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Dr Ashok Kumar Deorari 16 January 2018

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.
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.
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.
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.
Time and schedule of screening:

Category	Time schedule
At risk neonates	2, 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 nutrition	Initial 72 hours – every 6-8 hours; after 72 hours – once a day

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.
For glucose estimation, arterial samples have slightly higher value compared to venous or capillary samples. Stored samples give fallaciously low readings.
Plan for management:

Hypoglycemia is not a complete diagnosis. Treating hypoglycemia alone is not enough. Always identify the underlying cause and treat it.

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