Synopsis
Identify newborns at risk, support feeding and metabolic adaptation, interpret glucose within the BAPM operational-threshold framework, and treat symptomatic, severe or persistent hypoglycaemia without delaying investigation.
- Screen only babies with recognised risk or abnormal signs; routine testing of healthy term babies without risk can disrupt feeding and cause unnecessary treatment.
- Risk includes maternal diabetes, beta-blocker exposure, fetal growth restriction, birth weight below the 2nd centile, macrosomia, hypothermia and significant perinatal illness.
- Feed an at-risk well baby within the first hour, support skin-to-skin contact and check blood glucose before the second feed at 2–4 hours of age.
Key red flags
Seizures, altered consciousness, apnoea, cyanosis, marked hypotonia or abnormal feeding with low glucose requires emergency IV treatment and investigation.
Investigation priorities
Confirm hypoglycaemia and guide time-critical treatment.
Management branches
A term baby is well but has a recognised hypoglycaemia risk.
- Keep warm and in skin-to-skin contact and feed within 1 hour.
- Measure glucose before the second feed at 2–4 hours and assess feeding directly.
Key medicines
Dextrose 40% oral gel200 mg/kg, equivalent to 0.5 mL/kg, massaged into the buccal mucosa and followed immediately by an effective feed. Repeat only within the current BAPM and local pathway after reassessment.
Glucose 10% intravenousUnder the BAPM term pathway for glucose below 1.0 mmol/L or abnormal signs, give 2.5 mL/kg IV over 5 minutes, then start 60 mL/kg/day by infusion and recheck glucose after 30 minutes. Titrate glucose infusion rate through the neonatal protocol.