Contents Chapter Topic Page Neonatology Respiratory Cardiology

NEONATAL HYPOGLYCAEMIA
A. Definition:
Blood sugar < 2.6 mmol/L (approximately 45 mg/dl) in a term or premature infant.
B. Prevention and Early Detection
Anticipation & prevention, when possible, are keys to the management of
hypoglycaemia. Hypoglycaemia may produce long term neurological injury and
the level at which it occurs is controversial.
(i) Identify all high-risk neonates
Prematurity Small for gestational age
Hypothermia Birth Asphyxia / Perinatal Stress
Sepsis Infant of Diabetic Mother
Infant > 4 kg. Polycythaemia
Rhesus disease
(ii) Check glucometer/dextrostix on admission
(iii) Immediate feeding for all well babies who are at risk.
If hypoglycaemic on admission, repeat glucometer 1 hour later after feeding.
Continue monitoring at 2 hours and 4 hours later. (i.e. O,1,2, 4 hours)
If normoglycaemic on admission feed and monitor 6-8 hourly till past stage of
hypoglycaemic risk
(iv) Unwell babies (e.g. birth asphyxia or premature): set up a 10% dextrose drip.
Monitor blood sugar Hourly X 2
Then 2 hourly X 2
Then 4 → 6 → 8 hourly until stable
(v) Clinical features are:
Symptoms are non-specific. For example: apathy, hypotonia, apnoea, poor
sucking, cyanosis, abnormal cry, jitteriness, seizure, lethargy and temperature
instability.
C. If Hypoglycaemia is detected
1. Repeat the glucometer test. Send RBS stat for confirmation.
(Note: monitoring using reagent strip measurement is quick, cheap and easy
but not a precise method)
Check expiry date of test stick!
2. Is the infant symptomatic?
3. When was the last feed given? Is the intravenous drip adequate and running
well? (i.e. not disconnected or extravasated)