Hi!  I'm back from a long time away.

This issue of whom to screen and whom to treat for low blood sugar in the
neonatal period is contentious.  I cannot agree with the list:

"Blood glucose levels are drawn on babies considered at risk, i.e. <2500 gm,
meconium stained amniotic fluid, fetal distress, >4000 gm, temperature <97
degrees rectally."

Meconium-stained amniontic fluid (10% of normal deliveries), fetal distress
(difficult to define), >4000g (common in many populations) and temp >97
degrees rectally are NOT, in my mind, absolute indications for glucose
checking.  Even 2.5kg may not be appropriate in ethnic groups who have
smaller babies (probably appropriate in N America in general).

As a rule infants should be divided into sick and well.  Sick infants all
need a blood sugar checked.  Well infants only need a blood sugar check for
a proven risk factor.   My limited list would include:

1.  Infants of diabetic mothers
2.  Small or large for gestational age for a given population - the
implication being that these infants are either malnourished or infants of
undiagnosed diabetics.
3.  Infants admitted to ICU (symptomatic by definition)

In a well, asymptomatic child, even with a risk factor, the first response
should be to breast feed if the sugar is low (<2mmol/l or 40 mg/dl).  If
this fails alternative sources of calories should be discussed with the
parents.

Khalid

Khalid Aziz
Memorial University of Newfoundland