Committee issues guidance on neonatal hypoglycemia

Recognizing infants at risk of neonatal hypoglycemia and instituting early measures to prevent and treat low glucose concentrations are the subject of a clinical report published in the March issue of Pediatrics.

The Committee on Fetus and Newborn offers up the guidance because of an absence of evidence to define clinically important neonatal hypoglycemia, and managing it remains largely empirical.

Infants most at risk of neonatal hypoglycemia are those who are small for gestational age, whose mothers have diabetes, and those who are late preterm. Another group at risk are infants who are large for gestational age. Blood glucose screening should focus on these infants, according to the committee.

Late-preterm infants and infants who are small for gestational age should be screened before each feeding (every 2 to 3 hours) for at least the first 24 hours. Screening should continue beyond 24 hours if plasma glucose concentration remains lower than 45 mg/dL.

Infants with clinical signs of hypoglycemia-jitteriness, cyanosis, seizures, apnea, tachypnea, weak or high-pitched cry, lethargy, floppiness, poor feeding, or eye rolling-should have their plasma or blood glucose concentration measured as soon as possible.

Rapid measurement of blood glucose concentration can be achieved with a bedside reagent test-strip glucose analyzer, although their accuracy may be off as much as 20 mg/dL. For this reason, the level obtained with any rapid bedside analyzer must be confirmed by laboratory testing ordered stat.

“The definition of a plasma glucose concentration at which intervention is indicated needs to be tailored to the clinical situation and the particular characteristics of a given infant,” the researchers write. A reasonable cutoff for treating symptomatic infants with IV glucose is 40 mg/dL, with a reasonable goal being maintenance of plasma glucose level in the range of 40 mg/dL to 50 mg/dL.

In at-risk asymptomatic infants from birth to 4 hours of age, if the glucose concentration at the initial screen is

In asymptomatic infants who are 4 to 24 hours old, if the glucose concentration at the initial screen is

Committee on Fetus and Newborn. Postnatal glucose homeostasis in late-preterm and term infants. Pediatrics. 2011;127(3):575-579.