The latest expert consensus on clinical management of neonatal hypoglycemia

2022-08-03 0 By

There are many high-risk factors for neonatal hypoglycemia. Severe and persistent hypoglycemia will lead to irreversible nervous system damage, which will bring great burden to the family and society.Early standardized prevention and clinical management can effectively reduce the incidence of neonatal hypoglycemia and brain injury caused by hypoglycemia.The Expert Consensus on clinical Standard Management of Neonatal hypoglycemia (2021) provides 21 recommendations for the prevention, monitoring and management of neonatal hypoglycemia at gestational age of 35 weeks and above.Recommendation for early prevention of infants at high risk of hypoglycemia 1: skin contact, early sucking and early opening of milk as early as possible and no less than 1 hour after birth (high quality evidence, strongly recommended).Recommendation 2: Breastfeeding is encouraged, with supplementation of formula when breast milk is insufficient. Feeding with sugar water is not recommended (medium quality evidence, strong recommendation).Recommendation 3: Feeding interval ≤3 h on day 1 after birth [Statement of High Quality Clinical Practice (GPS)].Monitoring blood glucose in high-risk infants with hypoglycemia and Diagnostic Methods Recommendation 4: Routine peripheral blood glucose monitoring with bedside glucose meter is recommended for high-risk infants with hypoglycemia (high quality evidence, strong recommendation).Recommendation 5: Hexokinase is recommended to improve plasma glucose testing in the diagnosis of neonatal hypoglycemia (high quality evidence, strong recommendation).Timing and frequency of neonatal blood glucose monitoring recommendation 6: Healthy newborns without high risk factors for hypoglycemia should not be routinely monitored. When symptoms or signs of hypoglycemia appear, blood glucose monitoring should be conducted immediately (high quality evidence, strongly recommended).Recommendation 7: For asymptomatic newborns at high risk of hypoglycemia, the first glucose monitoring should be 30 min after the first effective feeding and no later than 2 h after birth, followed by routine glucose monitoring before feeding (medium quality evidence, strong recommendation).Recommendation 8: If BGL≥ 2.6mmol /L for the first 2 sessions, pre-feeding glucose can be monitored q3h to q6h (medium quality evidence, strong recommendation).Recommendation 9: For 3 consecutive BGL≥2.6 mmol/L, the frequency of glucose monitoring within 24 to 48 hours of birth can be appropriately reduced based on specific risk factors for hypoglycemia (moderate quality evidence, strong recommendation).Recommendation 10 for blood glucose monitoring after neonatal hypoglycemia: Retest of blood glucose (GPS) 30 minutes after supplemental feeding, intravenous infusion of glucose, or alteration of glucose infusion rate (GIR).Recommendation 11: It is recommended to monitor blood glucose within q1h until BGL≥ 2.6mmol /L;If BGL> 2.8mmol /L within 48 h of birth or 3.3mmol /L after 48 h of birth, the frequency should be adjusted to monitor blood glucose before feeding at q3h to Q6h (medium quality evidence, strong recommendation).Recommendation 12: Cessation of supplemental feeding and/or intravenous glucose monitoring may be discontinued if BGL> 2.8mmol /L before 3 consecutive feedings within 48 h of birth or 3.3mmol /L before 3 consecutive feedings after 48 h of birth (medium quality evidence, strong recommendation).13: The threshold for clinical management of neonatal hypoglycemia is BGL 14: For the first BGL 15: For clinical management of hypoglycemia after the first 2.0 mmol/L≤BGLNICU/ Neonatology 16:Early feeding within 2 h of birth is recommended, and intravenous maintenance GIR of 5 to 8 mg/(kg·min) during unconditional feeding or non-nutritional feeding (medium quality evidence, strong recommendation).Recommendation 17: When BGL recommendation 18: Clinical management after 2.8 mmol/L neonatal recurrent or persistent hypoglycemia within 48 h of birth recommendation 19: When GIR> 8-10 mg/(kg·min) and still cannot maintain normal BGL, central venous catheterization should be considered;When GIR>10~12 mg/(kg·min), medication (GPS) should be considered.Recommendation 20: Neonates with recurrent or persistent hypoglycemia should be investigated for further etiology (GPS).Severe, persistent, or symptomatic hypoglycemia neonates are at high risk of hypoglycemic brain injury. It is recommended to evaluate hypoglycemic brain injury and its severity (GPS) by amplitude integrated electroencephalography (aEEG) and cranial magnetic resonance imaging (MRI) before discharge.Excerpted from: Ju Rong, Bao Lei, Mu Dezhi, Feng Xing, Fu Jianhua, Shi Yuan, Zhou Wenhao.Expert consensus on clinical standard management of neonatal hypoglycemia (2021) [J]. Chinese Journal of Contemporary Pediatrics,202,24(01):1-13.