Hypoglycemia in High-Risk Infants Within the Immediate Postnatal Period

The incidence of hypoglycemia in the immediate postnatal period is rising because of the increasing rate of preterm births, maternal diabetes, and maternal obesity. Severe hypoglycemia has been considered a risk factor for neuronal cell death and adverse neurodevelopmental outcomes. The American Academy of Pediatrics (AAP) suggests a goal of ≥45 mg/dL (≥2.5 mmol/L) for infants who are asymptomatic within the first 48 hours. The Pediatric Endocrine Society (PES) suggests that infants who are unable to maintain their blood glucose >50 mg/dL (>2.77 mmol/L) within the first 48 hours or >60 mg/dL (>3.33 mmol/L) after the first 48 hours are at risk for persistent hypoglycemia. While there is disagreement for target glucose levels within the first 48 hours, both the AAP and the PES suggest further investigation for persistent hypoglycemia beyond 48-72 hours, which is beyond the scope of this article. However, in the immediate postnatal period, much can be gained with familiarization of the two guidelines, as well as current management techniques. This article presents current definitions and treatment modalities for management of hypoglycemia in infants considered at high risk in the immediate postnatal period.