Should glucagon vs. control be used for neonatal hypoglycaemia?

Consider use of intramuscular glucagon for short-term management of neonatal hypoglycaemia until IV access can be established. [Conditional recommendation]

Three non-randomised studies showed a large effect in correcting hypoglycaemia, with a large increase in blood glucose concentrations.

The safety of glucagon for treatment of hypoglycaemia has been established in adults, and there is no evidence of differing safety in babies.

Nausea is reported by some adults using glucagon, but it is uncertain whether babies may experience this.

The cost of glucagon was considered moderate to negligible.

Long-term outcomes and safety in babies remain uncertain, necessitating comprehensive information sharing with families for informed decision-making.

Severe or symptomatic hypoglycaemia is an emergency. If there is difficulty or delay in starting IV glucose, give glucagon 0.2 mg/kg as an intramuscular injection. Establish an IV infusion as soon as possible. Intramuscular glucagon may not be effective in situations outside of hyperinsulinism, and IV glucose may still be necessary.

The increase in glucose concentration usually occurs within 5-20 minutes. The dose can be repeated after 1 hour if IV access remains problematic, but there may be a smaller increase in glucose concentration in response to the second dose.

In refractory hypoglycaemia, glucagon infusion 5-20 microgram/kg/h may be considered.

Measuring blood glucose concentration 30 minutes after giving IM glucagon.

Studies are needed on:

• The benefits, adverse effects and long-term outcomes of glucagon use in babies, including optimal dose and route of administration.

Whānau need to be fully informed of the health benefits and potential adverse effects of glucagon. Refer to health equity summary below.

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.