What is the target blood glucose range for babies diagnosed with neonatal hypoglycaemia?

A target blood glucose of ≥2.6 mmol/L should be used for treating neonatal hypoglycaemia within the first 72 hours after birth. [Conditional recommendation]

A target blood glucose of ≥3.4 mmol/L should be used for treating neonatal hypoglycaemia after the first 72 hours after birth.

There is some evidence supporting the most common target for treatment of ≥2.6 mmol/L and a lack of evidence to justify changing it.

Very low certainty evidence shows that using a lower threshold than 2.6 mmol/L has little to no effect on neurodevelopmental outcomes at 18 months. Low certainty evidence shows use of lower thresholds may result in a large increase in moderate hypoglycaemia (2.0 – 2.6 mmol/L), and a moderate increase in severe hypoglycaemia (<2.0 mmol/L).

Most guidelines recommend a target of ≥2.6 mmol/L for hypoglycaemia in babies, but some advocate for a higher target threshold in older babies. This is because severe and prolonged hypoglycaemia can sometimes indicate congenital hyperinsulinism, which is associated with a high risk of neurodevelopmental impairment.

A blood glucose concentration of 3.3 mmol/L is the threshold for onset of autonomic symptoms in adults experiencing hypoglycaemia, and is the lower target recommended by some for babies with persistent hypoglycaemia. It was estimated that this would apply to approximately 4 per 1000 babies so would not have a large impact on feasibility or costs.

Consider additional investigations (see recommendation 18) and consultation with an paediatric endocrinologist if hypoglycaemia persists after 72 hours of age.

There are no data on resources required, but with a higher threshold, longer treatment would most likely be necessary.

Blood glucose concentrations should be monitored regularly while babies are being treated for hypoglycaemia and for at least 12 hours after treatment stops and the baby is feeding adequately.

Studies are needed on:

• Outcomes of using the target of ≥2.6 mmol/L compared to lower or higher targets.

The impact on health equity is not clear.