Let me paint a scene for you from a sleepy 2 a.m. call in the Special Care Baby Unit (SCBU) of our hospital. I had just finished convincing Dr. Faisal Afridi that no, orthopedics does not manage hypoglycemia (although he still offered to “cast the situation”), when a nurse rushed in from a cot labelled “Baby from Kohlu”. 👶
The baby was jittery, blue-lipped, breathing like he’d just sprinted across Saryab Road. My gut said hypoglycemia. And if you’ve ever had a sugar crash during a 36-hour call, you’ll empathize with the tiny patients.
Neonatal hypoglycemia is a clinical landmine. It’s common, sneaky, and if missed, can cause permanent neurodevelopmental damage — not something you want hanging over your head during rounds with Dr. Basit Khan grilling you on neonatal protocols.
📚 Mnemonic: “JITTERY BABY”
| Letter | Symptom | Clinical Tip |
|---|---|---|
| J | Jitteriness | Not the cute kind — rhythmic, high-frequency tremors |
| I | Irritability | Persistent crying, not just hunger screams |
| T | Tachypnea | RR > 60/min — often subtle |
| T | Temperature instability | Especially hypothermia; check axillary! |
| E | Eye-rolling / seizures | May mimic benign movements |
| R | Reduced feeding | Classic in sleepy hypoglycemic neonates |
| Y | Yawning (excessive) | Often overlooked; early CNS sign |
| B | Bradycardia | A late sign — act before this |
| A | Apnea | Common in preterms |
| B | Blue (cyanosis) | Especially perioral |
| Y | Yikes! (Hypotonia) | Floppy baby syndrome vibes |
🧠 Key Point: Always check blood glucose in any neonate who’s jittery, feeding poorly, or has unusual tone. You’re not being dramatic — you’re being medically literate.
👶 Clinical Glimpse: Baby from Kohlu, Balochistan
This was a preterm baby born via C-section, 34 weeks. Temp 35°C, jittery limbs, occasional apnea. Mother was GDM-positive but undiagnosed until delivery. Capillary blood sugar? 28 mg/dL. 😳
We immediately gave 2 mL/kg 10% dextrose IV bolus, started a maintenance drip, and monitored q30min. By morning, the baby was stable, feeding, and no longer doing Michael Jackson-style limb tremors.
💬 Pro Tip from the Ward
“Any unexplained neonatal weirdness? Sugar first. Everything else later.”
– Dr. Behroz Rahim, Psychiatrist by day, Neonatal sugar advocate by necessity.
I hope that you find this medical useful in your studies/clinical practice. Happy learning! 🙂
Authored by:
Dr. Aurangzaib Qambrani
MBBS | PLAB | MRCP-UK
General Medicine, Gastroenterology & CCU
Sheikh Khalifa Bin Zayed Hospital, Quetta 🏥
