Blood glucose | NeoResus

4.2. Management of blood glucose levels

Assessment and management of blood sugar within the first hour of life is imperative as infants who require resuscitation are more likely to develop dangerous hypoglycaemia.

Adverse neurological outcomes have been demonstrated in asphyxiated animal models when hypoglycaemia is present at the time of a hypoxic ischaemic insult. The optimal range of blood glucose concentration to minimise brain injury following asphyxia and resuscitation is yet to be defined.

Blood sugar levels should be monitored in all neonates who require resuscitation and treated to maintain in the normal range ( ≥ 2.6 mmol/L) and above 3.0 mmol/L in any infant who has signs of neurological compromise following birth. (ANZCOR, 2016, Guideline 13.9).

General Principles:

A newborn who has required extensive resuscitation measures should be nil by mouth during the initial stabilisation process.
Insert a peripheral intravenous cannula or an umbilical venous catheter.
Perform a blood glucose level (BGL) within an hour of birth.
Confirm the result (if possible) with a true blood glucose (TBG) but do not wait for the results to initiate treatment.
A 10% glucose infusion at 4 – 6 mg/kg/min is usually sufficient to maintain blood glucose homeostasis.
(1 ml 10% glucose contains 100 mg).

Specific management:

TBG ≥ 2.6 mmol/L

Commence 10% glucose infusion at 60mL/kg/day (4mg/kg/min)
To calculate 60mL/kg/day: 60 x birth weight in kg, divided by 24 = mL/hr
Repeat TBG in one hour to ensure TBG remains ≥ 2.6 mmol/L.
If the TBG is ≥ 2.6 mmol/L and the infant is receiving a continuous infusion of glucose intravenously, the TBG can be checked three hourly thereafter.

TBG 1.5 – 2.5 mmol/L

AGA infant: Commence 10% glucose infusion at 70 mL/kg/day (5 mg/kg/min) and increase to 90 mL/kg/day if the subsequent TBG in one hour is <2.6mmol/L.
SGA infant: Commence 10% glucose infusion at 90 mL/kg/day (6 mg/kg/min) and increase to 120 mL/kg/day if the subsequent TBG in one hour is <2.6mmol/L.
Repeat TBG in one hour to ensure TBG is ≥ 2.6mmol/L

TBG <1.5 mmol/L

Administer 300micrograms/kg/dose Glucagon IM (up to a total of 1mg) in infants ≥ 34 weeks gestation to stabilise the blood glucose level whilst intravenous access is being established.
AGA infant: Commence 10% glucose infusion at 70mL/kg/day (5mg/kg/min) and increase to 90mL/kg/day if the subsequent TBG in one hour is <2.6 mmol/L.
SGA infant: Commence 10% glucose infusion at 90mL/kg/day (6mg/kg/min) and increase to 120mL/kg/day (8mg/kg/min) if the subsequent TBG in one hour is <2.6 mmol/L.
Administer an intravenous bolus of 2mL/kg 10% glucose (200mg/kg) over 3 – 5 minutes.
Repeat TBG in one hour to ensure TBG ≥ 2.6 mmol/L.

Notes:

Avoid giving bolus doses of 10% glucose: this can result in rebound hypoglycaemia.

If fluid restriction is necessary, increase the concentration of glucose to 12.5%, rather than increasing the fluid volume.

Glucose concentrations above 12.5% must be infused via a central line (e.g. a UVC).

Intravenous fluids must not be increased above 120mL/kg in the first 24 hours of life without further consultation with PIPER.

State specific resources:

Victoria: Better Safer Care Victoria Neonatal e-Handbook:

Hypoglycaemia in neonates (Updated January 2019)

Queensland Health staff should refer to the Queensland Maternity and Neonatal Clinical Guideline: Neonatal Hypogylcaemia

Available via the Queensland Health Clinical Guidelines website.

Tasmanian healthcare providers should refer to the Royal Hobart Hospital Clinical Practice Guideline:

Hypoglycaemia Risk Management for Newborns (June 2013, PDF 995 KB)