Neonates at high risk for hypoglycemia:
(1) neonates large for gestational age
(2) neonates small for gestational age; low birth weight (< 1,250 grams)
(3) infants of insulin-dependent diabetic mothers or mothers with gestational diabetes
(4) neonates born to massively obese mothers
(5) smaller of discordant twins
(6) Apgar score < 5 at 5 or 10 minutes
(7) infants requiring significant resuscitation
(8) infants with significant hypoxemia
(9) infants with perinatal distress
(10) infants with severe erythroblastosis
(11) infants of mothers receiving tocolytic therapy
(12) infants of mothers on oral hypoglycemic agents (overlaps with diabetes, above)
(13) infants of mothers on beta-adrenergic blockers
(14) infants with isolated hepatomegaly
(15) infants with microphallus or anterior midline defect especially if there is persistent hyperbilirubinemia
(16) infant with exomphalos (congenital umbilical hernia), macroglossia and gigantism
(17) family history of a neonate with hypoglycemia
(18) family history of unexplained death in infancy
Neonates with clinical findings suggesting hypoglycemia:
(1) changes in levels of consciousness, including coma
(2) tremors
(3) cyanosis
(4) seizures
(5) apnea
(6) irregular respirations
(7) apathy
(8) limpness
(9) hypothermia
(10) difficulty feeding
(11) exaggerated Moro reflex
(12) high-pitched cry
Screening:
(1) on admission to newborn nursery, or at 2 hours after delivery
(2) before feedings (preprandial) for the next 24 hours
(3) if symptomatic
Screening can be discontinued if there are 3 or normal readings in a row.
