Neonatal hypoglycaemia--the controversy regarding definition.

Abstract

SUMMARY Major paediatric textbooks and the views of neonatologists in the United Kingdom were surveyed to establish a definition of neonatal hypoglycaemia. The definition ranged from a glucose concentration of <1 mmol/l to <4 mmol/l. Hypoglycaemia is recognised to cause neurological sequelae and yet there is no accepted definition of the lower limit of normality for circulating blood glucose concentrations.There are few areas in neonatology that are as controversial as the definition of hypoglycaemia. Hypoglycaemia is recognised as a common problem in newborn babies but its incidence is difficult to ascertain due to the controversy over definition. Sexson highlighted the issue in his paper where he showed that the incidence of hypoglycaemia in the 232 babies he studied would be 8-1% if hypoglycaemia was defined as a blood glucose concentration of <1*7 mmol/ or 20-6% if it was defined as <2-2 mmol/l.1The aim of our study was to establish the degree of variation in the definitions of hypoglycaemia among paediatric textbooks and paediatricians in charge of special care nurseries in the United Kingdom. MethodsThe definition of hypoglycaemia, with reference to the glucose concentrations in whole blood in term babies who were born with a weight appropriate for gestational age and in babies who were preterm or small for gestational age, was ascertained (a) in 36 current paediatric textbooks and (b) from consultants in charge of special care nurseries with one or more intensive care cots. The names of the consultants were obtained from the Directory of Emergency and Special Care Units 1986,2 and postal questionnaires were sent to them. ResultsThe definitions of hypoglycaemia obtained from the review of the 36 textbooks of paediatrics are shown in fig 1. There was a very wide variation in the definitions given ranging from a glucose concentration of <1 mmol/ to <2*5 mmol/l with a modal value of <1-7 mmol/l for term babies of appropriate weight, and <1-1 mmol/l for babies who were preterm or small for gestational age.

Long-Term Lanreotide Treatment in Six Patients with Congenital Hyperinsulinism

“…Hypoglycemic episodes were defined as glucose levels <50 mg/dl according to national guidelines for the diagnosis of CHI (AWMF guideline No. 027-045), the definition of hypoglycemia according to the literature and based on a clinical treatment trial in which the use of LAR octreotide has been analyzed in CHI patients [23,24,25,26,27,28]. …”

Assessment of glycemic status and BMI of resident and non - resident female students of Jessore University of science and technology, Bangladesh

“…Throughout a 24 hour period blood plasma glucose levels are generally maintained between 4-8 mmol/L (72 and 144 mg/dl). 4 Although 3.3 or 3.9 mmol/L (60 or 70 mg/dl) is commonly cited as the lower limit of normal glucose, symptoms of hypoglycemia usually do not occur until 2.8 to 3.0 mmol/L (50 to 54 mg/dl). 5 It can produce a variety of symptoms and effects but the principal problems arise from an inadequate supply of glucose to the brain, resulting in impairment of function (neuroglycopenia).…”

Impact of Calibration Algorithms on Hypoglycaemia Detection in Newborn Infants Using Continuous Glucose Monitors

“…There is a wide range of risk factors thought to result in hypoglycaemia including prematurity, low birth weight (LBW) or high birth weight (HBW), and having a mother with diabetes (Stanley and Baker, 1999). There remains significant controversy regarding the definition of hypoglycaemia, and consequently, the effect it can have on the child's later development (Cornblath et al, 2000, Koh et al, 1988. Diagnosis is typically by blood glucose (BG) measurements.…”