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.