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During intrauterine life, the neonate receives a continuous supply of glucose from maternal sources. When this supply abruptly stops at birth, the neonate must adapt and stimulate its own glucose supply with the assistance of enteral feeds.
When there is an imbalance between glucose supply and utilisation, a low blood glucose level (BGL) may occur. There are a wide range of factors which can cause a neonate to remain hypoglycaemic. If left untreated, the neonate is at risk of brain dysfunction, brain damage and mortality.
This guideline will provide information about the clinical signs, investigations, assessment and management strategies of neonatal hypoglycaemia.
Most neonates with hypoglycaemia are initially asymptomatic, and detection of hypoglycaemia is based on surveillance of at-risk infants.
Neonates with identified risk factors must have a BGL on admission. BGL’s should then be monitored in consultation with medical teams, and as clinically indicated.
Risk factors include, but are not limited to:
Other possible causes of hypoglycaemia include, but are not limited to:
A comprehensive nursing assessment must be conducted when hypoglycaemia is suspected and/or identified. Patients who are symptomatic may present with these clinical manifestations:
Altered conscious state
Nurse-initiated investigations may include:
Bedside urinalysis, or
Via glucometer (purple strip)
Basic nursing management of the neonate can influence a neonate’s blood glucose level
During the management phase of neonatal hypoglycaemia, careful consideration and action must be given to the cause of the hypoglycaemia
and medical management of neonatal hypoglycaemia
Education for family members regarding hypoglycaemia is an important aspect of the neonate’s holistic care.
Education may include:
Family-centered care must always be upheld during clinical concerns of the neonate. Communication of a hypoglycaemic event, investigations taken and subsequent results should be discussed with the family when appropriate. Communication with the family can be documented within EMR progress notes.
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The development of this nursing guideline was coordinated by Shanai Cramer, Butterfly Ward, and approved by the Nursing Clinical Effectiveness Committee. Updated June 2019.