Neonatal Hypoglycemia

[SGA or LGA] infant > 4 hours of life with maternal h/o GDM and poor feeding presents with whole blood glucose (WBG) < 45 mg/dL. Hypothermia, decreased respiratory rate, abnormal cry, irritability/jitteriness, hypotonia on exam.

• Symptomatic infant:

  • Administer 2 mg/kg D10 IV bolus followed by 6 mg/kg/min D10 IV infusion

  • Monitor WBG q2h until > 45 mg/dL

  • For WBG < 45 mg/dL, increase D10 infusion by 2 mg/kg/min to maximum of 12 mg/kg/min

  • Parents informed that aggressive management is necessary as neonatal hypoglycemia may result in brain injury

• Asymptomatic patient:

  • Implement q2h feeds and measure WBG 20 minutes after each feed

  • Repeat WBG measurement until values > 45 mg/dL x 4

Notes

• Monitor whole blood glucose (WGB) as compared to fingerstick glucose

• For infants < 4 hours of life, target WBG is > 25 mg/dL