Abstract
Objective Hypoglycemia, the most common metabolic derangement in the newborn period remains
a contentious issue, not only due to various numerical definitions, but also due to
limited therapeutical options which either lack evidence to support their efficacy
or are increasingly recognized to lead to adverse reactions in this population. This
study aimed to investigate neonatologists' current attitudes in diagnosing and managing
transient and persistent hypoglycemia in newborns admitted to the Neonatal Intensive
Care Unit (NICU).
Methods A web-based electronic survey which included 34 questions and a clinical vignette
was sent to U.S. neonatologists.
Results There were 246 survey responses with most respondents using local protocols to manage
this condition. The median glucose value used as the numerical definition of hypoglycemia
in first 48 hours of life (HOL) for symptomatic and asymptomatic term infants and
preterm infants was 45 mg/dL (2.5 mmol/L; 25–60 mg/dL; 1.4–3.3 mmol/L), while after
48 HOL the median value was 50 mg/dL (2.8 mmol/L; 30–70 mg/dL; 1.7–3.9 mmol/L). There
were various approaches used to manage transient and persistent hypoglycemia that
included dextrose gel, increasing caloric content of the feeds using milk fortifiers,
using continuous feedings, formula or complex carbohydrates, and use of various medications
such as diazoxide, glucocorticoids, and glucagon.
Conclusion There is still large variability in current practices related to hypoglycemia. Further
research is needed not only to provide evidence to support the values used as a numerical
definition for hypoglycemia, but also on the efficacy of current strategies used to
manage this condition.
Key Points
-
Numerical definition of glucose remains variable.
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Strategies managing transient and persistent hypoglycemia are diverse.
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There is a need for further research to investigate efficacy of various treatment
options.
Keywords
hypoglycemia - hyperinsulinism - NICU - dextrose gel - diazoxide - complex carbohydrates
- glucocorticoids
