Who to test?

Screening is recommended for babies with the following risk factors:

• Maternal diabetes (any type);
• Preterm birth (<37 weeks’ gestation);
• Small for gestational age (<10th percentile using customised or population growth charts);
• Large for gestational age (>90th percentile using customised or population growth charts);
• If gestation unknown: low birthweight (<2500 g) or macrosomia (>4500 g);
• Unwell (e.g. respiratory distress, history of fetal distress or asphyxia, hypothermia, delayed or poor feeding);
• Maternal use of antidepressant medications, alpha or beta blocker medications, amphetamines (both prescribed and not prescribed), anti-psychotic medications.

Screening is recommended for babies with any clinical signs potentially related to hypoglycaemia including:

jitteriness, seizures, poor feeding, lethargy, irritability, cyanosis, hypotonia, apnoea, tachypnoea, hypothermia, respiratory distress, asphyxia, abnormal cry, pallor, and vomiting. [Conditional recommendation]

These criteria are similar to those already in use around Aotearoa New Zealand.
The cost of testing is likely to be small compared to the cost of brain injury from undetected hypoglycaemia for the individual, although the evidence that prompt detection and treatment of hypoglycaemia alters neurodevelopmental outcomes is very uncertain.

Testing should be undertaken using a reliable analyser (see recommendation 14).

Address how babies can be supported during tests, and how the test can be made less painful for the baby (see recommendation 13).

A full assessment, including clinical history, should be made for babies exhibing any signs of neonatal hypoglycaemia. Consider prompt referral to a paediatrician if a baby is unwell or shows clinical signs associated with neonatal hypoglycaemia. However, testing and treatment if required should not be delayed pending such referral (see recommendation 21).

The Small for Gestational Age / Fetal Growth Restriction Guidelines of Aotearoa New Zealand recommend using customised centiles to define small for gestational age.

Nil.

Studies are needed on:

• Outcomes of screening versus not screening large-for-gestational age babies.

The frequency of risk factors for hypoglycaemia varies with ethnicity.

Ensure whānau are fully informed of the reasons for testing, health benefits and potential adverse effects of blood glucose testing, and the results of any tests.

Health equity for Māori

Health professionals must apply this guideline equitably to prevent harm and ensure accountability in implementing recommendations for Māori as part of a pro-equity approach. Pākehā benefit from health system privileges, while Māori face systemic racism, leading to reduced health benefits. Health equity can be improved if Māori receive effective interventions.

Ensure Māori whānau are fully informed about their healthcare options as a part of a mana motuhake (self-determination), including prevention, monitoring and treatment options, health benefits and potential risks. Detailed explanations of all interventions, their necessity, and results should also be provided to help achieve equitable health outcomes. Ensure whānau are provided with information in multiple formats (oral, written, online, video) that align with cultural values.

Whānau living in rural areas may face additional financial costs and barriers to accessing specialist services. Proactively support these whānau by informing and supporting them to access available financial assistance and resources to access specialist services.

Health equity for other groups

Health professionals must apply this guideline equitably to prevent harm. Health equity can be improved if all whānau receive effective interventions.
Many groups, including Pacific, Asian, migrant and rural communities, also face significant health inequities. These groups often encounter barriers such as language difficulties, lower health literacy, and challenges in understanding their healthcare options. It is important that all whānau are fully informed about their healthcare options, including prevention, monitoring and treatment options, health benefits and potential risks. Detailed explanations of all interventions, their necessity, and results should also be provided to help achieve equitable health outcomes. Culturally appropriate communication, use of interpreter services where required, along with the use of multiple formats (oral, written, online, video), can help improve engagement with health services.

Rural communities may also experience additional challenges, such as increased travel costs and limited access to specialist care. Providing proactive support, including information about and assistance to access financial and other resources to help access specialist services, is crucial to reducing these inequities and improving health outcomes. Specific additional issues are addressed under the recommendations and EtDs where relevant.