What neurological monitoring/ imaging is needed?

Neurological monitoring and brain imaging should not be used routinely for monitoring babies with neonatal hypoglycaemia. [Conditional recommendation]

Consider using early MRI (within 6 days of onset of hypoglycaemia) for babies with severe (<mmol/L) or persistent hypoglycaemia to assist with counselling and prognosis.
 

Early MRI findings, particularly diffusion-weighted imaging, are moderately predictive of later neurodevelopmental outcomes after neonatal hypoglycaemia. This may be helpful in some cases, e.g. for counselling whānau, guiding management decisions, supporting Accident Compensation Commission claims and access to early neurodevelopmental therapy to optimise outcomes.

One study found that changes in cotside aEEG were not clinically useful for monitoring brain function in relation to neonatal hypoglycaemia.

Timely access to MRI can be challenging due to the high cost and limited availability. It is important to discuss this decision with a neonatologist, as this may involve transfer to a secondary or tertiary centre.

Nil.

Nil.

Health equity may be increased if all whānau are offered access to MRI and are appropriately informed about the risks and benefits.