The screening and management of newborns at risk for low blood glucose

Abstract

Hypoglycemia in the first hours to days after birth remains one of the most common conditions facing practitioners across Canada who care for newborns. Many cases represent normal physiologic transition to extrauterine life, but another group experiences hypoglycemia of longer duration. This statement addresses key issues for providers of neonatal care, including the definition of hypoglycemia, risk factors, screening protocols, blood glucose levels requiring intervention, and managing care for this condition. Screening, monitoring, and intervention protocols have been revised to better identify, manage, and treat infants who are at risk for persistent, recurrent, or severe hypoglycemia. The role of dextrose gels in raising glucose levels or preventing more persistent hypoglycemia, and precautions to reduce risk for recurrence after leaving hospital, are also addressed. This statement differentiates between approaches to care for hypoglycemia during the ‘transitional’ phase—the first 72 hours post-birth—and persistent hypoglycemia, which occurs or presents for the first time past that point.

Evaluating antenatal breastmilk expression outcomes: a scoping review

“…The most commonly reported outcomes focused on the collection and use of colostrum, breastfeeding status and success at various time points, and outcomes related to newborn health and safety. Documentation of the volumes of colostrum that mothers express, and the amount administered to newborns is important to provide insight into the impact of using expressed breastmilk on newborn health versus with standardized newborn hypoglycemia management protocols which can include enteral feeds of breastmilk, breastmilk substitutes, intrabuccal dextrose gel, or intravenous glucose to stabilize newborn blood glucose levels [ 51 ]. Outcomes related to breastfeeding success and status were common among the studies included in this scoping review, however breastfeeding success was often not defined and duration of participant follow-up varied greatly.…”

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

“…27 Maternal and infant categories at increased risk for hypoglycemia are listed in Table 2. [47][48][49] Large for gestational age infants born to screened nondiabetic mothers appear not at risk of hypoglycemia 50 nor at increased risk of poor psychomotor development at 4 years of age. 51 Umbilical cord blood glucose does not seem to predict early hypoglycemia.…”

“…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).…”

Pathogenesis and Prevention of Fetal and Neonatal Brain Injury

“…Current screening and management guidelines are that neonates with hypoglycemia persisting beyond the first 72 should be investigated further when levels remain ≤2.8 mmol/L, and ≥ 3.3 mmol/L should be the therapeutic glucose target level in symptomatic/at risk infants. Also, before discharge, those experiencing persistent hypoglycemia should have a 5-6 hour fast, while maintaining blood glucose levels ≥3.3 mmol/L, to ensure safety at home [39].…”