Background Information

Risk Factors

Risk factors for hypoglycaemia in full-term infants include:

• Maternal diabetes
• Maternal use of beta blockers (3rd trimester/ at time of birth)
• Infants with fetal growth restriction

Guidelines

Investigation and Diagnosis

BAPM recommends that ward-based blood gas analysers can provide accurate and rapid measurement of neonatal blood glucose concentration.

• Neonatal hypoglycemia diagnostic threshold: <2.6 mmol/L 
  • Severe neonatal hypoglycaemia: <1 mmol/L

Routine neonatal glucose monitoring is indicated if there are risk factors for neonatal hypoglycemia (not routinely offered)

• Maternal diabetes
• Maternal use of beta blockers (3rd trimester/ at time of birth)
• Infants with fetal growth restriction

Management

Management largely depends on whether the infant is symptomatic or not and on the blood glucose level.

IV glucose is indicated if:

• Baby is symptomatic, or
• Blood glucose <1.0 mmol/L

Asymptomatic

Feeding interventions can be trialled first:

• Increase breastfeeding frequency
• Supplementing with formula feed is usually sufficient
• Consider buccal glucose gel

Re-check blood glucose in 1 hour to ensure there has been a response.

If feeding interventions are not effective → IV glucose 10% infusion.

Symptomatic OR Blood Glucose <1.0 mmol/L

Treat immediately with IV glucose 10% infusion (2.5 mL/kg)

• If there is a delay in obtaining IV access → consider buccal glucose gel / IM glucagon

References

Original Guideline