Hypoglycemia in the newborn period - New Born Baby

Introduction
AIIMS- NICU protocols updated 2007
Hypoglycemia is a common disorder. 1,2 There is still no universal definition for this disorder. 3
Koh et al did a detailed survey and found that the definitions ranged from 18 mg/dL to 72
mg/dL. 4 Confusion exists due to the fact that the “normal” range of blood glucose is different for
each newborn and depends upon a number of factors including birth-weight, gestational age,
body stores, feeding status, availability of energy sources as well as the presence or absence of
disease. 5,6 . Thus the definition of hypoglycemia should be flexible and encompass all these
aspects. Further, there is no concrete evidence to show the causation of adverse long-term
outcomes by a particular level or duration of hypoglycemia. 7 A recent consensus has been to
evolve an “operational threshold”.
Definition
The operational threshold for hypoglycemia is defined as that concentration of plasma or whole
blood glucose at which clinicians should consider intervention, based on the evidence currently
available in literature. 7 This threshold is currently believed to be a blood glucose value of less
than 40 mg/dL (plasma glucose less than 45 mg/dL).
Screening for hypoglycemia
Normal blood glucose levels are maintained by gluconeogenesis. 8 Neonatal hypoglycemia most
commonly occurs in infants with impaired gluconeogenesis, brought about by increased insulin
production, altered counter-regulatory hormone production or an inadequate substrate supply.
Screening for hypoglycemia is recommended in the following high risk infants.
Table 1: High risk situations where screening is recommended
1 Low birth weight infants (