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The goals of managing neonatal hypoglycemia are: To correct blood glucose levels in symptomatic patients (see "Pathogenesis, screening, and diagnosis of neonatal hypoglycemia", section on 'Clinical presentation') To prevent symptomatic hypoglycemia in at-risk patients.
The AAP recommends goal blood glucose levels equal to or greater than 45 mg/dL prior to routine feedings, and intervention for blood glucose <40 mg/dL in the first 4 hours of life and <45 mg/dL at 4 to 24 hours of life. [1] [3] The best intervention for asymptomatic hypoglycemia is to increase feeding frequency. [5]
It is important to remember that buccal dextrose gel can be used as first-line treatment for hypoglycemia, allowing the infant–mother relationship not to be interrupted, avoiding NICU hospitalization and improving the chances of effective breastfeeding after discharge .
Hypoglycemia in neonates, infants and children should be considered a medical emergency that can cause seizures, permanent neurological injury, and in rare cases, death, if inadequately treated. Under normal conditions, glucose is the primary fuel for brain metabolism.
One major difference between the 2 sets of guidelines is the goal blood glucose value in the neonate. This article reviews transitional and pathologic hypoglycemia in the neonate and presents a framework for understanding the nuances of the AAP and PES guidelines for neonatal hypoglycemia.
Give preventive treatment (using oral or IV glucose) to infants of diabetic mothers, extremely premature infants, and infants with respiratory distress. If glucose falls to ≤ 50 mg/dL ( ≤ 2.75 mmol/L), promptly give enteral feeding or an IV infusion of 10% to 12.5% D/W, 2 mL/kg over 10 minutes; follow this bolus with supplemental IV or ...
In otherwise healthy newborns with asymptomatic moderate hypoglycemia, a lower glucose treatment threshold (36 mg per deciliter) was noninferior to a traditional threshold (47 mg per...
What are the optimal thresholds for diagnosis and treatment of neonatal hypoglycaemia and for which infants? Who should be tested for neonatal hypoglycaemia, how should they be tested, and for how long? How is hypoglycaemia best prevented and treated? Does mild neonatal hypoglycaemia or its treatment, or both, influence later neurodevelopment?
The guidelines are relatively consistent in their recommendations on clinical symptoms of neonatal hypoglycemia, but different in risk factors, preventive measures, thresholds for clinical management of hypoglycemia, target glucose ranges for its control, and pharmacotherapy. Conclusion.
Between 4 - 24 hours of life: Any glucose level less than 45 mg/dL in a baby with severe symptoms requires immediate IV fluid therapy. In an asymptomatic baby, a glucose level of less than 45 mg/dL should prompt dextrose gel with immediate feeding, and another glucose check in an hour.