal History Nil 31 41.3%
GDM 26 34.7%
DM 3 4.0%
PIH 5 6.7%
Hypothyroidism 4 5.3%
PROM 3 4.0%
Other 3 4.0%
Mode of Delivery Nvd 21 28.0%
Forceps 2 2.7%
Vacuum 1 1.3%
Elective CS 12 16.0%
Emergency CS 39 52.0%

Patel et al. Int J Pediatr Res 2020, 6:066 • Page 2 of 7 •

DOI: 10.23937/2469-5769/1510066 ISSN: 2469-5769

hours, 12 hours, 24 hours, 48 hours, and 72 hours of life mothers had a higher incidence of hypoglycemia than
and recorded. The babies were observed for signs and those of primigravida mothers. Hypoglycemia was
symptoms attributable to hypoglycemia. Hypoglycemia found to be more in newborns whose mother’s age was
definition that was used in the study was blood glucose > 30 years than in newborns whose mother’s age was <
level below 40 mg/dl [7]. 30 years at the time of delivery and higher in neonates
who were delivered through cesarean section than the
Following the detection of hypoglycemia, the neo-
vaginal route. These observations were found to be sta-
nates were managed as per institutional protocol. p-val-
tistically significant after applying the tests of propor-
ue < 0.05 was considered statistically significant.
tion Table 3.
Results In the present study, out of 38 LBW neonates 24%
During the study period, a total of 758 deliveries oc- (9/38) neonates were hypoglycemic, which was found
curred. Overall 683 cases were excluded from the study: to be statistically significant. (Proportion test, p-value:
502 newborns because of being non-high-risk; 5 new- 0.004). Out of 29 IDM 14% (4/29) neonates were hypo-
borns for having major congenital malformation; 173 glycemic, which was found to be statistically significant.
newborns required I.V fluid; 3 newborns in whom exclu- (Proportion test, p-value: 0.001). Out of 14 Late preterm
sive breastfeeding could not be continued. The popula- neonates 14% (2/14) neonates were hypoglycemic,
tion demographics are depicted in Table 1 and Figure 1. which was found to be statistically significant. (Propor-
Of the 75 high-risk neonates that were enrolled in tion test, p-value: 0.02) Table 4.
this study, 15 neonates developed hypoglycemia in the In the present study, after analyzing the distribution
first 72 hours of life. So, the incidence of hypoglycemia of hypoglycemia and birth weight of the neonates, it
in the high-risk newborns is found to be 20% in this was found that amongst the 38 low birth weight new-
study Table 2. borns, 23.7% (9/38) were hypoglycemic. (Proportion
In the present study, the neonates of multigravida test, p: 0.004). Out of 27 normal birth weight neonates,

Total deliveries during the present study

period: 758

Excluded from the present study

based on exclusion criteria
N=683
Declined to participate/  Not fulfilled inclusion
refused consent : criteria (Non high-risk
N=0 neonates : 502
 Newborns with major
congenital
malformation : 5
 Newborns requiring
I.V. fluid : 173
Total cases enrolled in the
 Newborns in whom
present study:
exclusive breastfeeding
N = 75
cannot be continued : 3

Hypoglycemic Non – Hypoglycemic

15 60
(20%) (80%)

Figure 1: Flow diagram of the distribution of cases in the present study.

Patel et al. Int J Pediatr Res 2020, 6:066 • Page 3 of 7 •

DOI: 10.23937/2469-5769/1510066 ISSN: 2469-5769

Table 2: Characteristics of high-risk neonates that were enrolled in the present study.

N = 75 Number of cases Percentage of cases

SGA 16 21.3%
LGA 11 14.7%
MACROSOMIC 10 13.3%
Inclusion Criteria LBW 38 50.7%
IDM 29 38.7%
Late Preterm 14 18.7%
Birth Weight LBW 38 50.7%
( Birth weight : < 2500 gm)
Normal Birth Weight 27 36%
( Birth weight : 2500-3999 gm)
MACROSOMIC 10 13.3%
( Birth weight : > 4000 gm)
Gestational Age Late Preterm - 14 18.7%
34 wk to 36 wk 6 days
Early term - 31 41.3%
37 wk to 38 wk 6 days
Full-term - 28 37.3%
39 wk to 40 wk 6 days

Late-term - 1 1.3%
41 wk to 41 wk 6 days
Post-term - 1 1.3%
42 wks and beyond

Table 3: Characteristics of the hypoglycemic neonates (n = 15).

N = 15 Number Incidence p-value

Sex Male 9 60% 0.45
Female 6 40%
Residence Urban 7 47% 0.8
Rural 8 53%
Religion Hindu 4 27% 0.1
Christian 11 73%
Muslim 0 0%
Other - -
Antenatal History Booked 4 27% 0.1
Unbooked 11 73%
Obstetric History Primigravida 3 20% 0.04
Multigravida 12 80%
Maternal Age < 30 Years 3 20% 0.04
> 30 Years 12 80%
Mode of Delivery Vaginal Route 3 20% 0.04
Cesarean Section 12 80%

14.8% (4/27) were hypoglycemic. (Proportion test, p: gestational age, it was observed that among the 14
0.002). Whereas in Macrosomic newborns we did not Late preterm newborns, 14.3% (2/14) were hypoglyce-
see a statistically significant difference. (Proportion test, mic, which was statistically significant. (Proportion test,
p: 0.1) Table 5. p: 0.03). Out of 31 Early term neonates, 22.6% (7/31)
were hypoglycemic, which was statistically significant.
On analysis of the hypoglycemic neonates and their

Patel et al. Int J Pediatr Res 2020, 6:066 • Page 4 of 7 •

DOI: 10.23937/2469-5769/1510066 ISSN: 2469-5769

Table 4: Distribution of hypoglycemia in the high-risk neonates in the present study (n = 75).

HIGH-RISK NEONATES HYPOGLYCEMIA ABSENT HYPOGLYCEMIA PRESENT p-value

(N = 75) Number of Percentage of Number of Percentage of
newborns newborns newborns newborns
SGA (N = 16) 10 62.5% 6 37.5% 0.33
LGA (N = 11) 9 82% 2 18% 0.07
MACROSOMIC (N = 10) 8 80% 2 20% 0.1
LBW (N = 38) 29 76% 9 24% 0.004
IDM (N = 29) 25 86% 4 14% 0.001
Late Preterm (N = 14) 12 86% 2 14% 0.02

Table 5: Distribution of hypoglycemia in the present study according to birth weight of the neonates (n = 75).

BIRTH WEIGHT HYPOGLYCEMIA ABSENT HYPOGLYCEMIA p-value

(N=75) PRESENT
Number of Percentage of Number of Percentage of
newborns newborns newborns newborns
Low Birth Weight (N = 38) 29 76.3% 9 23.7% 0.004
Normal Birth Weight (N = 27) 23 85.2% 4 14.8% 0.002
MACROSOMIC (N = 10) 8 80% 2 20% 0.1

Table 6: Distribution of Hypoglycemia in the present study according to gestational age of neoantes (N = 75).

Gestational Age Hypoglycemia Absent Hypoglycemia Present p-value

(N = 75) Number of Percentage of Number of Percentage of
newborns newborns newborns newborns
Late Preterm - 34 Wk To 36 12 85.7 % 2 14.3% 0.03
Wk 6 Days
(N = 14)
Early Term - 37 Wk To 38 Wk 24 77.4% 7 22.6% 0.007
6 Days
(N = 31)
Full-Term - 39 Wk To 40 Wk 23 82.1% 5 17.9% 0.004
6 Days
(N = 28)
Late-Term - 41 Wk To 41 Wk 1 100% 0 0% --
6 Days
(N = 1)
Post-Term - 42 Wks And 0 0% 1 100% --
Beyond
(N = 1)

(Proportion test, p 0.007). Among the 28 Full-term new- hours vs. > 24 hours of life). This further reinforces the
borns 17.9% (5/28) were hypoglycemic, which was sta- fact that proper monitoring of blood glucose is highly
tistically significant. (Proportion test, p 0.004) Table 6. essential for the first 24 hrs of life Figure 2.
Out of 15 newborns who developed hypoglycemia, The authors of this study did not find any neonate
all except one neonate developed hypoglycemia by 24 with symptomatic hypoglycemia. None of the neonates
hrs of age: 26.7% (4/15) neonates had hypoglycemia required IV fluid therapy or NICU admission following
at 2 hours of life, 40% (6/15) neonates had hypoglyce- the development of hypoglycemia. All were managed
mia at 6 hours of life, 20% (3/15) neonates had hypo- with frequent breastfeeding as per institutional policy.
glycemia at 12 hours of life, 6.7% (1/15) neonate had
hypoglycemia at 24 hours of life, 6.7% (1/15) neonate
Discussion
had hypoglycemia in at 48 hours of life and none had In the present study, out of 75 newborns, 15 new-
hypoglycemia at 72 hours of life. This observation was borns were found to be hypoglycemic whereas 60 new-
found to be statistically significant (p-value: 0.01 - 1st 24 borns did not have hypoglycemia. Hence the incidence

Patel et al. Int J Pediatr Res 2020, 6:066 • Page 5 of 7 •

DOI: 10.23937/2469-5769/1510066 ISSN: 2469-5769

Figure 2: Detection of hypoglycemia in hours of life in newborns in the present study (n = 75).

Table 7: Various studies have shown a varying incidence of hypoglycemia.

Sr No. Authors Year Place Incidence of hypoglycemia

1 Present study 2019 Meghalaya, India 20%
2 Harris DL, et al. [4] 2012 Auckland, New Zealand 51%
3 Turner D, et al. [8] 2019 Boston, MA, USA 40%
4 Kumar TJ, et al. [9] 2018 Chennai, India 33.3%
5 Saini A, et al. [10] 2018 Haryana, India 24%
6 Mehta YP, et al. [11] 2017 Maharastra, India 22%
7 Atrushi AM, et al. [12] 2016 Duhok, Iraq 17.8%
8 Zhou W, et al. [13] 2015 Shanghai, China 16.9%
9 Kanagagiri R, et al. [14] 2018 Imphal, India 16.5%
10 Singh YP, et al. [15] 2014 Imphal, India 15.20%
11 Das A, et al. [16] 2019 Jharkhand, India 8.63%
12 Bromiker R, et al. [17] 2017 Jerusalem, Israel 3.4%

of hypoglycemia in exclusively breastfed but high-risk In our study, the incidence of hypoglycemia in male
neonates was 20% (Table 7). neonates was found to be more than female neonates
(27.3 vs. 14.3%). However, when the incidence of hypo-
Various researchers have used different definitions
glycemia was compared with each other it was conclud-
of hypoglycemia, a variety of methods of detection of
ed that hypoglycemia in exclusively breastfed high-risk
hypoglycemia and their studies have used different in-
newborns, did not have any sex predilection (p: 0.45).
clusion and exclusion criteria for their studies. Hence we
This observation was similar to the studies conducted
see a wide variation in the incidence figures. Population
by Saini A, et al. [10] from Haryana, India in the year
characteristics may also have led to variation in the fig-
2018, and a study conducted by Jonas D, et al. [20] from
ures of incidence.
Feldkirch, Austria the year 2014.
The relatively high incidence of hypoglycemia in this
We found that the incidence of hypoglycemia in
study amongst exclusively breastfed high-risk neonates
newborns was higher when maternal age was more
born in a tertiary care hospital in Meghalaya could be
than ≥ 30 years, but the results were different from the
attributed to certain population characteristics such as
study conducted by Kumar TJ, et al. [9] in the year 2018,
the high prevalence of multiparity and elderly gravidae.
where they found that the incidence of hypoglycemia in
Meghalaya has a TFR 3 (NFHS 4 data) [18] which is the
infants born to mothers less than 30 years of age was
second-highest in the country and much higher than
38%, while the incidence in infants born to ≥ 30 years
the national average of 2.2 [19]. This would have a cas-
was 18.9%. In our study, the enrolled subjects that were
cading effect and lead to preterm births, late preterm
more than 30 years usually had multiparity and poor
births, and the birth of low birth weight neonates. This
maternal health and had poor access to medical ser-
study also enrolled a relatively high number of Infants of
vices.
diabetic mothers which is a reflection of the high preva-
lence of diabetes in the population. In our study, the neonates of multigravida mothers

Patel et al. Int J Pediatr Res 2020, 6:066 • Page 6 of 7 •

DOI: 10.23937/2469-5769/1510066 ISSN: 2469-5769

had a higher incidence of hypoglycemia than primigrav- newborn infants with gestational age ≥ 35 weeks. Acta Pae-
idae. Similar results were obtained by Sasidharan CK, et diatr 109: 31-44.
al. [21]. But result was different in the study which was 4. Harris DL, Weston PJ, Harding JE (2012) Incidence of neo-
conducted by Purnima Samayam, et al. [22] in the year natal hypoglycemia in babies identified as at risk. J Pediatr
161: 787-791.
2015 where they found 23.07% of neonates born to
primiparous mothers had hypoglycemia, against 5.4% 5. Kaiser JR, Bai S, Gibson N, Holland G, Lin TM, et al. (2015)
Association between transient newborn hypoglycemia
neonates born to multiparous mothers. This finding can
and fourth-grade achievement test proficiency: A popula-
also be explained by the advanced age of the mothers tion-based study. JAMA Pediatr 169: 913-921.
(above 30 years) with poor maternal health and access
6. Lubchenco LO, Hansman C, Dressler M, Boyd E (1963)
to maternal health services in the multiparous mothers. Intrauterine growth as estimated. Pediatrics 32: 793-800.
The infants who were delivered by cesarean section 7. Jr WWH, Raju TNK, Higgins RD, Mbbs SCK, Devaskar
were found to be at higher risk for developing hypo- SU (2009) Knowledge gaps and research needs for under-
glycemia in our study (p-value: 0.04). Potential mech- standing and treating neonatal hypoglycemia: Workshop
report from eunice kennedy shriver national institute of child
anisms that might mediate this association include de-
health and human development. J Pediatr 155: 612-617.
layed lactogenesis, delayed skin-to-skin, and impaired
thermoregulation 8. Turner D, Monthé-Drèze C, Cherkerzian S, Gregory K, Sen
S (2019) Maternal obesity and cesarean section delivery:
Conclusion additional risk factors for neonatal hypoglycemia? J Perina-
tol 39: 1057-1064.
The present study has shown that the incidence of 9. Kumar TJ, Vaideeswaran M. AST (2018) Incidence of hy-
hypoglycemia was high in high-risk newborns. The blood poglycemia in newborns with risk factors. Int J Contemp
glucose level of a newborn was affected by maternal Pediatr 5: 1952-1955.
factors like - parity of mother, maternal age, maternal 10. Saini A, Gaur BK, Singh P (2018) Hypoglycemia in low birth
morbidity, mode of delivery, and neonatal risk factors weight neonates: Frequency, pattern, and likely determi-
like gestational age and birth weight. There is no associ- nants. IJCP 5: 526-532.
ation between blood glucose level and sex of neonate, 11. Mehta YP, Munde BP (2017) Study of blood sugar levels in
residence & religion of mother, and APGAR score. high risk neonates using glucometer method and laboratory
glucose oxidase peroxidase method. Int J Contemp Pediatr
We conclude that healthy high-risk newborns in the 4: 1185.
postnatal ward can be exclusively breastfed, but their
12. Atrushi AM (2016) Frequency and risk factors of hypogly-
blood glucose levels need to be monitored at least for caemia in neonatal nursery in duhok. ISRA Med J 8: 39-42.
the first 72 hours with the greatest emphasis on the first
24 hrs and asymptomatic hypoglycemia in newborns 13. Zhou W, Yu J, Wu Y, Zhang H (2015) Hypoglycemia in-
cidence and risk factors assessment in hospitalized neo-
need to be detected and managed promptly. nates. J Matern Neonatal Med 28: 422-425.
Acknowledgment 14. Kanagagiri R, Y TS, Suryaprakash T (2018) Incidence of
hypoglycemia in high risk neonates and its relationship with
Dr. Parth Patel was the principal investigator and the gestational age birth weight and ponderal index. IOSR J
corresponding author; Dr. Palash Ranjan Gogoi and Dr. Dent Med Sci 17: 20-26.
Santanu Deb were co-investigators; Dr. Prasenjit Paul, 15. Singh YP, Devi TR, Gangte D, Devi TI (2014) Hypoglyce-
Dr. Pramod Paharia, Dr. Sabrina Yesmin, and Dr. Lima mia in newborn in Manipur. J Med Soc 280: 108-111.
Sangla Jamir with all other authors prepared and re- 16. Das A, Kallem VR, Sharma V, Nath S (2019) Hypoglycemic
viewed the manuscript. profile of exclusively breastfed low birth weight neonates.
Indian J Pediatr 86: 299-300.
Funding
17. Bromiker R, Perry A, Kasirer Y, Einav S, Klinger G, et al.
None. (2017) Early neonatal hypoglycemia: incidence of and risk
factors. A cohort study using universal point of care screen-
Conflict of Interest ing. J Matern Neonatal Med 32: 786-792.
None. 18. (2016) National Family Health Survey - 4. State Fact Sheet
Meghalaya.
References 19. National Family Health Survey, India.
1. Cornblath M, Hawdon JM, Williams AF, Aynsley-green A,
20. Stark J, Simma B, Blassnig-ezeh A (2019) Incidence of hy-
Ward-platt MP, et al. (2000) Controversies regarding defi-
poglycemia in newborn infants identified as at risk. J Matern
nition of neonatal hypoglycemia : Suggested operational
Neonatal Med, 1-6.
thresholds. Pediatrics 105: 1141-1145.
21. Sasidharan CK, Gokul E, Sabitha S (2004) Incidence and
2. Murty VY, Ram KD (2012) Study of pattern of blood sug-
risk factors for neonatal hypoglycaemia in Kerala, India.
ar levels in low birth weight babies who are exclusively on
Ceylon Med J 49: 110-113.
breast milk. J Dr NTR Univ Heal Sci 1: 90-93.
22. Samayam P, Balasundaram R (2015) Study of asymptom-
3. Wackernagel D, Gustafsson A, Edstedt Bonamy A, Reims
atic hypoglycemia in full term exclusively breastfed neo-
A, Ahlsson F, et al. (2019) Swedish national guideline for
nates in first 48 hours of life. J Clin Diagnostic Res 9: 7-10.
prevention and treatment of neonatal hypoglycaemia in

Patel et al. Int J Pediatr Res 2020, 6:066 • Page 7 of 7 •