Recommendations for Plasma Glucose Testing of Neonates While in the Hospital
John A. Widness, MD
Peer Review Status: Internally Peer Reviewed
|HYPOGLYCEMIA||0-24 hr||1-3 d||4-7 d(if on i.v. fluids)||>4 d (enterally fed)||>7 d (if on i.v. fluids|
|Infants at risk on i.v. fluids † *||x5: 1, 2, 4, 8, &24 hr (includes enterally fed & without i.v.)||x3/d => x1/shift (includes those enterally fed||x1/d (only if on parenteral fluids)||prn clinical signs||x2/wk (only if on parenteral fluids)|
|Infants not at risk on i.v. fluids||x2: 1-4 hr & 8-16 hr||x1-2/d||x1/d||prn clinical signs||x2/wk|
|Infants not at risk enterally fed||prn clinical signs||prn clinical signs||NA||prn clinical signs||NA|
|Any infant with signs of hypoglycemia||STAT x1||STAT x1||STAT x1||STAT x1||STAT x1|
|Confirmed gluc <40 mg/dL|
every 1-2 hour with Tx until normal, then resume screening
|Symptomatic||every 20-30 minutes with Tx until asymptomatic & gluc >40, then resume screening|
|Screening||same as for high & low risk hypoglycemia above|
|Confirmed gluc >200 mg/dL||every 1-4 hr until <200 mg/dL depending on severity|
† Infants at risk include: IDMs, IGDMs (especially those whose mothers recieved oral hypogylcemic agents), LGA (>90%ile), SGA ("IGUR": <10%ile>, post-asphyxiated, APGAR <5 at five minutes, polycythemic, immune hemolytic disease, suspected sepsis, hypothermia (rectal temperature >35°C), congenital anomalies, Beckwith-Weidman syndrome, infants < 36 wks gestation, infants > 42 wks gestation, & infants whose mothers recieved large amounts of i.v. glucose prior to delivery.
*In the "micropremie" with transparent skin which could break down, consider decreasing the number of plasma glucose determinations by monitoring urine "dipsticks" for the appearance of dextrose. Since these infants will invariably have parenteral glucose infusions runing, hyperglycemia is often a more common clinical finding.