What are the benefits and risks of testing?

Blood glucose measurements should be offered for babies with identified risk factors of neonatal hypoglycaemia (see recommendation 12). [Conditional recommendation]

Most babies with hypoglycaemia have no clinical signs, so blood testing is the only way to detect low glucose concentrations.

It is common practice to test babies considered at risk of neonatal hypoglycaemia and there is no evidence to support changing this approach.

There is no robust evidence of benefit for at-risk babies and some evidence of harm, primarily from painful procedures and a reduction in breastfeeding. Nevertheless, the potential for death and brain damage from undiagnosed hypoglycaemia was considered to outweigh the pain and distress caused by testing.

Although resource requirements are substantial, with current screening criteria applicable to 26-28% of all babies, it is feasible as it is currently being done.

Whānau should be fully informed about the reasons for testing and encouraged to participate in decisions about pain relief (see recommendation 13). Provide easily understandable information in a range of formats, including videos and apps. Address how babies can be supported during tests, and how the test can be made less painful for the baby (see recommendation 14).

Nil.

Studies are needed on:

• Outcomes in children whose whānau declined screening for neonatal hypoglycaemia and the reasons for declining.

Screening rates for babies delivered rurally or from underrepresented groups are not known. However, if testing is implemented equitably, this is likely to increase health equity. Ask whānau what their preferences are for painful procedures. Some whānau may wish to use rongoā Māori (traditional Māori medicine that takes a holistic approach) e.g. waiata, karakia, oriori to support pēpi during a painful procedure.