From the Guidelines
Normal blood sugar levels in newborns are typically considered to be above 2.5 mmol/L (45 mg/dL) to avoid hypoglycaemia, as repetitive and/or prolonged hypoglycaemia at this level should be avoided in all ICU patients, including newborns 1.
Definition of Hypoglycaemia in Newborns
Hypoglycaemia in newborns has been proposed to be defined as a blood glucose level below 2.2-2.5 mmol/L (40-45 mg/dL) 1. This definition is based on a recent systematic review and meta-analysis, which aimed to establish a clear threshold for hypoglycaemia in this population.
Importance of Monitoring Blood Sugar Levels
Monitoring blood sugar levels is crucial in newborns, especially in the first 24-48 hours after birth, as they transition from receiving glucose through the placenta to producing and regulating their own glucose levels. Premature babies, those born to diabetic mothers, or infants who experienced birth stress may require more frequent blood sugar checks due to their increased risk of hypoglycaemia.
Signs of Hypoglycaemia
Signs of low blood sugar in newborns include irritability, poor feeding, lethargy, tremors, and in severe cases, seizures. If a newborn shows these symptoms, immediate medical attention is necessary as prolonged hypoglycaemia can lead to neurological damage.
Management of Hypoglycaemia
The suggested blood glucose operational threshold concentrations at which clinicians should consider intervention in newborns are: a single measurement of blood glucose <1 mmol/L (18 mg/dL); blood glucose level <2 mmol/L (36 mg/dL) which remains below the same value at the next measurement; or a single measurement of <2.5 mmol/L (45 mg/dL) in a newborn with abnormal clinical signs 1. Newborns with risk factors for hypoglycaemia, such as premature birth, low birth weight, and perinatal asphyxia, require close monitoring and management of their blood glucose levels.
From the Research
Normal Blood Sugar Levels in Newborns
- Normal blood sugar levels in newborns are not explicitly defined in the provided studies, as they focus on hypoglycemia treatment and management in various contexts 2, 3, 4, 5, 6.
- However, study 2 mentions that median change in blood glucose concentration after first dextrose gel was greater in formula and donor milk fed vs. breastfed infants, but does not provide a specific normal blood sugar range for newborns.
- Study 3 discusses the impact of dextrose dose on hypoglycemia development, but does not provide information on normal blood sugar levels in newborns.
- Study 4 evaluates blood glucose reduction in patients treated with insulin and dextrose for hyperkalaemia, but does not provide information on normal blood sugar levels in newborns.
- Study 5 provides recommendations for managing hyperkalemia with insulin and glucose, but does not discuss normal blood sugar levels in newborns.
- Study 6 compares the use of D50 and D10 for treating out-of-hospital hypoglycemia, but does not provide information on normal blood sugar levels in newborns.
Hypoglycemia Treatment and Management
- The provided studies focus on hypoglycemia treatment and management in various contexts, including the use of dextrose gel 2, insulin and dextrose 3, 4, 5, and D50 vs. D10 6.
- These studies provide information on the effectiveness and safety of different treatments, but do not provide a clear definition of normal blood sugar levels in newborns.
Blood Glucose Levels
- Study 3 mentions that patients with a pretreatment blood glucose <110 mg/dl or without diabetes had lower rates of hypoglycemia when 50 g of dextrose was administered.
- Study 4 reports that the median blood glucose change over 6 hours was -24 mg/dL, and hypoglycemia developed in 22.2% of patients.
- Study 6 compares the post-treatment glycemic profile between D50 and D10, with a lower profile observed in the D10 group.