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Cited by 122Neonatal Health and BiochemistryInfant Development and Preterm CareMetabolism and Genetic Disorders

Screening guidelines for newborns at risk for low blood glucose

Open access
Aziz, K, Dancey, P, Canadian Paediatric Society, Fetus and Newborn Committee·2004·Paediatrics & Child Health
DOI 10.1093/pch/9.10.723PMC PMC2724150
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Abstract

Despite decades of scientific observation, investigation and discussion, there is limited evidence-based consensus regarding the screening and management of infants at risk for neonatal hypoglycemia. A number of questions remain unresolved: How is neonatal hypoglycemia defined? Who is at risk for neonatal hypoglycemia? When should at-risk infants be screened? How should screening for neonatal hypoglycemia be performed? What levels of blood glucose require intervention? What interventions should be offered when neonatal hypoglycemia is suspected? How frequently should asymptomatic, at-risk infants be screened? How should caregivers be educated or counselled regarding screening for neonatal hypoglycemia? Given the paucity of evidence, the purpose of the present statement is to provide a consensus guideline that has practical applications for Canadian newborns and their caregivers. An algorithm has also been developed to give direction in managing infants at risk for neonatal hypoglycemia, see Figure 1. It should be noted that this guidelines is a pragmatic approach, one that will require refinement as futher scientific data become available. A MEDLINE search was performed for studies up to March 2004 using the key words “Hypoglycemia”, “Blood Glucose” and “All Infant: birth-23 months”, limited to “Human”, “English” and “French”, and including all trials, reviews, clinical practice guidelines, follow-up studies and meta-analyses. The Cochrane Database was searched for reviews and articles relating to glucose and infant feeding. It is noteworthy that no randomized clinical trials were found relating to strategies for screening for neonatal hypoglycemia in at-risk infants. All case-control and cohort studies were reviewed. Levels of evidence and grades of recommendations (Tables 1 and 2) were assigned according to the Oxford Centre for Evidence-Based Medicine guidelines [1]. Levels of evidence Adapted with permission from reference [1] Grades of recommendation Adapted with permission from reference [1] Neonatal hypoglycemia cannot be defined by a single value of glucose applicable to all clinical situations and to all infants. It appears that infants may develop signs suggestive of hypoglycemia over a range of blood glucose levels that is substantially lower than normal adult levels. “In approximate order of frequency there are jitteriness or tremors, apathy, episodes of cyanosis, convulsions, intermittent apneic spells or tachypnea, weak or high-pitched cry, limpness or lethargy, difficulty in feeding, and eye rolling. Episodes of sweating, sudden pallor, hypothermia, and cardiac arrest and failure also occur. There is frequently a clustering of episodic symptoms. Because these clinical manifestations may result from various causes, it is critical to measure serum glucose levels and to determine whether they disappear with the administration of sufficient glucose to raise the blood sugar to normal levels; if they do not, other diagnoses must be considered” [2]. So-called ‘normal ranges’ are presumably dependent on the infant’s size, gestation and clinical condition, as well as the availability of energy sources and ongoing energy demands. Definitions of hypoglycemia should be flexible enough to encompass all of these groups. There are three approaches to defining a safe range for blood glucose [3]: Using normative ranges: Studies of exclusively breastfed, appropriate-for-gestational-age, term babies, show that blood glucose falls immediately after birth from two-thirds of maternal levels to the 5th percentile of approximately 1.8 mmol/L at 1 h of age (Level 2b) [4],[5]. There is a subsequent rise to levels over 2.0 mmol/L that is maintained for 72 h [6]. It is important to note that 12% to 14% of normal, appropriate-for-gestational-age, breastfed newborns have a blood glucose level of less than 2.6 mmol/L in the first three days of life [7]. Using the presence or absence of sequelae: A number of studies in at-risk term, preterm and small-for-gestational-age (SGA; weight at less than the 10th percentile) infants have suggested an association of blood glucose levels of less than 2.6 mmol/L with abnormal short- (Level 4) and long-term neurological (Level 2a) or neuroimaging changes (Level 4) [2],[8]–[14]. Data from infants of diabetic mothers (IDMs) suggest that long-term outcome may be negatively affected at lower levels (less than 1.6 mmol/L). Unfortunately, given the wide range of normal blood glucose levels found in newborns and the variety of causes of low blood glucose, cohort and case-control studies cannot determine whether low blood glucose is the direct cause of an adverse outcome or simply an associated finding. Using prospective clinical trials to determine whether the benefit of intervention outweighs the short- and long-term risks: Unfortunately, there are no randomized controlled trials of interventions at differing thresholds. It must also be recognized that there are differences between capillary

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Authors
Aziz, K., Dancey, P., Canadian Paediatric Society, & Fetus and Newborn Committee
ORCID
Venue
Paediatrics & Child Health
Publisher
Oxford University Press (OUP)
Published
2004-12-01
Volume
9
Issue
10
Pages
723-729
ISSN
  • 1205-7088 (ISSN-L)
  • 1918-1485
DOI
10.1093/pch/9.10.723
PMC
PMC2724150
OpenAlex
W2305282041
Cited by
122
References
60
Citations by year
2026: 1 · 2025: 1 · 2024: 4 · 2023: 8 · 2022: 5 · 2021: 7 · 2020: 10 · 2019: 11 · 2018: 12 · 2017: 10 · 2016: 10 · 2015: 11 · 2014: 8 · 2013: 3 · 2012: 6
FWCI
0.88
Type
journal article
Language
en
Open access
Locations
  • Paediatrics & Child Health (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Neonatal Health and Biochemistry
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Metabolism and Genetic Disorders
Keywords
neonatal hypoglycemia, newborn screening, high-risk infants, blood glucose threshold, hypoglycemia definition, hypoglycemia prevention, infant feeding, caregiver education, consensus recommendations, level of evidence, grades of recommendation, hypoglycemia severity

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