Neonatal Hypoglycemia Algorithm: Glucose Thresholds & Dextrose Gel

About this tool

This tool guides screening and treatment of low blood glucose in late-preterm and term newborns. It is for clinicians caring for newborns, and calculates dextrose gel and IV dextrose volumes from the weight entered.

Screening is for at-risk infants (late preterm 34–36 6/7 weeks, small or large for gestational age, infant of a diabetic mother) and any infant with symptoms. The tool asks about symptoms, then age band, then the glucose value. From birth to 4 hours the cut-offs are under 25, 25–39 and 40 mg/dL or higher; from 4 to 24 hours they are under 35, 35–44 and 45 mg/dL or higher. After 24 hours, glucose under 50 mg/dL (up to 48 hours) or under 60 (after 48 hours) is treated as low and prompts a search for a persistent cause.

Results include feeding with 40% dextrose gel 0.5 mL/kg, a repeat check in 1 hour, or IV dextrose 10% 2 mL/kg followed by an infusion. Symptomatic infants with glucose under 40 mg/dL need IV glucose straight away. It follows the AAP 2011 statement (Adamkin), the Pediatric Endocrine Society 2015 recommendations (Thornton) and the Sugar Babies trial (Harris, Lancet 2013).

Common questions

What glucose level is low in a newborn in the first 24 hours?

This tool uses under 25 mg/dL from birth to 4 hours and under 35 mg/dL from 4 to 24 hours as low, with 25–39 and 35–44 mg/dL as borderline. Targets are 40 mg/dL or more under 4 hours and 45 or more at 4–24 hours.

What is the dose of dextrose gel for neonatal hypoglycemia?

40% dextrose gel 0.5 mL/kg (200 mg/kg), rubbed into the cheek and followed by a feed. It may be repeated up to 6 times in 48 hours.

When does a newborn need IV dextrose for hypoglycemia?

IV dextrose is started when glucose stays low after a feed and gel, or immediately when a symptomatic infant has glucose under 40 mg/dL. The tool gives dextrose 10% 2 mL/kg over 5–10 minutes, then an infusion of 80–100 mL/kg/day.

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