The Evidence Informing Hypoglycaemia Treatment Thresholds in Asymptomatic, Term, Well Newborns: A Review of Literature and Critical Appraisal of Methodological Challenges.

Abstract

Background: There is worldwide inconsistency in blood glucose level treatment thresholds for hypoglycaemia in healthy, term asymptomatic newborns. Differing testing policies and broader inclusion criteria from maternal conditions have increased the incidence of testing. The use of human milk substitutes to treat hypoglycaemia may adversely influence the establishment of breastfeeding and early bonding between mother and baby.

Research aim: To determine if current research informs a high-quality evidence-based therapeutic treatment threshold for hypoglycaemia in well, asymptomatic newborns in the first 24 hours of life.

Methods: A comprehensive review accessing CINAHL, Medline, Scopus, Web of Science, Cochrane, and CENTRAL databases was performed. Original English-language quantitative studies reporting hypoglycemic treatment thresholds, and their neurodevelopmental outcomes for over 11,000 newborns, were appraised for quality and validity using independent screening and Crowe's Quality Appraisal Tool.

Results: Thirteen papers were included with outcomes grouped into two categorical definitions of hypoglycaemia (statistical and neurodevelopmental). Nine of the included studies were assessed as producing low quality evidence, with a moderate to high risk of bias, unreliable methodology, and smaller sample sizes. One study provided high quality evidence, with a sample size of > 1000 newborns, that a blood glucose threshold of 2.09 mmol/L was a potentially safe treatment threshold.

Conclusion: Published high quality research is lacking to inform a therapeutic treatment threshold for hypoglycaemia in well, term asymptomatic newborns in the first 24 hours. Current treatment may interfere with breastfeeding and bonding. Rigorous research is required to establish a safe threshold and inform future practice.