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Extracted from Mayes' Midwifery 14th Edition, Sue Macdonald, Julia Magill-Cuerden (Eds) Oxford; Baillre Tindall: 2011 Courtesy Elsevier, and

Myles Textbook for Midwives 15th Edition. Diane M. Fraser, Margaret A. Cooper (Eds). London; Churchill Livingstone: 2009. Courtesy Elsevier.

A generally accepted definition of hypoglycaemia in infants is serum glucose of <2.6mmo/l. Non-specific signs in the newborn can be vague: they include lethargy, poor feeding and 'jitteriness'. These signs can also be due to sepsis and sometimes a healthy term infant can be sleepy and reluctant to feed. However, if these signs persist or worsen, the midwife should seek immediate paediatric advice and anticipate investigations for sepsis and hypoglycaemia. Specific signs comprise increasing lethargy and irritability with a reduction in level of consciousness and eventually seizures, associated with a risk of cerebral damage.

Be aware that reagent strips can be unreliable when blood glucose levels are very low, and a blood sample is required to provide a true blood (plasma) glucose level.

If low serum glucose is confirmed, urgent treatment is required to avoid permanent cerebral damage.

Risk factors for neurological sequelae of hypoglycaemia

  • Pre-term infants (<37 weeks)
  • Growth restricted infants (<3rd centile for gestation)
  • Infants of diabetic mothers
  • Sick, term infants e.g. sepsis or following perinatal hypoxia-ischaemia
  • Infants with inborn errors of metabolism


If serum glucose concentration is <2.6 mmol/l then feed should be give at increased volume and decreased frequency. Supplementary feeding with formula milk may be required in infants who are breastfed, and/or nasogastric tube (NGT) feeding - expressed breast milk can be used for NGT. Infants where enteral feeding is contraindicated for any reason, then intravenous 10% dextrose, 60 ml/kg per day should be initiated.

Further reading

Medscape. Cranmer H. (2014) Neonatal Hypoglycemia. Available at:

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