The healthy, term infant experiences a brief, self-limited period of hypoglycemia during the first two hours of life. Infants are normally asymptomatic during this time. As this transient drop is physiologic, routine glucose screening is not recommended. Screening should be directed towards those infants at risk for pathologic hypoglycemia.
Glucose screening is recommended for infants in the following categories who are at increased risk for pathological hypoglycemia:
- Born to mothers with gestational diabetes or diabetes mellitus
- Large for gestational age (LGA) (>8 pounds 12 ounces or >3969g)
- Small for gestational age (SGA) (<5 pounds 12 ounces or <2608g)
- Premature (<37 weeks gestation)
- Low birth weight (<2500g)
- Smaller twin when sizes are discordant
- Polycythemia (hct >70%)
- Hypothermia
- Low Apgar scores (<5 at one minute, <6 at five minutes)
- Stress (sepsis, respiratory distress, etc)
Glucose screening is also recommended for infants with clinical signs consistent with hypoglycemia:
- Tremors, jitteriness, irritability
- Exaggerated Moro reflex
- High pitched cry
- Lethargy, listlessness, hypotonia
- Cyanosis, apnea, tachypnea
- Hypothermia, temperature instability
- Poor suck, refusal to feed
Glucose levels in the term newborn normally range between 40 - 200. In the first few hours of life, levels as low as 36 may be acceptable.
If glucose levels between 25 - 36 are obtained, the infant should immediately be breastfed. If the mother is unwilling or unable to breastfeed, then at least 15ml of formula should be offered. The glucose level should then be rechecked 30 minutes after the feeding. IV fluids may be required if the glucose level does not improve significantly.
Any glucose level less than 20 requires immediate IV fluid therapy.
"Hypoglycaemia of the Newborn: Review of the Literature." World Health Organization. Geneva, 1997.
"Incidence of Hypoglycemia in Newborn Infants Classified by Birth Weight and Gestational Age." Pediatrics. May 1971.
JAbyMD, 2/07
