Disorders of Neonatal Glycemia

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The management of the extremes of plasma or blood glucose concentrations, hypoglycemia and hyperglycemia, in the first 48 hours of life to several days of life in both preterm and term newborn infants is one of the most frequently encountered issues clinicians face. The concentrations of glucose upon which we base our decision-making remain more a matter of expert opinion than being evidence-based, and a consensus on blood glucose concentrations that should be treated in the newborn has not been definitive enough . This lack of consensus has led to further confusion for clinician as two pediatric organizations, the Committee on the Fetus and Newborn of the American Academy of Pediatrics (AAP) and the Pediatric Endocrine Society (PES), have provided expert opinion on the management of neonatal hypoglycemia that suggested different ranges of actionable blood glucose concentrations. The AAP guidance applies only to the first 24 h of life, while the PES strategy focuses on infants beyond 48 h of life with the emphasis on assuring that cases of persistent hypoglycemia are identified before these infants are discharged. This book provides an approach to neonatal hypo- and hyperglycemia that incorporates opinions from authoritative organizations, the literature, and clinical practice and provides management that meets the newborns’ energy requirements while still promoting successful breastfeeding and preventing unnecessary NICU admissions. It is also helpful medicolegally, as both disorders, but particularly hypoglycemia, have been the subject of numerous legal cases, often decided on misinformation or prejudicial bias. Written by experts in the field, Disorders of Neonatal Glycemia provides valuable details to help clinicians recognize and understand all the grey areas in these two disorders and recognize the difference among standard guidelines, such as those from the AAP and the PES.

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