Table 2

Assessment of screening for neonatal hypoglycaemia against the criteria for an effective screening programme

Screening principle50CommentsMeets criteria
ConditionThe condition should be an important health problemSevere neonatal hypoglycaemia is rare but probably causes brain injury. Transitional hypoglycaemia is common and associated with developmental delayYes
The natural history of the condition, including development from latent to declared disease, should be adequately understoodThe natural history of the condition (ie, the risk of brain injury from transitional neonatal hypoglycaemia) is poorly understoodNo
A recognisable latent or early symptomatic phase should be presentHypoglycaemia is commonly asymptomatic. Even one incidence of a low blood glucose concentration, however, has been associated with poor academic outcomesMaybe
TestA suitable test or examination should be availableTesting for blood concentrations of glucose is simple, although painful. A reliable test for neuroglycopenia to determine which infants with a positive screening test would benefit from intervention is not yet availableNo
The test should be acceptable to the populationNo data on acceptability of the test to parents or infants (as adults)No
InterventionAn accepted treatment for patients with recognised disease should be availableTreatment options include oral dextrose gel, formula, intravenous dextrose, diazoxide, and glucagon. No direct evidence exists that any of these interventions improve neurodevelopmentNo
An agreed policy on who to treat as patients should existTarget population varies from country to country, but all guidelines recommend screening infants born preterm, small for gestational age, and to mothers with diabetes. Screening in infants born large for gestational age is contentiousYes
Screening programmeThe cost of case finding (including diagnosis and treatment of patients with a diagnosis) should be economically balanced in relation to possible expenditure on medical care as a wholeNo data are available on the cost effectiveness of screening for neonatal hypoglycaemiaNo
Implementation criteriaCase finding should be a continuing process and not a once and for all projectYes
Facilities for diagnosis and treatment should be availableInaccurate non-enzymatic analysers are frequently used to diagnose neonatal hypoglycaemiaMaybe