exp date isn't null, but text field is
Guidance on the screening and management of hypoglycaemia in the first 48 hours of life for late preterm infants (born at 34+0-36+6 weeks gestation).
This document and complementary flow charts describe the criteria for screening and the subsequent management of hypoglycaemia in late preterm infants. For the purpose of this guidance this includes all infants born at 34+0 -36+6 gestation.
Such infants are at risk of hypoglycaemia during the first 48 hours due to impaired metabolic adaptation, and be potentially at risk of neurological damage when their blood glucose levels fall. They therefore require prompt and appropriate intervention.
This guidance does not apply to infants born 37 week and above; such infants should be managed separately according the Hypoglycaemia in Infants ≥ 37 weeks guideline
All infants born at 34+0-36+6 week gestation should undergo routine screening for hypoglycaemia as detailed in this document.
Use of glucose buccal gel is not appropriate in late preterm infants and is therefore not part of this guideline.
All the advice regarding feeding and fluids within this document assume that there are no other medical issues. Where this is not the case individualised care plans will be required.
The importance of parents as partners in care is reinforced throughout this guidance which includes a parent information leaflet which explains why their baby is receiving extra monitoring for blood glucose levels and how to raise concerns about their baby’s feeding pattern or well being.
All staff involved the screening and management for hypoglycaemia should be familiar with the signs and symptoms of hypoglycaemia.
Signs and Symptoms of Hypoglycaemia in the Neonate
Hypoglycaemia may present in a number of ways within the first 48 hours of life. These include;
This list is not exhaustive. Medical review should be obtained for any generally unwell infant as these symptoms may warrant further investigation and consideration of other causes including sepsis
A late preterm infant who is at risk of hypoglycaemia should be screened with regular monitoring of the capillary glucose concentrations.
Near patient testing devices tend to be less accurate in the lower range, especially < 2.0mmol/l  and therefore all low values (≤2.6mmol/L) require confirmation using blood gas analysis as this is considered the gold standard for measuring blood glucose.
Hand held glucometers should meet ISO standards (ISO15197:2013). If a handheld glucometer is used, low levels must be confirmed using an accurate method as cot-side monitors may be inaccurate in the lower ranges and require checking using a True Blood Glucose (TBG) to guide therapy. A TBG can be obtained by sending a formal laboratory sample but significant delays can occur in obtaining a result, alternatively a TBG can also be obtained from a blood gas analyser, where available, as these are equally reliable . All units must ensure they have readily accessible methods for accurate measurement of a TBG . Each unit must be aware of the characteristics of any near patient testing device used in their hospital.
Local Arrangements for Confirming Blood Glucose <2.6mmol/L
GG&C - GG&C Maternity and Neonatal units use the Precision Exceed Pro meter©. For this device glucose values 2.6 - 3.0mmol/l may prove to be <2.6mmol/l when a TBG is obtained from a blood gas machine or laboratory testing. Therefore a TBG should be obtained for:
Normal Pathway – Blood Glucose >2.5mmol/l
Green Zone – Blood Glucose 2.0 – 2.5 mmol/l - Increased vigilance and feeding support
Amber Zone – Blood Glucose 1.0 - 1.9 mmol/l - Supplement and Paediatric review
Red Zone – Blood Glucose <1.0 mmol/l - Admit to SCBU
1- Babies who are asymptomatic and have not had an adequate feed prior to admission
2 - Babies who cannot tolerate enteral feeds or whose blood glucose remains <2.6mmol/l despite frequent NG feeds (as above) OR who become symptomatic
*It is usual to use the mother’s own breast milk for top-ups. However mother’s own EBM may be unavailable or insufficient for the required volume of top-up. Under these circumstances donor EBM or infant formula should be used.
1. Beardsall K. Measurement of glucose levels in the newborn. Early HumDev. 2010;86(5):263-267
2. Dahlberg M, Whitelaw A. Evaluation of HemoCue Blood Glucose Analyzer for the instant diagnosis of hypoglycaemia in newborns. (1997) Scand J Clin Lab Invest Dec; 57(8):719-24 1
3. Aynsley-Green A, Soltesz G. (1986) Disorder of blood glucose homeostasis in the neonate. In: Roberton NRC, ed.Textbook of neonatology. Edinburgh: Churchill Livingstone,.
4. Hetenyi G, Cowan JS. Glucoregulation in the newborn. (1980) Can J Physiol Pharmacol ;58:879-88.
Last reviewed: 01 July 2020
Next review: 01 July 2023
Author(s): Dr Natalie Smee – Paediatric Trainee RHC; Dr Lesley Jackson – Neonatal Consultant RHC
Co-Author(s): Other Professionals consulted: Ms Gillian Bowker - Infant Feeding Advisor GG&C; Mrs Anisa Patel - Neonatal Pharmacist RHC; Mrs Lauren Williams - Neonatal Pharmacist RHC