Glucose Monitoring in the Healthy Newborn Clinical Pathway — Inpatient
Neonatal Glucose Monitoring
Transitional hypoglycemia can be normal for newborn up 48 to 72 hours of age. Clinically significant neonatal hypoglycemia reflects an imbalance between supply and use of glucose and alternative fuels. Acute symptoms and long-term neurologic sequelae occur within a continuum of low plasma glucose values of varied duration and severity.
Which Infants to Screen
Because plasma glucose homeostasis requires gluconeogenesis and ketogenesis to maintain normal rates of fuel use, neonatal hypoglycemia occurs most often in infants in which these are impaired. It occurs most often in infants who are SGA, born to mothers who have diabetes, and late-preterm infants. There are a number of other factors that place that infant at risk (Risk Factors for Neonatal Hypoglycemia). Routine glucose monitoring is not needed in healthy term infants following a normal pregnancy and delivery. It should be measured in symptomatic infants or those at risk.
Bedside vs Laboratory Testing
Plasma glucose values are approximately 10-18% higher than blood glucose values.
Neonates with blood glucoses < 40 mg/dL, consider sending confirmatory plasma BG to lab. If symptomatic, treat while awaiting results.