Healthy term newborns have great nutritional and metabolic adaptive capabilities. Early and exclusive breastfeeding meets their needs.

Usually severe or recurrent or prolonged clinical hyperinsulinemic hypoglycemia causes neurological insult and it occurs in at risk babies. So always segregate babies “at risk” of hypoglycemia and monitor them:

1. SGA: <10th percentile wt or clinically evident wasting; LBW; prematurity (<35 weeks, or late preterm infants with clinical signs or extremely poor feeding); discordant twin weight 10% < larger twin; all infants of diabetic mothers, especially if poorly controlled; LGA: >90th percentile for weight and macrosomic appearance.
2. Perinatal stress: severe acidosis or hypoxia-ischemia; cold stress; suspected infection; respiratory distress.
3. Maternal drug treatment (e.g., terbutaline, beta-blockers, oral hypoglycemics).
4. Polycythemia (venous Hct >70%)/hyperviscosity; erythroblastosis fetalis; Beckwith-Wiedemann syndrome; microphallus or midline defect; known or suspected inborn errors of metabolism or endocrine disorders.
5. Infants displaying signs associated with hypoglycemia.

Rather than routine prelacteal formula or milk supplementation, give attention to general management recommendations for all term infants:

1. Act to support early (within 1st hour of birth); frequent (10-12 times/day in initial days); on demand cues; exclusive breastfeeding and promote skin-to-skin contact of mother with infant.
2. Help mother to provide stimulation to the breasts by manual or mechanical expression with appropriate frequency (>8 times/day) until baby is latching and suckling well to protect milk supply.

Routine monitoring of blood sugar in term newborns without risk factors is unnecessary and may be harmful.

We should technically train ourselves and staff in how to support breastfeeding. When we irrationally sanction prelacteal milk or formulas instead of trained support to breastfeeding, a mother without a trained support is itself now a risk factor for breastfeeding success!!