When to test?

Test the blood glucose concentration of babies at risk of neonatal hypoglycaemia at 1-2 hours after birth, (preferably after the first feed but before 2 hours) then at intervals of 3-4 hours, independent of feeding schedule. [Conditional recommendation]

Stop testing after glucose concentrations have remained ≥2.6 mmol/L for 12 hours from birth or from the first normal test (≥2.6 mmol/L) after any low glucose concentrations (< 2.6 mmol/L) provided the baby is feeding adequately.

There is a physiological nadir in blood glucose concentrations at approximately 30-90 minutes after birth. In many babies, low glucose concentrations during this period will resolve spontaneously. Limited evidence suggests that low glucose concentrations are more common at 1 hour than at 2 hours and become less common thereafter.

A relatively small proportion (0.3-1.1%) of cases of neonatal hypoglycaemia may be missed if screening ends at 12 hours.

Severe hypoglycaemia is most common within the first 12 hours after birth.

Limited evidence suggests that 10 – 17% of episodes occur between the initial test at 1–2 hours and the second test, approximately 3–4 hours later, so repeated testing is required.

There is very little change in blood glucose concentrations with feeding in the first 48 hours, so timing of testing can be independent of feeding.

The criteria for stopping testing should be 12 hours of blood glucose concentrations ≥2.6 mmol/L with adequate feeding, not the number of tests conducted.

Babies who have required intravenous dextrose or supplemental feeds for the treatment of neonatal hypoglycaemia should have 12 hours of blood glucose concentrations ≥2.6 mmol/L after these additional measures have ended before testing is stopped.

The correct time to stop testing is not known. The GLOW study showed that healthy term babies continued to have episodes of glucose concentrations <2.6 mmol/L up to 5 days after birth, although few occurred after 3 days.

Studies are needed on:

1. whether extending screening beyond 12 hours improves outcomes.
2. the frequency and clinical significance of glucose concentrations <2.6 mmol/L after 12 hours in babies who previously had glucose concentrations ≥2.6 mmol/L.

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.