What care settings are appropriate?

Consider caring for babies who require monitoring for neonatal hypoglycaemia at a primary care setting if timely and accurate blood glucose monitoring is possible, treatment can be initiated if required, e.g. with buccal dextrose gel, and the baby can be transferred promptly to a secondary or tertiary facility if necessary. [Conditional recommendation for either option]

Based on a UK study, the panel considered that even if all babies were cared for in a tertiary care unit, not all cases of hypoglycaemia would be detected.

Primary care settings are associated with better breastfeeding outcomes, while quicker access to hypoglycaemia treatment in secondary or tertiary settings may lead to improved outcomes.

However, the costs associated with transferring to secondary or tertiary care are considered moderate to high.

There is considerable variability in parental preferences, with some preferring a secondary or tertiary care setting regardless of distance, while others may prioritise proximity to home.

Other considerations, including maternal health and stability of diabetes management, may play a role in the decision about place of birth.

All babies at risk of hypoglycaemia should have access to accurate blood glucose monitoring. Prompt treatment of hypoglycaemia is essential, so initial treatment such as dextrose gel should be available immediately.

If the blood glucose concentration is <2.0mmol/L, dextrose gel alone is unlikely to be sufficient treatment. Administer dextrose gel while arranging transfer to a facility where IV infusion is available.

Ensure that appropriate glucose analysers and dextrose gel for treatment of neonatal hypoglycaemia are available in all settings where newborn babies are cared for, including in primary units, to avoid potentially widening health inequities.

Nil.

Nil.

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.