Table 3

Examples of guidance for management of asymptomatic neonatal hypoglycaemia

Guideline (listed in date order); scopeGlucose concentration threshold for intervention (mmol/L)Target glucose concentration during treatment (mmol/L)First line treatmentSecond line treatmentThird line treatmentLength of monitoring if glucose normalLength of monitoring after last low glucose measurementFurther investigation and referral
WHO 1997122; newborns at risk<2.6>2.6FeedingIntravenous 10% dextrose 60 mL/kg/dayNSNSNSNS
AAP 201178; late preterm and term infants at risk<1.4 if <4 hours,
<1.9 if 4-24 hours
>2.5 before feedsMore feedingIntravenous 10% dextrose 80-100 mL/kg/day (5-8 mg/kg/min) or bolus 2 mL/kg 10% dextrose, or bothNS12 hours for infant of mother with diabetes and large for gestational age,
24 hours for preterm and small for gestational age
NSGlucose <2.5 mmol/L after 24 hours, intravenous dextrose 5-8 mg/kg/min
BAPM 2017106; term newborns in first 48 hours<1.0 or two values <2.0≥2.0 initially, ≥2.6 if receiving intravenous dextroseFeeding supportBuccal 40% dextrose gel 0.5 mL/kg with feeding supportIntravenous 10% dextrose 60 mL/kg/dayUntil two glucose samples ≥2.0 mmol/L taken before feedsUntil glucose ≥2.6 mmol/L for at least 24 hours>8 mg/kg/min intravenous dextrose
Canada 2019107; newborns at risk<2.6 if <72 hours,
<2.8 if ≥72 hours
>2.6 if <72 hours,
>3.3 if ≥72 hours
More feedingBuccal 40% dextrose gel 0.5 mL/kg with feedIntravenous 10% dextrose 80 mL/kg/day (5.5 mg/kg/min).
Bolus 2 mL/kg 10% dextrose
12 hours for infant of mother with diabetes and large for gestational age,
24 hours for small for gestational age and preterm
Until two samples in normal range taken before feeds>10 mg/kg/min intravenous dextrose and aged >72 hours
Switzerland 2020123; late preterm and term infants on maternity wards<2.6≥2.6Buccal 40% dextrose gel 0.5 mL/kg with more feedsNSNSThree measures ≥2.6 mmol/L taken before feedsNSGlucose <2.6 mmol/L after feeds with dextrose gel
ABM109; late preterm and term infants<2.5≥2.5More feedingBuccal 40% dextrose gel 0.5 mL/kg with feeding planIntravenous dextrose bolus 1-2 mL/kg 10% dextrose, infusion 5-8 mg/kg/minThree measures ≥2.5 mmol/L taken before feeds, preterm and small for gestational age for 24 hoursBlood glucose >3.9 mmol/L over several fast feed cycles if hypoglycaemia persists for >4 days or requiring intravenous dextrose>72 hours or requiring >10-12 mg/kg/min dextrose
Queensland124;
babies at risk
<2.6 if <48 hours,
<3.3 if >48 hours,
<4.0 if known hypoglycaemic disorder
>2.6 if <48 hours,
>3.3 if >48 hours,
>4.0 if known hypoglycaemic disorder
If 1.5-2.5 mmol/l, buccal 40% dextrose gel 0.5 mL/kg with more feeds.
If <1.5 mmol/L, glucagon 200 μg/kg
Intravenous 10% dextrose 1-2 mL/kg bolus and infusion 60 mL/kg/day (4.2 mg/kg/min)Another intravenous dextrose bolus 1 mL/kg24 hoursUntil ≥2.6 mmol/L for 24 hours in first 48 hours or ≥3.3 mmol/L after 48 hours or ≥4.4 mmol/L after 6 hour fast if known hypoglycaemic disorderPersistent or recurrent despite ≥8 mg/kg/min intravenous dextrose, clinical features, or family history
  • .AAP, American Academy of Paediatrics; ABM, Association of Breastfeeding Medicine; BAPM, British Association of Perinatal Medicine; NS, not specified; WHO, World Health Organization.