AAP guidelines advise against routine monitoring for neonatal hypoglycemia

New guidelines on neonatal hypoglycemia (NH) from the American Academy of Pediatrics (AAP) Committee on Fetus and Newborn recommend against routine glucose monitoring except for “high-risk infants.”

Infants who are small or large for gestational age born to mothers with diabetes or born late preterm (34 to 36 6/7 weeks) have the highest risk for clinically significant NH and should be routinely monitored, the guidelines state, as should infants who have clinical manifestations of NH (ie, jitteriness, cyanosis, seizures, an apneic episode, tachypnea, weak or high-pitched cry, floppiness, lethargy, poor feeding, eye rolling).

“Current evidence does not support a specific concentration of glucose that can discriminate normal from abnormal or can potentially result in acute or chronic irreversible neurologic damage,” the committee writes. It recommends early identification and prophylactic measures as a practical approach to infants at risk for NH “despite the absence of a consistent definition of hypoglycemia in the literature.”

Immediate intravenous glucose for symptomatic infants with glucose levels below 40 mg/dL is advised. Asymptomatic at-risk infants should receive glucose screening after the initial feed, which should occur an hour after birth. Prompt laboratory confirmation of bedside measurements is essential because point-of-care screening isn’t reliable enough to be the sole screening method. The guidelines warn that “treatment of suspected NH should not be postponed while awaiting laboratory confirmation” despite a lack of hard evidence that rapid treatment prevents neurologic damage. They emphasize that managing NH shouldn’t “necessarily disrupt the mother-infant relationship and breastfeeding.”

Screening schedules and plasma glucose levels are detailed in the guidelines, which were published in Pediatrics (2011;127[3]:575-579).