Neonatal Hypoglycemia Risk Assessment
Identify at-risk newborns
All Pathways
PediatricsEmergency
Neonatal Hypoglycemia (PES 2015)
Neonatal Hypoglycemia (PES 2015): Neonatal Hypoglycemia Risk Assessment → Risk Factors for Neonatal Hypoglycemia → Treatment Thresholds → Symptomatic? →...
Pathway Overview
10 steps
Algorithm Steps
10 total
01Start 02Action Risk Factors for Neonatal Hypoglycemia
Screen high-risk infants
- HIGH RISK:
- • Infant of diabetic mother (IDM)
- • Large for gestational age (LGA)
- • Small for gestational age (SGA)
- • Preterm (<37 weeks)
- • Perinatal stress (asphyxia, sepsis, hypothermia)
- • Maternal beta-blockers, sulfonylureas
- Screen glucose at 30-60 min of age if risk factors
03Action Treatment Thresholds
When to treat (varies by guideline)
- COMMON THRESHOLDS:
- • <25 mg/dL (<1.4 mmol/L): Always treat
- • 25-40 mg/dL: Treat if symptomatic, feed if asymptomatic
- • <45-50 mg/dL after 4-24 hrs: Consider treatment
- AAP: <25 mg/dL in first 4h, <35 mg/dL at 4-24h
- PES: <50 mg/dL if symptomatic
- GOAL: Maintain ≥45-50 mg/dL
04Decision Symptomatic?
Assess for symptoms of hypoglycemia
- SYMPTOMS:
- • Jitteriness, tremors
- • Lethargy, hypotonia
- • Poor feeding, weak cry
- • Hypothermia
- • Seizures, apnea
- • Cyanosis
05Action Asymptomatic - Oral Feeding Trial
Feed and recheck
- Initiate feeding (breast or formula)
- Feed 10-15 mL/kg
- Recheck glucose 30-60 min after feed
- If still low after feed:
- • May give 40% dextrose gel 0.5 mL/kg buccal
- • Recheck in 30 min
- • If still low → IV dextrose
06Decision Glucose Normalizing?
Monitor response to treatment
07Action Wean IV Glucose
Transition to enteral feeding
- Wean GIR by 1-2 mg/kg/min q3-6h
- Increase enteral feeds simultaneously
- Monitor pre-feed glucose
- Discontinue IV when:
- • Taking full enteral feeds
- • Pre-feed glucose ≥50 mg/dL consistently
08Action Increase GIR
Persistent hypoglycemia
- Increase GIR by 2 mg/kg/min increments
- May need GIR 10-15+ mg/kg/min
- If requiring GIR >12 mg/kg/min:
- • Consider hyperinsulinism
- • Send critical sample before correction:
- - Insulin, cortisol, GH, free fatty acids
- - Beta-hydroxybutyrate, lactate, ammonia
- Consult endocrinology if persistent
09Warning Persistent Hypoglycemia Workup
If hypoglycemia persists >48-72h
- CONSIDER:
- • Hyperinsulinism (most common)
- • Hypopituitarism
- • Cortisol deficiency
- • Fatty acid oxidation defects
- • Glycogen storage disease
- Send critical sample during hypoglycemia
- MRI brain if hypopituitarism suspected
- Genetic testing may be indicated
- Path rejoins step 07Shared downstream outcome
10Action Symptomatic or Severe - IV Dextrose
Immediate IV treatment
- IV BOLUS:
- D10W 2 mL/kg (200 mg/kg) over 5-10 min
- THEN INFUSION:
- D10W at glucose infusion rate (GIR) 5-8 mg/kg/min
- GIR calculation:
- GIR = (rate mL/kg/day × dextrose %) / 144
- Recheck glucose q30-60 min
- Titrate to maintain ≥50 mg/dL
- Path rejoins step 06Shared downstream outcome
Guideline Source
Pediatric Endocrine Society Recommendations for Evaluation and Management of Persistent Hypoglycemia 2015
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Threshold definitions vary by institution
- Does not address hyperinsulinism workup in detail
- Premature infant thresholds may differ
Applicable Regions
USEU
Version 1Next review: 2027-01-11
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Related Resources
Frequently Asked Questions
What is the Neonatal Hypoglycemia (PES 2015)?
The Neonatal Hypoglycemia (PES 2015) is a emergency clinical algorithm for Pediatrics. It provides a structured decision tree to guide clinical decision-making, based on Pediatric Endocrine Society Recommendations for Evaluation and Management of Persistent Hypoglycemia 2015.
What guideline is the Neonatal Hypoglycemia (PES 2015) based on?
This algorithm is based on Pediatric Endocrine Society Recommendations for Evaluation and Management of Persistent Hypoglycemia 2015 (DOI: 10.1016/j.jpeds.2015.03.057).
What are the limitations of the Neonatal Hypoglycemia (PES 2015)?
Known limitations include: Threshold definitions vary by institution; Does not address hyperinsulinism workup in detail; Premature infant thresholds may differ. Individual patient factors may require deviation from these recommendations.
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