ESPE Abstracts

Background: Hypoglycaemia is a common metabolic condition affecting up to 15% of all neonates and 50% of neonates with risk factors including diabetic mothers, large or small for gestational age, perinatal stress, or prematurity. It is well known that severe and prolonged hypoglycaemia, as commonly seen in congenital hyperinsulinism, can lead to brain injury. However, data on the effect of mild neonatal hypoglycaemia on neurodevelopment are limited. There is still no international consensus on glucose thresholds and management recommendations for neonatal hypoglycaemia differ worldwide. In Germany, there exists only one consensus guideline for management of infants of diabetic mothers.

Objective: Our aim was to create a standard operating procedure (SOP) for neonatal hypoglycaemia that provides a risk-adapted screening and a management strategy with appropriate and effective escalation steps, but also with minimal burden on the newborn.

Methods: A comparative analysis of published guidelines and current literature was performed. Based on the recommendations of different national guidelines, a flowchart was created, adapted from the ‘Swedish national guideline for prevention and treatment of neonatal hypoglycaemia in newborn infants with gestational age ≥ 35 weeks‘ (Wackernagel et al., Acta paediatrica, 2019). The new SOP for neonatal hypoglycaemia was clinically tested for feasibility and finalized after repeated revisions by a multiprofessional team of nurses, midwives, neonatologists, paediatric endocrinologists and obstetricians. In March 2020, the final version of the SOP was introduced at the University Hospital Düsseldorf, Germany.

Results: Although neonatal hypoglycaemia is a common metabolic disorder, screening recommendations and treatment thresholds are inconsistent among guidelines. Most do not have specific recommendations for persistent hypoglycaemia. The new SOP includes preventive measures and a risk-dependent glucose screening. Detailed escalation steps for screening and treatment are provided for children with persistent hypoglycaemia.

Conclusion: We established a new SOP for neonatal hypoglycaemia that is practical for daily care and balances the aims of minimal neonatal distress and prevention of brain damage. Currently, this SOP is being systematically evaluated in a prospective longitudinal cohort study, both in terms of neurodevelopmental outcomes and its feasibility and potential to balance risks and benefits.