Screening and Management of at-risk Infants for Hypoglycemia


Dr Ashok Kumar Deorari    16 January 2018

  1. The most concerning outcomes of neonatal hypoglycemia are seizures that may progress to coma and death or severe neurodevelopmental abnormalities even a single episode of hypoglycemia (40 mg/dL) soon after birth has been found to be associated with a 50% reduction in the odds of achieving proficiency in literacy and numeracy at 10 year.
  2. In a study by Burns et al, 65% of term neonates with symptomatic hypoglycemia in the early neonatal period had abnormal neurodevelopmental outcome at 18 months.
  3. Clinical signs specifi c to hypoglycemia – Majority of hypoglycemic infants are asymptomatic; nonspecifi c signs include poor suck or diffi culty in feeding, weak cry, jittery, lethargy, convulsion, apnea. It is important to identify at risk newborns. Perform screening in a timely manner.
  4. At risk newborn identifi cation – Preterm, late preterm, SGA and LGA, LBW (<2,000 gm), infant of diabetic mother, hypothermia (<36.5°C), sick newborn.
  5. Time and schedule of screening:
CategoryTime schedule
At risk neonates2, 6, 12, 24, 48 and 72 hours of life
Sick neonates (sepsis, asphyxia, polycythemia, shock/during acute phase of illness)Every 6-8 hours (individualize as needed)
Neonates on parenteral nutritionInitial 72 hours – every 6-8 hours; after 72 hours – once a day
  1. Point of care reagent strips (glucose oxidase method) is a widely used method of glucose estimation. This method is unreliable, especially at levels where therapeutic intervention is required. It is useful for screening but low values need confirmation by lab.
  2. For glucose estimation, arterial samples have slightly higher value compared to venous or capillary samples. Stored samples give fallaciously low readings.
  3. Plan for management:
Feed trialYesNo
10% Dextrose bolusNoYes
Low sugar persistsStart IVFIncrease GIR
  1. Hypoglycemia is not a complete diagnosis. Treating hypoglycemia alone is not enough. Always identify the underlying cause and treat it.

To comment on this article,
create a free account.

Sign Up to instantly get access to 10000+ Articles & 1000+ Cases

Already registered?

Login Now

Most Popular Articles

News and Updates

eMediNexus provides latest updates on medical news, medical case studies from India. In-depth medical case studies and research designed for doctors and healthcare professionals.