A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical conditions that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
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References
1.
EbellMH, SiwekJ, WeissBD, et al.Strength of recommendation taxonomy (SORT): A patient-centered approach to grading evidence in the medical literature. Am Fam Physician, 2004; 69:548–556.
2.
Adamkin DH; Committee on Fetus and Newborn. Postnatal glucose homeostasis in late-preterm and term infants. Reaffirmed June 2015. Pediatrics, 2011; 127:575–579.
TasE, GaribaldiL, MuzumdarR. Glucose homeostasis in newborns: An endocrinology perspective. Neoreviews, 2020; 21:e14–e29.
5.
ThorntonPS, StanleyCA, De LeonDD, et al.Recommendations from the Pediatric Endocrine Society for Evaluation and Management of Persistent Hypoglycemia in Neonates, Infants, and Children. J Pediatr, 2015; 167:238–245.
StanleyCA, RozancePJ, ThorntonPS, et al. Re-evaluating “transitional neonatal hypoglycemia”: Mechanism and implications for management. J Pediatr 2015;166:1520–1525.e1521.
8.
KalhanSC, D'AngeloLJ, SavinSM, et al.Glucose production in pregnant women at term gestation. Sources of glucose for human fetus. J Clin Invest, 1979; 63:388–394.
9.
SrinivasanG, PildesRS, CattamanchiG, et al.Plasma glucose values in normal neonates: A new look. J Pediatr, 1986; 109:114–117.
10.
AdamkinDH, PolinR. Neonatal hypoglycemia: Is 60 the new 40? The questions remain the same. J Perinatol, 2016; 36:10–12.
11.
HawdonJM, Ward PlattMP, Aynsley-GreenA. Patterns of metabolic adaptation for preterm and term infants in the first neonatal week. Arch Dis Child, 1992; 67(4 Spec No):357–365.
12.
SwenneI, EwaldU, GustafssonJ, et al.Inter-relationship between serum concentrations of glucose, glucagon and insulin during the first two days of life in healthy newborns. Acta Paediatr, 1994; 83:915–919.
13.
CornblathM, HawdonJM, WilliamsAF, et al.Controversies regarding definition of neonatal hypoglycemia: Suggested operational thresholds. Pediatrics, 2000; 105:1141–1145.
14.
SweetDG, HaddenD, HallidayHL. The effect of early feeding on the neonatal blood glucose level at 1-hour of age. Early Hum Dev, 1999; 55:63–66.
15.
ZhouY, BaiS, BornhorstJA, et al.The effect of early feeding on initial glucose concentrations in term newborns. J Pediatr, 2017; 181:112–115.
16.
NattaVRS, PagaliD, DandugulaVP, et al.Glycemic status in exclusively breast fed low birth weight babies in first 72 hours of life in a teriary care hospital. Int J Contemp Pediatr, 2019; 6:5.
HayWWJr., RajuTN, HigginsRD, et al.Knowledge gaps and research needs for understanding and treating neonatal hypoglycemia: Workshop report from Eunice Kennedy Shriver National Institute of Child Health and Human Development. J Pediatr, 2009; 155:612–617.
19.
Levy-KhademiF, PerryA, KlingerG, et al.Normal point of care glucose values after birth in the well-baby nursery. Am J Perinatol, 2019; 36:219–224.
BromikerR, PerryA, KasirerY, et al.Early neonatal hypoglycemia: Incidence of and risk factors. A cohort study using universal point of care screening. J Matern Fetal Neonatal Med, 2019; 32:786–792.
22.
DurandR, HodgesS, LaRockS, et al.The effect of skin-to-skin breast-feeding in the immediate recovery period on newborn thermo regulation and blood glucose values. Neonatal Intensive Care, 1997; 10:23–29.
23.
HosethE, JoergensenA, EbbesenF, et al.Blood glucose levels in a population of healthy, breast fed, term infants of appropriate size for gestational age. Arch Dis Child Fetal Neonatal Ed, 2000; 83:F117–119.
24.
SinghP, UpadhyayA, SreenivasV, et al.Screening for hypoglycemia in exclusively breastfed high-risk neonates. Indian Pediatr, 2017; 54:477–480.
25.
HoopsD, RobertsP, Van WinkleE, et al.Should routine peripheral blood glucose testing be done for all newborns at birth?. MCN Am J Matern Child Nurs, 2010; 35:264–270.
26.
WhippleAO, FrantzVK. Adenoma of islet cells with hyperinsulinism: A review. Ann Surg, 1935; 101:1299–1335.
27.
CornblathM, IchordR. Hypoglycemia in the neonate. Semin Perinatol, 2000; 24:136–149.
InderT. How low can I go? The impact of hypoglycemia on the immature brain. Pediatrics, 2008; 122:440–441.
33.
RozancePJ, HayWW. Hypoglycemia in newborn infants: Features associated with adverse outcomes. Biol Neonate, 2006; 90:74–86.
34.
HawdonJM. Hypoglycaemia and the neonatal brain. Eur J Pediatr, 1999; 158Suppl 1:S9–S12.
35.
ShahR, HardingJ, BrownJ, et al.Neonatal glycaemia and neurodevelopmental outcomes: A systematic review and meta-analysis. Neonatology, 2019; 115:116–126.
36.
KerstjensJM, Bocca-TjeertesIF, de WinterAF, et al.Neonatal morbidities and developmental delay in moderately preterm-born children. Pediatrics, 2012; 130:e265–e272.
37.
McKinlayCJ, AlsweilerJM, AnsellJM, et al.Neonatal glycemia and neurodevelopmental outcomes at 2 years. N Engl J Med, 2015; 373:1507–1518.
38.
McKinlayCJD, AlsweilerJM, AnsticeNS, et al.Association of neonatal glycemia with neurodevelopmental outcomes at 4.5 years. JAMA Pediatr, 2017; 171:972–983.
39.
KaiserJR, BaiS, GibsonN, et al.Association between transient newborn hypoglycemia and fourth-grade achievement test proficiency: A population-based study. JAMA Pediatr, 2015; 169:913–921.
40.
GoodeRH, RettigantiM, LiJ, et al.Developmental outcomes of preterm infants with neonatal hypoglycemia. Pediatrics, 2016; 138.
41.
van KempenA, EskesPF, NuytemansD, et al.Lower versus traditional treatment threshold for neonatal hypoglycemia. N Engl J Med, 2020; 382:534–544.
42.
BurnsCM, RutherfordMA, BoardmanJP, et al.Patterns of cerebral injury and neurodevelopmental outcomes after symptomatic neonatal hypoglycemia. Pediatrics, 2008; 122:65–74.
43.
HawdonJM, BeerJ, SharpD, et al.Neonatal hypoglycaemia: Learning from claims. Arch Dis Child Fetal Neonatal Ed, 2017; 102:F110–F115.
44.
RozancePJ, HayWWJr. Describing hypoglycemia—definition or operational threshold?. Early Hum Dev, 2010; 86:275–280.
45.
KoivistoM, Blanco-SequeirosM, KrauseU. Neonatal symptomatic and asymptomatic hypoglycaemia: A follow-up study of 151 children. Dev Med Child Neurol, 1972; 14:603–614.
NarveyMR, MarksSD, Canadian PediatricSociety, et al.The screening and management of newborns at risk for low blood glucose. Paediatr Child Health, 2019; 24:536–554.
48.
LeveneI, WilkinsonD. Identification and management of neonatal hypoglycaemia in the full-term infant (British Association of Perinatal Medicine-Framework for Practice). Arch Dis Child Educ Pract Ed, 2019; 104:29–32.
49.
BatemanBT, PatornoE, DesaiRJ, et al.Late pregnancy beta blocker exposure and risks of neonatal hypoglycemia and bradycardia. Pediatrics, 2016; 138:e20160731.
50.
Van HoweRS, StormsMR. Blood glucose determinations in large for gestational age infants. Am J Perinatol, 2008; 25:283–289.
51.
BrandPL, MolenaarNL, KaaijkC, et al.Neurodevelopmental outcome of hypoglycaemia in healthy, large for gestational age, term newborns. Arch Dis Child, 2005; 90:78–81.
52.
KennedyLML, CrawfordTM, AndersenCC, et al.Does umbilical cord blood glucose extraction discriminate the risk of early neonatal hypoglycaemia in at-risk newborns?. J Paediatr Child Health, 2019; 55:1476–1480.
53.
ShawM, LutzT, GordonA. Does low body fat percentage in neonates greater than the 5th percentile birthweight increase the risk of hypoglycaemia and neonatal morbidity?. J Paediatr Child Health, 2019; 55:1424–1428.
54.
StarkJ, SimmaB, Blassnig-EzehA. Incidence of hypoglycemia in newborn infants identified as at risk. J Matern Fetal Neonatal Med, 2019; 33:3091–3096.
55.
HardingJE, HarrisDL, HegartyJE, et al.An emerging evidence base for the management of neonatal hypoglycaemia. Early Hum Dev, 2017; 104:51–56.
56.
WooHC, TolosaL, El-MetwallyD, et al.Glucose monitoring in neonates: Need for accurate and non-invasive methods. Arch Dis Child Fetal Neonatal Ed, 2014; 99:F153–157.
57.
GlasgowMJ, HardingJE, EdlinR. Cost analysis of cot-side screening methods for neonatal hypoglycaemia. Neonatology, 2018; 114:155–162.
58.
BeardsallK. Real time continuous glucose monitoring in neonatal intensive care. Early Hum Dev, 2019; 138:104844.
59.
GalderisiA, LagoP, SteilGM, et al. Procedural pain during insertion of a continuous glucose monitoring device in preterm infants. J Pediatr 2018;200:261–264.e261.
60.
McKinlayCJD, ChaseJG, DicksonJ, et al.Continuous glucose monitoring in neonates: A review. Maternal Health Neonatol Perinatol, 2017; 3:18.
HarrisDL, WestonPJ, GambleGD, et al. Glucose profiles in healthy term infants in the first 5 days: The glucose in well babies (GLOW) study. J Pediatr 2020;223:34.e4–41.e4.
63.
BourchierD, WestonP, HeronP. Hypostop for neonatal hypoglycaemia. N Z Med J, 1992; 105:22.
64.
HarrisDL, AlsweilerJM, AnsellJM, et al. Outcome at 2 years after dextrose gel treatment for neonatal hypoglycemia: Follow-up of a randomized trial. J Pediatr 2016;170:54–59.e51–e52.
65.
HarrisDL, GambleGD, WestonPJ, et al.What happens to blood glucose concentrations after oral treatment for neonatal hypoglycemia?. J Pediatr, 2017; 190:136–141.
66.
HarrisDL, WestonPJ, SignalM, et al.Dextrose gel for neonatal hypoglycaemia (the Sugar Babies Study): A randomised, double-blind, placebo-controlled trial. Lancet, 2013; 382:2077–2083.
67.
WestonPJ, HarrisDL, HardingJE. Dextrose gel treatment does not impair subsequent feeding. Arch Dis Child Fetal Neonatal Ed, 2017; 102:F539–F541.
68.
BarberRL, EkinAE, SivakumarP, et al.Glucose gel as a potential alternative treatment to infant formula for neonatal hypoglycaemia in Australia. Int J Environ Res Public Health, 2018; 15:876.
69.
TerM, HalibullahI, LeungL, et al.Implementation of dextrose gel in the management of neonatal hypoglycaemia. J Paediatr Child Health, 2017; 53:408–411.
70.
MakkerK, AlissaR, DudekC, et al.Glucose gel in infants at risk for transitional neonatal hypoglycemia. Am J Perinatol, 2018; 35:1050–1056.
71.
BennettC, FaganE, ChaharbakhshiE, et al.Implementing a protocol using glucose gel to treat neonatal hypoglycemia. Nurs Womens Health, 2016; 20:64–74.
72.
PlummerEA, NinkovicI, ReesA, et al. Neonatal hypoglycemia algorithms improve hospital outcomes. J Matern Fetal Neonatal Med 2020; [Epub ahead of Print]; doi: 10.1080/14767058.2020.1785421.
73.
NewnamKM, BunchM. Glucose gel as a treatment strategy for transient neonatal hypoglycemia. Adv Neonatal Care, 2017; 17:470–477.
74.
CoorsSM, CousinJJ, HaganJL, et al.Prophylactic dextrose gel does not prevent neonatal hypoglycemia: A quasi-experimental pilot study. J Pediatr, 2018; 198:156–161.
75.
HegartyJE, HardingJE, GambleGD, et al.Prophylactic oral dextrose gel for newborn babies at risk of neonatal hypoglycaemia: a randomised controlled dose-finding trial (the pre-hPOD study). PLoS Med, 2016; 13:e1002155.
76.
WestonPJ, HarrisDL, BattinM, et al. Oral dextrose gel for the treatment of hypoglycaemia in newborn infants. Cochrane Database Syst Rev, 2016:CD011027.
77.
LeBlancS, HaushalterJ, SeashoreC, et al.A quality-improvement initiative to reduce NICU transfers for neonates at risk for hypoglycemia. Pediatrics, 2018; 141:e20171143.
78.
WackernagelD, GustafssonA, Edstedt BonamyAK, et al.Swedish national guideline for prevention and treatment of neonatal hypoglycaemia in newborn infants with gestational age >/ = 35 weeks. Acta Paediatr, 2020; 109:31–44.
HawdonJM. Identification and management of neonatal hypoglycemia in the full-term infant. British Association of Perinatal Medicine Framework for Practice, 2017. J Hum Lact, 2019; 35:521–523.
82.
American Academy ofPediatrics, Section onBreastfeeding. Policy statement: Breastfeeding and the use of human milk. Pediatrics, 2012; 129:e827–e841.
83.
World Health Organization. Guideline: protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services. In: Department of Nutrition for Health and Development, ed. Geneva: World Health Organization. 2017. Available at https://www.who.int/publications/i/item/9789241550086 (accessed August15, 2019).
VenturaAK. Associations between breastfeeding and maternal responsiveness: A systematic review of the literature. Adv Nutr, 2017; 8:495–510.
86.
WhitfieldKC, VenturaAK. Exploration of responsive feeding during breastfeeding versus bottle feeding of human milk: A within-subject pilot study. Breastfeed Med, 2019; 14:482–486.
87.
EmdeRN, SwedbergJ, SuzukiB. Human wakefulness and biological rhythms after birth. Arch Gen Psychiatry, 1975; 32:780–783.
88.
ChiruvoluA, MiklisKK, StanzoKC, et al.Effects of skin-to-skin care on late preterm and term infants at-risk for neonatal hypoglycemia. Pediatr Qual Saf, 2017; 2:e030.
89.
MooreER, BergmanN, AndersonGC, et al.Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev, 2016; 11:CD003519.
90.
SmithHA, BeckerGE. Early additional food and fluids for healthy breastfed full-term infants. Cochrane Database Syst Rev, 2016:CD006462.
EskandarifarA, RasouliMA, MansouriM, et al.Validity of glucose measurements in the blood by a glucometer reagent strip in critically ill infants. Diabetes Metab Syndr, 2019; 13:464–466.
93.
FerrarelloD, SchumacherA, AncaR. Nurse-driven initiative to increase exclusive human milk feeding by using pasteurized donor human milk to treat hypoglycemic term neonates. Nurs Womens Health, 2019; 23:316–326.
94.
SenS, AndrewsC, AndersonE, et al.Type of feeding provided with dextrose gel impacts hypoglycemia outcomes: Comparing donor milk, formula, and breastfeeding. J Perinatol, 2020; 40:1705–1711.
95.
KellamsA, HarrelC, OmageS, et al.ABM clinical protocol #3: Supplementary feedings in the healthy term breastfed neonate, revised 2017. Breastfeed Med, 2017; 12:188–198.
96.
AlsaleemM, SaadehL, KumarVHS, et al.Continued enteral feeding is beneficial in hypoglycemic infants admitted to intensive care for parenteral dextrose therapy. Glob Pediatr Health, 2019; 6:2333794x19857415.
97.
ThorntonPS. Neonates at risk for hypoglycemia: Associated neurological outcomes. J Pediatr, 2016; 170:343–344.
98.
LeveneI, O'BrienF. Fifteen-minute consultation: Breastfeeding in the first 2 weeks of life-a hospital perspective. Arch dis Child Educ Pract Ed, 2019; 104:20–26.
99.
ForsterDA, MoorheadAM, JacobsSE, et al.Advising women with diabetes in pregnancy to express breastmilk in late pregnancy (Diabetes and Antenatal Milk Expressing [DAME]): A multicentre, unblinded, randomised controlled trial. Lancet, 2017; 389:2204–2213.
100.
TozierPK. Colostrum versus formula supplementation for glucose stabilization in newborns of diabetic mothers. J Obstet Gynecol Neonatal Nurs, 2013; 42:619–628.
