What is the recommended capillary blood glucose checking schedule for newborn babies, including those with Infant of Diabetic Mother (IDM) and preterm babies?

Capillary Blood Glucose Monitoring Schedule for Newborns

Blood glucose monitoring should be performed using blood gas analyzers with glucose modules for the most accurate and rapid results in newborn infants, with handheld glucose meters used only when necessary and with confirmation by laboratory testing for critical values. 1, 2

Risk Factors Requiring Glucose Monitoring

Approximately 26.3% of all newborns require hypoglycemia screening due to the following risk factors 1, 2:

• Infant of diabetic mother (IDM)
• Preterm infants (<37 weeks gestation)
• Small for gestational age (SGA, <10th percentile)
• Large for gestational age (LGA, >90th percentile)
• Low birth weight (<2500g)
• High birth weight (>4500g)
• Post-term infants (>42 weeks)

Monitoring Schedule by Infant Category

Term Healthy Newborns (Without Risk Factors)

• Routine glucose monitoring not required

Term Newborns with Risk Factors

First 24 Hours:

• First check: Within 1 hour after birth
• Subsequent checks: At 3,6, and 12 hours of life
• Continue: Every 6 hours until 24 hours of age if stable

After 24 Hours:

• Every 6-8 hours until 48 hours of life
• Discontinue if glucose levels remain >2.5 mmol/L (45 mg/dL) for 3 consecutive readings

Infants of Diabetic Mothers (IDM)

First 24 Hours:

• First check: Within 30 minutes after birth
• Subsequent checks: At 1,2,3,6, and 12 hours of life 3
• Continue: Every 3-4 hours until 24 hours of age

After 24 Hours:

• Every 6 hours until 48 hours of life
• Discontinue if glucose levels remain >2.5 mmol/L (45 mg/dL) for 3 consecutive readings

Preterm Infants (<37 weeks)

First 24 Hours:

• First check: Within 1 hour after birth
• Subsequent checks: At 2,3,6, and 12 hours of life
• Continue: Every 3-4 hours until 24 hours of age 4, 5

After 24 Hours:

• Every 6 hours until 72 hours of life for infants 32-36 weeks
• Every 4-6 hours until 7 days of life for infants <32 weeks 5
• More frequent monitoring for extremely preterm infants (<28 weeks) due to 50% risk of hyperglycemia 4

Intervention Thresholds

Clinical Scenario	Intervention Threshold
Symptomatic infants	<2.6 mmol/L (47 mg/dL)
Asymptomatic infants	<2.5 mmol/L (45 mg/dL)
Preterm infants	<2.0 mmol/L (36 mg/dL)
Single measurement (any infant)	<1.0 mmol/L (18 mg/dL)

Additional Monitoring Considerations

1. Feeding-Related Monitoring:

   • Check glucose levels 30-60 minutes after feeding
   • For infants receiving parenteral nutrition, monitor before each feed change

2. Symptomatic Infants:

   • Immediate glucose check regardless of scheduled time
   • Symptoms include: jitteriness, lethargy, poor feeding, apnea, seizures

3. Extended Monitoring:

   • Continue monitoring for 24-48 hours after last abnormal value
   • For persistent hypoglycemia (>72 hours), consider endocrine consultation

4. Method of Measurement:

   • Blood gas analyzers with glucose modules provide most accurate results 1, 2
   • Point-of-care glucometers may be inaccurate in neonates due to high hemoglobin and bilirubin levels 2
   • Laboratory samples may give falsely low results due to glycolysis if not processed properly 1

Important Clinical Considerations

• Continuous glucose monitoring detects significantly more episodes of hypoglycemia than intermittent capillary testing (81% of low glucose episodes may be missed by intermittent testing) 6
• SGA infants are at higher risk for both hypoglycemia and hyperglycemia and require vigilant monitoring 5
• Early feeding is beneficial for maintaining euglycemia and reduces risk of both hypo- and hyperglycemia 5
• Hyperglycemia >8 mmol/L (145 mg/dL) should be avoided in neonatal ICU patients as it is associated with increased morbidity and mortality 1
• Recurrent or prolonged hypoglycemia ≤2.5 mmol/L (45 mg/dL) should be avoided in all infants to prevent neurological damage 1, 2

This protocol prioritizes early detection of glucose abnormalities to prevent adverse neurodevelopmental outcomes while minimizing unnecessary testing in low-risk infants.