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Hypoglycaemia was the third most common reason for admission of term babies to neonatal units in England in the period 2011–2013.1 Of those babies admitted with ‘hypoglycaemia’, one-third had a blood glucose level higher than the WHO threshold of 2.6 mmol/L, while half did not require intravenous dextrose.1 These findings suggest that a significant number of babies may be separated from their mothers inappropriately. There is also significant variability in defining at-risk groups and intervention thresholds.1 Guidance should seek to minimise the risk of potentially devastating brain injury that can result from severe neonatal hypoglycaemia, without exposing large numbers of babies to the harm of unnecessary interventions, separation from their mothers and neonatal unit admission.
The British Association of Perinatal Medicine published its framework for identification and management of hypoglycaemia in term newborns in April 2017.2 The working group was made up of neonatologists, midwives, an infant feeding coordinator, officers from National Health Service Improvement and the Unicef Baby Friendly Initiative and a parent representative. They reviewed published literature and used national audit data and themes arising from cases of litigation to formulate the guidance. Professional consensus was used when there was insufficient evidence.
There are many consensus guidelines covering neonatal hypoglycaemia including WHO guidance (1997),3 an American Academy of Pediatrics clinical report (2011)4 and the 2015 National Institute for Health and Care Excellence guideline5 (table 1).
What does the guideline recommend?
Prevention of hypoglycaemia in at-risk babies
Newborns at risk of hypoglycaemia are identified in box 1. They should be managed proactively to prevent hypoglycaemia. This includes providing thermal care, regular monitoring and intensive breastfeeding support with a maximal feed interval of 3 hours. The first feed should be offered within the first hour of life and the first blood glucose level checked before the …