Question

A term neonate has a blood glucose of 36 mg/dL. The infant is feeding well and has no clinical signs. Which characteristic of this neonate favours continued breastfeeding (with monitoring) rather than immediate intravenous dextrose infusion?

• A. The neonate is asymptomatic
• B. The neonate is symptomatic with jitteriness
• C. The neonate is having seizures
• D. The neonate is lethargic and not feeding

Hint:

No symptoms and feeding well? Feed and recheck rather than reach for the IV.

Answer 1

The Correct Option is A

Step 1: Frame the management of neonatal hypoglycaemia.
Management hinges on whether the baby is symptomatic and on the absolute glucose value. Symptoms (jitteriness, lethargy, poor feeding, apnoea, seizures) mandate immediate IV dextrose (e.g., a mini-bolus of 2 mL/kg of 10% dextrose followed by infusion).

Step 2: Apply to this neonate.
This term infant is asymptomatic with a glucose of 36 mg/dL and is feeding well. An asymptomatic infant with mild hypoglycaemia in this range can be managed by encouraging/continuing breastfeeding (or oral feeds) with a glucose recheck after the feed, reserving IV dextrose for failure to respond or development of symptoms.

Step 3: Eliminate the others.
Jitteriness, seizures and lethargy/poor feeding are all symptomatic states that require IV dextrose, not conservative feeding.

Key fact: Asymptomatic mild neonatal hypoglycaemia to feed and recheck; symptomatic hypoglycaemia to IV dextrose.