Comparative review of guidelines on the diagnosis and management of neonatal hypoglycemia.

Objective The aim of this study was to review and compare the recommendations from the most recently published guidelines on the screening, prevention, diagnosis and management of neonatal hypoglycemia. Methods We conducted a comparative review of guidelines from the American Academy of Pediatrics, the British Association of Perinatal Medicine, the European Foundation for the Care of the Newborn Infants, the Queensland Clinical Guidelines-Australia, the Canadian Pediatric Society and the Pediatric Endocrine Society on this frequent metabolic disturbance encountered by the neonate. Results There is agreement among the reviewed guidelines concerning the risk factors, the clinical manifestations of neonatal hypoglycemia as well as the main preventive strategies. Moreover, the early recognition of infants at risk, the timely identification of neonatal hypoglycemia and the prompt initiation of treatment are universally considered as cornerstones for the improvement of neonatal outcomes. In addition, all guidelines, except Pediatric Endocrine Society, recommend screening for neonatal hypoglycemia in asymptomatic high-risk and symptomatic newborns, but they disagree regarding the screening policy. Furthermore, the diagnosis should be confirmed by laboratory methods of blood glucose levels measurement, although treatment should not be deferred until then. The definition of neonatal hypoglycemia lacks uniformity, but it is agreed that a single blood glucose value cannot accurately define this clinical entity. Thus, the use of operational thresholds for the management of neonatal hypoglycemia is endorsed by all the reviewed guidelines, although discrepancies exist regarding the recommended cut-off values, the optimal treatment and surveillance strategies of both symptomatic and asymptomatic hypoglycemic neonates as well as the treatment targets. Conclusion Neonatal hypoglycemia is a matter of keen debate in contemporary neonatology and one of the leading causes of term admission to Neonatal Intensive Care Unit. The development of consistent international protocols for the management of this biochemical abnormality seems of insurmountable importance in order to prevent brain injury and neurodevelopmental impairment and optimize the outcomes of hypoglycemic neonates. [ABSTRACT FROM AUTHOR]