Hypoglycemia is when a person’s blood glucose levels fall below normal levels to a level that causes the brain not to function normally. As a result, the brain shuts down functions that it does not feel are necessary.
This may lead to varied reactions that can cause catastrophic impacts, particularly on an infant. Our birth injury lawyers have seen cases where the child has a blood glucose level of literally zero. The risks of this kind of severe hypoglycemia include loss of cognitive function, speech problems, and anxiety attacks, among others.
Hypoglycemia can often go undiagnosed as symptoms are sometimes mild and resolve after eating foods or fluids containing carbohydrates. However, some more severe health issues can lead to hypoglycemia, including liver or pancreatic problems and diabetes mellitus. Hypoglycemia must be diagnosed early to ensure no more serious issues are involved during the pregnancy.
Studies show that low blood sugar in newborns can increase the chances of various issues such as learning difficulties, seizures, trouble focusing, delays in development, excessive activity, and conditions like autism. In the beginning, these low sugar levels might not show any obvious signs or may only appear as slight sweating, tiredness, feeding problems, and reduced alertness. These subtle symptoms can make it difficult for doctors who are not dialed into the risks to detect a hypoglycemia brain injury before it is too late.
Three Kinds of Hypoglycemia
The three types of hypoglycemia that impact newborns are:
- Transitional Hypoglycemia: This affects all healthy newborns during their first few days after birth.
- Perinatal Stress-Induced Hypoglycemia: This happens to some high-risk newborns, approximately 1 in 1,200.
- Genetic Congenital Hyperinsulinism (CHI): This genetic condition – which is also called hyperinsulinemic hypoglycemia (HH) – affects a smaller number of newborns, around 1 in 10,000 to 40,000. In about half of the patients, we still don’t know what causes CHI.
What Causes Hypoglycemia in Newborns?
Several factors can contribute to hypoglycemia in newborns. Most of these medical malpractice lawsuits come in to meet the standard of care, and it is crucial to promptly identify and treat this condition before it spirals out of control. Here are some common causes of hypoglycemia in newborns:
- Insufficient Glycogen Stores: Newborns rely on stored glycogen (a form of glucose) in their liver for a steady supply of glucose. Some babies may have limited glycogen stores at birth, making them more susceptible to hypoglycemia brain damage.
- Prematurity: Premature babies are at a higher risk of a hypoglycemia brain injury because they often have lower glycogen stores and may not fully develop the mechanisms to regulate blood sugar levels, diminished insulin reaction to glucose, and limited fat reserves.
- Low Birth Weight: Babies with a low birth weight – usually but not always premature – are more likely to experience hypoglycemia because they have fewer glycogen reserves.
- Inadequate Feeding: One of the most common causes of neonatal hypoglycemia is inadequate feeding, especially during the first few days of life. This is why doctors have to stay vigilant. If newborns do not receive enough breast milk or formula, their blood sugar levels can drop.
- Delayed Feeding: Some newborns may experience delayed initiation of breastfeeding or formula feeding, which can lead to a gap in the glucose supply.
- Maternal Diabetes: Babies born to mothers with diabetes of any type are at greater risk for hypoglycemia because they are accustomed to higher glucose levels during pregnancy. After birth, their insulin production may exceed their glucose needs.
- Excessive Insulin Production: In some cases, newborns produce excessive amounts of insulin which can lead to hypoglycemia brain injury. Why? As we discuss above, when you continuously produce insulin, it lowers your blood sugar level, resulting in hypoglycemia.
- Inborn Errors of Metabolism: Inborn errors of metabolism, often referred to as metabolic disorders or inborn errors, are a group of rare genetic conditions that affect the body’s ability to process specific substances, leading to problems with normal metabolic functions. These disorders typically result from gene mutations responsible for enzymes or proteins in various metabolic pathways. As a result, individuals with inborn errors of metabolism may have difficulties breaking down certain substances, leading to the accumulation of toxic byproducts or the deficiency of essential molecules.
- Stress or Illness: Stressors like infection, oxygen deprivation during birth – which is strongly associated with medical malpractice – or respiratory distress can trigger the release of stress hormones, which may interfere with glucose regulation that can lead to a hypoglycemic brain injury.
- Medications: Some medications administered to the mother during labor and delivery, such as magnesium sulfate, can affect a newborn’s blood sugar levels.
- Post C-Section: Low blood sugar (hypoglycemia) can occur in newborns after a C-section birth, just as it can after a vaginal birth. After a C-section, the newborn may experience a delay in initiating breastfeeding or receiving formula. Early and frequent feedings are essential to help regulate any low blood sugar after a C-section. Medications administered to the mother during the C-section, such as anesthesia or medications for pain management, can also temporarily affect the baby’s blood sugar.
Symptoms of hypoglycemia during pregnancy are similar and include shaking, sweating, hot flashes, anxiety attacks, intense hunger, dizziness, headache, confusion, vision difficulties, and sudden irritability. Hypoglycemia in pregnancy is usually not diagnosed until labor, though symptoms may be present – and needs to be diagnosed – before that time.
How to Spot Malpractice
Normal glucose is between 60 and 100 mg/dl. Anything lower than that could deprive the body’s cells of a vital energy source. Medical malpractice occurs when a physician ignores the mother’s complaints of hypoglycemia or blood work showing low blood sugar. As a doctor, you must pay attention and see what can be seen.
Similarly, medical malpractice may happen if a physician fails to respond to the child’s low blood sugar after birth. Hypoglycemia is a perfectly treatable condition, but it requires attention to the signs and symptoms.
More Information for Moms
Hypoglycemia should be treated immediately upon noticing symptoms to prevent effects such as low blood sugar and hypoglycemia in the unborn child. In diabetics, the risk of miscarriage, preterm birth (the most significant risk factor for hypoglycemia), stillbirth, fetal macrosomia (high birth weight), and congenital malformation increases with worsening glycemic control. Unfortunately, treatment can be complex as often pregnant women are prone to dizzy spells and loss of consciousness.
Preventative care includes proper nutrition and evenly spaced meals, which often includes consultations with a physician and dietician to ensure adequate glucose levels are maintained throughout the day for the duration of the pregnancy.
What a Hypoglycemia Malpractice Claim Looks Like
Let’s drill down on what a viable hypoglycemia birth injury medical malpractice lawsuit looks like.
In a situation where a newborn has hypoglycemia due to a missed diagnosis of the mother’s condition, here are the pieces to the medical malpractice puzzle that lead to high settlement compensation amounts or jury payouts
- The mother had an underlying condition, like diabetes, that could lead to hypoglycemia in her baby.
- There was a failure on the part of the doctor or other healthcare provider to recognize or diagnose that the mother had this condition that we all know puts the child at risk of a lifelong injury.
- This failure to see what was there to be seen with due diligence resulted in the newborn developing hypoglycemia.
- The newborn suffered severe harm or death due to this hypoglycemia.
The big thing in these cases our birth injury lawyers come back to is if a mother has diabetes, a medical professional should be able to detect it. Period. If the doctors do not detect it and the baby then suffers from hypoglycemia, that is medical malpractice.
Here is a short laundry list of the types of mistake our medical malpractice lawyers see in these hypoglycemia brain damage lawsuits:
- The doctors did not properly investigate or document the mother’s medical and family history, especially factors like family diabetes history.
- Necessary blood tests were not done or were not evaluated to assess the mother’s glucose levels.
- Early signs of hypoglycemia in the baby were overlooked.
- There was a delay when the baby showed signs and symptoms of hypoglycemia that led to a delay in treatment.
The Child’s Hypoglycemia
Neonatal hypoglycemia occurs when a newborn child’s blood sugar drops abnormally low. The appropriate levels change with age. But, by way of example, an average glucose level for a 40-minute-old child is approximately 40 mg/dL. Low blood sugar can cause brain starvation at a time when children need brain development the most. From the doctor’s standpoint, there is no sign that the child is injured – you must see the hypoglycemia coming.
How do you see the hypoglycemia coming? There are several risk factors. The most important is growth retardation with low birth weight. Additionally, the presence of possible fetal compromise, coupled with the need for post-delivery resuscitation, are risk factors for developing hypoglycemia. When you have these factors, glucose monitoring is indicated.
The peer-reviewed medical research clarifies that severe or prolonged hypoglycemia is associated with neurological injury in newborns. The probability is high that infants with severe hypoglycemia or abnormal imaging studies will manifest subsequent neurological and neurodevelopmental problems.
Why? Low oxygen levels (hypoxia) and certain signaling pathways in our body (Hypoxia Inducible Factor or HIF) might be responsible for telling a growing fetus when to start releasing insulin in response to low glucose levels. This is because babies develop in an environment with lower oxygen levels, and this changes once they are born.
Because neonatal hypoglycemia is a common disorder that may result in severe neurologic sequelae if left untreated, screening strips and devices should never be used as a basis for the diagnosis of neonatal hypoglycemia without confirming the diagnosis by measuring the plasma glucose in the laboratory utilizing something called the glucose oxidase method. Screening test results with blood glucose values less than 40mgs/dL should be immediately followed with this better test.
How do you treat a baby with hypoglycemia? Treating a baby with hypoglycemia can be as easy as giving the child a glucose and water mixture. The key is getting the glucose levels right. The failure to take the most straightforward steps to help the child can lead to lifelong injuries that change the future of a newborn baby.
How Do You Know If Your Child Suffered a Hypoglycemia Birth Injury?
Initially, knowing whether your child has a birth injury is hard. The signs of hypoglycemia during infancy are subtle and nonspecific. They include irritability, hypotonia, jitteriness, hypothermia, lethargy, and poor feeding.
Another sign of a problem is a delay in reaching developmental milestones. But children miss milestones for many reasons, many of which are harmless and will resolve quickly or over time. Indeed, if there is evidence in the child’s records that suggests the possibility of a brain injury and there are significant delays in meeting milestones, the child may get an MRI that looks to see if there is a loss of white matter loss in the brain.
Brain damage from hypoglycemia often shows on an MRI as “diffuse lesions” in the brain. Periventricular leukomalacia is a brain injury that can be caused by hypoglycemia. But it is the most common ischemic brain injury in premature infants, so medical experts are critical to identifying whether the injury was from hypoglycemia. Another possible sign of hypoglycemia brain injury is that some experts say that hypoglycemia injuries tend to be occipital injuries.
- An example is the hypoglycemia birth injury lawsuit filed against St. Agnes in Baltimore City after the hospital allegedly failed to properly diagnose and treat a fetus whose brain was deprived of glucose.
- Gestational diabetes malpractice lawsuits
Hypoglycemia Birth Injury Settlements and Verdicts
We have not seen many hypoglycemia settlements and verdicts. Why? Few hypoglycemia or birth injury cases settle before trial with ironclad confidentiality clauses.
- C.M.G. v. Banner Health (Colorado 2022) $27 million: The plaintiff, born at 37 weeks and at risk for hypoglycemia, reportedly was diagnosed with e. coli sepsis, meningitis, metabolic acidosis, coagulopathy, and developed jaundice a few days after her birth, complicated by vacuum assistance and a diabetic mother. The infant suffered permanent brain injuries. The lawsuit alleged that the defendant’s staff was negligent in deviating from the standard of care by failing to diagnose and treat the infection promptly, properly monitor her, and promptly notify physicians of her worsening condition.
- E.G. v. Loma Linda Univ. Medical Center (California 2020) $2.5 million: A newborn baby boy reportedly sustained broad-scale and permanent neurological brain injuries from suffering hypoxic-ischemic encephalopathy during his birth at defendant Loma Linda University Medical Center. Contended the defendant’s staff failed to appreciate that E.G. was evidencing distress in utero and failed to deliver the baby in a timely manner, sending him to the NICU with respiratory failure-meconium aspiration syndrome, cardiopulmonary failure, hypoglycemia, neonatal encephalopathy, and metabolic acidosis.
- Trabue v. Atlanta Women’s Specialists (Georgia 2017) $45 million: The plaintiff was 38 years old, significantly overweight, and with an extensive history of preeclampsia and blood pressure issues. Three days after a C-section delivery, she suffered a cardiopulmonary arrest, causing a hypoxic brain injury that left her completely mentally disabled and requiring care and assistance for the rest of her life. She sued the doctors for negligently failing to recognize and manage the risks presented by her preeclampsia and post-delivery blood pressure. Defendants insisted that their pre-delivery labs and testing did not indicate preeclampsia. The jury in Atlanta’s Fulton County found in favor of the plaintiff and awarded a staggering $45 million in damages.
- Plaintiff Mother v. Defendant OB/GYN (New York 2017) $975,000: Mid-30s plaintiff experienced severe preeclampsia before and during delivery. After delivery, the headaches and hypertension from the preeclampsia continued. Still, she was discharged from the hospital anyway. 2 days after her discharge, she called the doctors complaining that her headaches were worse, but they told her to take pain medication. The following day, she suffered a large hemorrhagic stroke. The plaintiff sued for malpractice, claiming she should not have been discharged due to her significant preeclampsia. The plaintiff also alleged that the doctor should have told her to go to the hospital when she called about her headaches. Defendants disputed proximate cause and claimed that it would not have prevented her stroke even if she had been told to go to the hospital. The case settled just before trial for just under policy limits at $975,000.
- OG Pro Ami v. Kaiser Foundation Hosp. (California 2016) $4.5 million: The Plaintiff had diabetes and allegedly exhibited preeclampsia symptoms, including a headache and blurred vision. Despite these indications of preeclampsia, doctors did not perform an immediate C-section delivery. Instead, they waited another two weeks. The plaintiff claimed that this delay was negligent and resulted in the baby suffering a hypoxic brain injury. The baby was born with spastic cerebral palsy and had significant mental and physical disabilities. The case settled before trial with $2 million of the settlement put into an annuity and $1,296,266 to be placed into a special needs trust.
- Santiago Guzman v. USA (New York 2015) $4.6 million: The Plaintiff, a 20-year-old single mother, alleged that the defendant failed to recognize signs of preeclampsia, including leg edema and rapid weight gain. Despite these symptoms, the defendant sent her home instead of admitting her to the hospital, where her blood pressure could have been monitored. By the time the baby was eventually delivered the next week, the mother had severe preeclampsia, and her blood pressure reached 210/120 at one point. The baby was born healthy, but the mother claimed to suffer permanent physical injuries and could not walk without a mobility aid.
What are the Signs and Symptoms of Infant Hypoglycemia?
Infants with hypoglycemia often display no physical symptoms at all. Symptoms typically include pale or blue-colored skin (cyanosis), rapid breathing or apnea, lethargy, and floppy muscle tone.
How is Infant Hypoglycemia Diagnosed?
Hypoglycemia in a newborn can be definitively diagnosed with a blood glucose test. The key is for doctors to recognize symptoms of infant hypoglycemia, identify babies at higher risk, and perform the blood test immediately. Early diagnosis is critical to avoid permanent harm to the baby.
How is Infant Hypoglycemia Treated?
Treatment for infant hypoglycemia usually involves giving the baby dextrose (glucose) through an IV to immediately increase the glucose levels in the baby’s blood to acceptable levels. If a dextrose IV is not an option, glucagon can be administered subcutaneously.
What Are Possible Complications from Infant Hypoglycemia?
If infant hypoglycemia is not promptly diagnosed and effectively treated, it can result in neurologic damage, resulting in permanent disabilities such as cerebral palsy.
Getting a Birth Injury Lawyer to Fight for Your Family
If you believe your child has a brain injury from hypoglycemia, you may have a medical malpractice case for which you and your child could receive compensation. If so, call 800-553-8082 or get a free online consultation to determine if our law firm can help you.