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Neonatal hypoglycemia: is 60 the new 40? The questions remain the same

Journal of Perinatology volume 36, pages 10–12 (2016)Cite this article

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The Pediatric Endocrine Society (PES) recently published guidelines for evaluation and management of hypoglycemia in neonates, infants and children.1 One of the main goals was to provide recommendations for recognizing neonates requiring diagnosis and treatment during the first days of life for disorders causing severe and persistent hypoglycemia. How best to screen newborns for the diagnosis of persistent or genetic hypoglycemia disorders is essential to prevent or reduce the risk of hypoglycemia-induced brain injury. They suggest that mean plasma glucose levels are initially maintained at approximately 55 to 65 mg dl−1 but then increase to >70 mg dl−1 by 2 to 3 days of life. Using these initial mean plasma glucose levels we believe will lead to many more infants being evaluated and treated for asymptomatic hypoglycemia. Overscreening, overdiagnosing and overtreating are the concerns when a ‘lower limit threshold' is set too high.

The PES committee used major metabolic fuel and hormonal responses to hypoglycema to discover the mechanism of ‘transitional neonatal hypoglycemia'. This brief period of hypoglycemia occurs in all newborns, during the transition from fetal to extra-uterine life. The PES makes a strong case for this transient neonatal hypoglycemia seen in normal-term appropriate for gestational age newborns being associated with hypoketonemia, low free fatty acids, inappropriately large glycemic responses to glucagon and suppression of plasma insulin concentrations.1 These are well-recognized features of congenital hyperinsulinism caused by activating mutations of glucokinase.1 The PES suggests that this is a regulated process and that the concentrations of plasma glucose are remarkably stable and relatively unaffected by the timing of initial feeding or interval between feedings.1 The American Association of Pediatrics (AAP) provides an algorithm in which time of initial feeding and testing is clearly feeding based. The PES focused on mean responses where the AAP guideline considered ranges of plasma glucose in asymptomatic infants.2

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Authors and Affiliations

  1. Division of Neonatal Medicine, Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA

    D H Adamkin

  2. Division of Neonatal Medicine, Department of Pediatrics, Columbia University College of Medicine, New York, NY, USA

    R Polin

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  1. D H Adamkin
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  2. R Polin
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Correspondence to D H Adamkin.

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Adamkin, D., Polin, R. Neonatal hypoglycemia: is 60 the new 40? The questions remain the same. J Perinatol 36, 10–12 (2016). https://doi.org/10.1038/jp.2015.125

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