Glucose Profiles in Healthy Term Infants in the First 5 Days: The Glucose in Well Babies (GLOW) Study
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Updated: Dec 22, 2025
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Published on: November 13, 2016
Deborah L Harris1, Philip J Weston2, Greg D Gamble3
1Newborn Intensive Care Unit, Waikato District Health Board, Hamilton, New Zealand; Liggins Institute, University of Auckland, Auckland, New Zealand; School of Nursing, Midwifery and Health Practice, Victoria University of Wellington, Wellington, New Zealand.
Insights
Healthy infants
Area of Science:
- Neonatal physiology
- Pediatric endocrinology
Background:
- Understanding infant glucose homeostasis is crucial for identifying and managing hypoglycemia.
- Current treatment thresholds for neonatal hypoglycemia are based on limited data regarding typical glucose levels in healthy infants.
Purpose of the Study:
- To track plasma and interstitial glucose changes in healthy newborns.
- To compare observed low glucose levels with established treatment thresholds for at-risk infants.
Main Methods:
- A prospective observational study involving 67 healthy, term, singleton infants in New Zealand.
- Continuous glucose monitoring and frequent heel-prick plasma glucose measurements were performed from birth to 120 hours.
- Glucose oxidase method was used for plasma glucose analysis.
Main Results:
- Infant glucose levels increased over the first 18 hours, stabilized around 48 hours (mean 59 mg/dL), and reached a plateau by day 4 (mean 89 mg/dL).
- Nearly 40% of infants experienced glucose levels below 47 mg/dL in the first 48 hours.
- Early term infants showed lower glucose concentrations and a higher incidence of low glucose episodes compared to later term infants.
Conclusions:
- Healthy infants typically complete metabolic transition by day 4.
- A significant proportion of healthy newborns exhibit glucose levels below current treatment thresholds for hypoglycemia.
- Findings suggest a need to re-evaluate hypoglycemia treatment guidelines for newborns.
Objectives:
To determine postnatal changes in plasma and interstitial glucose concentrations of healthy infants receiving current recommended care and to compare the incidence of low concentrations with recommended thresholds for treatment of at-risk infants.
Study Design:
A prospective masked observational study in Hamilton, New Zealand. Healthy, term, appropriately grown singletons had continuous glucose monitoring and repeated heel-prick plasma glucose measurements (4 in the first 24 hours then twice daily using the glucose oxidase method) from birth to 120 hours.
Results:
The 67 infants had a mean birth weight of 3584 ± 349 g, and gestational age of 40.1 ± 1.2 weeks. The mean glucose concentrations increased over the first 18 hours, remained stable to 48 hours (59 ± 11 mg/dL; 3.3 ± 0.6 mmol/L)] before increasing to a new plateau by the fourth day (89 ± 13 mg/dL; 4.6 ± 0.7 mmol/L). Plasma glucose concentrations of 47 mg/dL (2.6 mmol/L) approximated the 10th percentile in the first 48 hours, and 39% of infants had ≥1 episode below this threshold. Early term infants had lower mean glucose concentrations than those born at later gestational ages and were more likely to have episodes <47 mg/dL (<2.6 mmol/L) (19/32 [59%] vs 7/35 [20%]; relative risk, 3.0; 95% CI, 1.4-6.1; P = .001).
Conclusions:
Healthy infants seem to complete their metabolic transition by day 4. Many have glucose concentrations below the accepted thresholds for treatment of hypoglycemia.
Trial Registration:
ACTRN: 12615000986572.
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