What clinical observations are needed?

Clinical observations are recommended for monitoring all babies at risk of or with neonatal hypoglycaemia. [Conditional recommendation]

All newborn babies require clinical observation in the first hours and days after birth. Any signs that are associated with neonatal hypoglycaemia should result in prompt measurement of blood glucose concentrations (see recommendation 11).

Clear evidence supports the benefits of monitoring, as babies showing clinical signs of hypoglycaemia tend to have poorer outcomes than those who do not.

Some babies who develop severe and potentially brain-threatening hypoglycaemia do not have risk factors or have a recurrence of hypoglycaemia after hospital discharge.  These babies will only be identified by clinical signs.

It is important to educate whānau of all babies about clinical signs that may indicate hypoglycaemia and how to seek help if these occur. This includes at-risk babies who have normal blood glucose concentrations in the first 12 hours and those whose hypoglycaemia appears to have resolved.   

Nil.

Studies are needed on:

• Optimal protocols for clinical observations in babies at risk of hypoglycaemia, including the best predictors of hypoglycaemia and duration of monitoring.

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.