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May 11, 2020

Guidelines for Management of Neonatal Hypoglycemia: Are They Actually Applicable?

Author Affiliations
  • 1Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
  • 2Department of Neurosciences, Psychology, Drug Research and Child Health, Careggi University Hospital of Florence, Florence, Italy
JAMA Pediatr. Published online May 11, 2020. doi:10.1001/jamapediatrics.2020.0632

Hypoglycemia may occur in 10% of healthy term infants, mainly during the first 24 to 48 hours of life.1 This fact is concerning because the high glucose consumption of the brain and the larger ratio of brain to body mass in newborns compared with children and adults increase newborns’ need for glucose and can expose them to neurologic injuries and a risk of abnormal outcome.2,3 Unfortunately, hypoglycemia can be asymptomatic or accompanied by nonspecific symptoms; therefore, screening programs have been developed to allow early detection and prompt treatment of hypoglycemia in high-risk infant populations (eg, infant of a diabetic mother, large for gestational age, or small for gestational age). Although this approach is accepted by neonatologists and widely diffused, it presents some evident limitations: infants with certain types of congenital disorders who are not included in the recognized high-risk categories are excluded from screening and can have a delayed diagnosis of severe and persistent hypoglycemia. On the other hand, asymptomatic euglycemic infants included in high-risk categories can experience excessive blood sampling, hospital admissions, and family separation.

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