The management of low blood glucose concentrations in the first 48 h of life is one of the most frequently encountered issues the clinician faces in the newborn nursery. The blood levels of glucose upon which we base our decision-making remain more a matter of expert opinion rather than being evidence-based, and a consensus on blood glucose levels that should be treated in the newborn has not been definitive enough to gain consensus.
This lack of consensus has led to further confusion for the clinician as two pediatric organizations, the Committee on the Fetus and Newborn from the American Academy of Pediatrics (AAP) and the Pediatric Endocrine Society (PES), have recently provided expert opinion on the management of neonatal hypoglycemia that suggested different ranges of actionable blood glucose levels. The AAP guidance applies only to the first 24 h of life, while the PES strategy focuses on infants beyond 48 h of life with the emphasis on assuring that cases of persistent hypoglycemia are identified before these infants are discharged.
This chapter will provide an approach to neonatal hypoglycemia that incorporates both opinions and will provide management that meets the newborns’ energy requirements while still promoting successful breastfeeding and preventing unnecessary NICU admissions.
Hypoglycemia Glucose LGA (large for gestational age) SGA (small for gestational age) Infant of a diabetic mother Late preterm
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Adamkin D. Committee on fetus and newborn. Postnatal glucose homeostasis in late-preterm and term infants. Pediatr. 2011;127(3):575–9.CrossRefGoogle Scholar
Thornton PS, Stanley CA, DeLeon DD, Harris D, Haymon MW, Hussain K, et al. Recommendations from the pediatric Endocrine Society for evaluation and management of persistent hypoglycemia in neonate, infants, and children. J Pediatr. 2015;167:238–45.CrossRefGoogle Scholar
Adamkin D. Hypoglycemia. In: Polin R, Yoder M, editors. Workbook in practical neonatology. 5th ed. New York: Saunders; 2014. p. 47.Google Scholar
Harris DL, Weston PJ, Signal M, Chase JG, Harding JE. Dextrose gel for neonatal hypoglycaemia (the sugar babies study): a randomized, double-blind, placebo-controlled trial. Lancet. 2013;382:2077–83.CrossRefGoogle Scholar
Harris DL, Alsweiler JM, Ansell JM, Gamble GD, Thompson B, Wouldes TA, et al. Outcome at 2 years after dextrose gel treatment for neonatal hypoglycemia: follow-up of a randomized trial. J Pediatr. 2016;170:54–9.CrossRefGoogle Scholar
Hoseth E, Jorgensen A, Ebbesen F, Moeller M. Blood glucose levels in a population of healthy, breastfed, term infants of appropriate size foe gestational age. Arch Dis Child Fetal Neonatal Ed. 2000;83(2):F117–9.CrossRefGoogle Scholar
Cornblath M, Hawdon JM, Willams AF, Aynsley-Green A, Ward-Platt MP, Schwartz R, et al. Controversies regarding definition of neonatal hypoglycemia: suggested operational thresholds. Pediatrics. 2000;105(5):1141–5.CrossRefGoogle Scholar
Cornblath M. Reminiscence of a 50 year adventure. NeoReviews. 2006;90(2):74–86.Google Scholar
Rozance P, Hay W. Hypoglycemia in newborn infants: features associated with adverse outcomes. Biol Neonate. 2006;90:74–86.CrossRefGoogle Scholar
Altimier L, Roberts W. One touch ll hospital system foe neonates: correlation with serum glucose values. Neonatal Netw. 1996;15(2):15–8.PubMedGoogle Scholar