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The new Framework for Practice highlights the limited evidence for our current clinical practice.1 It is helpful in emphasising the importance of accurate measurement of glucose concentrations, listening to the concerns of parents and acknowledging that untreated hypoglycaemia can have devastating longterm consequences. However we have the following concerns:
The Framework recommends lowering a commonly accepted screening threshold in infants considered to be at risk of hypoglycaemia, to a level that at any other time of life would be considered harmful. It fails to acknowledge the differences between screening and diagnostic thresholds; something neonatologists are very familiar with in the management of babies with jaundice. Phototherapy is provided to many babies with bilirubin levels well below a harmful level to prevent a harmful level being reached. Screening interventions are intended to prevent harmful events. Such thresholds will inevitably mean many individuals are treated ‘unnecessarily’ to avoid the risk of significant harm. In 2000 Cornblath et al published guidance on ‘operational thresholds’ in keeping with the current BAPM framework.2 However, and possibly reflecting concerns …
Contributors All authors jointly discussed and contributed to the manuscript.
Funding Dr K Beardsall receives funding from NIHR EME.
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.
Correction notice This paper has been amended since it was published Online First. There are 2 companion papers to go with this article and they have now been added. To access them click on the links in the gutter of the first page.