Neonatal Hypoglycaemia

Neonatal hypoglycaemia results from inadequate glucose supply relative to metabolic demand. High risk infants include preterm infants, small or large for gestational age infants, infants of diabetic mothers, hypothermic infants, infants with perinatal hypoxia and sick neonates.

A practical treatment threshold commonly used in the first 72 hours is blood glucose below 2.6 mmol/L.

• Jitteriness
• Tremors
• Irritability
• Poor feeding
• Lethargy
• Hypotonia
• Hypothermia
• Tachypnoea
• Apnoea
• Cyanosis
• Seizures

Symptoms are nonspecific. Measure glucose rather than relying on clinical appearance.

Check blood glucose urgently in symptomatic or high risk neonates.

Persistent or recurrent hypoglycaemia beyond the expected transitional period should prompt investigation for hyperinsulinism, endocrine deficiency or metabolic disease.

For symptomatic hypoglycaemia or glucose below approximately 1.8 mmol/L:

• Give 10% dextrose 2 mL/kg IV over approximately 3 minutes, then immediately commence a glucose containing maintenance infusion.

• Recheck glucose after approximately 30 minutes.

• Introduce expressed breast milk as soon as clinically possible.

Asymptomatic mild hypoglycaemia can often be managed initially with prompt feeding and close repeat glucose measurement.

Persistent hypoglycaemia requires increased glucose delivery and senior paediatric assessment.