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Consider screening ‘at risk’ newborns for neonatal hypoglycemia

Adamkin DH. Pediatrics. 2011;doi:10.1542/peds.2010-3851.

Clinicians should consider screening “at-risk” newborns for neonatal hypoglycemia within the first few hours of birth and through multiple feed cycles to help them better predict acute or chronic irreversible neurological damage, according to a report issued this week by the American Academy of Physicians.

David H. Adamkin, MD, and members from the Committee on Fetus and Newborns recommended feeding late, preterm infants and small-for-gestational-age infants every 2 to 3 hours, and then screening those children during the refeedings for the first 24 hours.

“After 24 hours, repeated screening before feedings should be continued if plasma glucose concentrations remain lower than 45 mg/dL,” they wrote.

The committee noted that transient, asymptomatic blood glucose levels as low as 30 mg/dL are common after birth, and that the commonly accepted definition of neonatal hypoglycemia (less than 46 mg/dL) is controversial, so screening during this period remains controversial.

They also noted that babies that are small or large for gestational age, born to mothers with diabetes or that are born prematurely, at 34 to 36 weeks gestation, should be monitored. However, they cautioned, that clinical signs of neonatal hypoglycemia are "not specific” and researchers should consider other causes of illness.

“The definition of a plasma glucose concentration at which intervention is indicated needs to be tailored to the clinical situation and the particular characteristics of a given infant,” the researchers noted. “For example, further investigation and immediate IV glucose treatment might be instituted for an infant with clinical signs and a plasma glucose concentration of less than 40 mg/dL, whereas an at-risk but asymptomatic term formula-fed infant may only require an increased frequency of feeding and would receive IV glucose only if the glucose values decreased to less than 25 mg/dL (birth to 4 hours of age) or 35 mg/dL (4-24 hours of age).” They recommended considering glucose and consulting with an endocrinologist if levels remain persistently low, since that infant may be at risk for hyperinsulinemic hypoglycemia.

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