Swedish national guideline for prevention and treatment of neonatal hypoglycaemia in newborn infants with gestational age ≥35 weeks

Abstract

Aim Postnatal hypoglycaemia in newborn infants remains an important clinical problem where prolonged periods of hypoglycaemia are associated with poor neurodevelopmental outcome. The aim was to develop an evidence‐based national guideline with the purpose to optimise prevention, diagnosis and treatment of hypoglycaemia in newborn infants with a gestational age ≥35 + 0 weeks. Methods A PubMed search‐based literature review was used to find actual and applicable evidence for all incorporated recommendations. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach was used for grading the evidence of the recommendations. Results Recommendations for the prevention of neonatal hypoglycaemia were extended and updated, focusing on promotion of breastfeeding as one prevention strategy. Oral dextrose gel as a novel supplemental therapy was incorporated in the treatment protocol. A new threshold‐based screening and treatment protocol presented as a flow chart was developed. Conclusion An updated and evidence‐based national guideline for screening and treatment of neonatal hypoglycaemia will support standardised regimes, which may prevent hypoglycaemia and the risk for hypoglycaemia‐related long‐term sequelae.

ABM Clinical Protocol #1: Guidelines for Glucose Monitoring and Treatment of Hypoglycemia in Term and Late Preterm Neonates, Revised 2021

“…As the ''normal'' range of blood glucose is different for each newborn and depends upon a number of factors 13 including birth weight, gestational age, availability of energy stores, feeding status, and presence or absence of disease, any hypoglycemia management must account for the overall metabolic and physiologic status of the infant, and should not unnecessarily disrupt the mother-infant relationship and breastfeeding. Several authors have suggested algorithms for screening and treatment, 2,47,48,[77][78][79] and the United Nations Children's Fund (UNICEF UK) published a monograph on how to develop a policy on the prevention and management of newborn hypoglycemia. 80 Of the multiple guidelines, algorithms, and practice frameworks available, there are few that are as clear as those from the AAP, 2 the Canadian Paediatric Society, 47 the Swedish National Guideline, 78 and the British Association of Perinatal Medicine 79 as summarized by Dr. Jane Hawdon in 2019 81 (Fig.…”

“…Several authors have suggested algorithms for screening and treatment, 2,47,48,[77][78][79] and the United Nations Children's Fund (UNICEF UK) published a monograph on how to develop a policy on the prevention and management of newborn hypoglycemia. 80 Of the multiple guidelines, algorithms, and practice frameworks available, there are few that are as clear as those from the AAP, 2 the Canadian Paediatric Society, 47 the Swedish National Guideline, 78 and the British Association of Perinatal Medicine 79 as summarized by Dr. Jane Hawdon in 2019 81 (Fig. 1).…”

“…Routine supplementation of healthy term infants with water, glucose water, or formula is unnecessary and may interfere with normal metabolic compensatory mechanisms 3 and establishing normal breastfeeding. [82][83][84]90 47 Unwell or abnormal clinical signs at any time < 47 mg/dL (< 2.6 mmol/L) with risk factor(s) SN, 2020 78 < 27 mg/dL (1.5 mmol/L) < 47 mg/dL (2.6 mmol/L) with abnormal clinical signs < 27-45 mg/dL (1.5-2.5 mmol/L) X 2 Notes * any symptomatic infant with glucose <40mg/dL (2.22mmol/L will require IV glucose 5. Clinicians must identify and document risk factors, coexisting conditions, clinical signs/normality, and make assessments and decisions to avoid harm from hypoglycemia, but also to avoid iatrogenic harm, such as the effects of separation of mother and infant.…”

Highlights in this issue

“…Postnatal hypoglycaemia in newborn infants remains an important clinical problem, and prolonged periods of hypoglycaemia have been associated with poor neurodevelopmental outcomes. Wackernagel et al have developed evidence‐based Swedish national guidelines to optimise the prevention, diagnosis and treatment of hypoglycaemia in neonates born at 35 weeks of gestation or more.…”

Hypoglycemia in Exclusively Breastfed High-Risk Neonates - A Hospital-Based Study

“…an important priority to prevent hypoglycemia in newborn infants [3]. Certain risk groups, including small for gestational age infants, preterm infants, and infants of diabetic mothers, are at high risk of hypoglycaemia [4].…”