Scoping review of evidence for managing postnatal hypoglycaemia

Abstract

Objectives: To identify what is known empirically about the screening, treatment and harm of exposure to neonatal hypoglycaemia.

Design: Scoping review that applied a preregistered protocol based on established frameworks.

Data sources: Medline and Embase, up to 12 May 2020.

Study selection: Comparative and case-series studies, as well as guidelines, published in English or French, on the topic of immediate inpatient postnatal glucose screening in newborns.

Data gathering: Article selection and characterisation were performed in duplicate using predefined data extraction forms specific to primary studies and guidelines.

Results: 12 guidelines and 74 primary studies were included. A neurodevelopmental outcome was primary in 32 studies: 30 observational studies followed up posthypoglycaemic, and the 2 intervention studies included 1 randomised controlled trial (RCT) about treatment thresholds. Three other RCTs assessed dextrose gel (two) and oral sucrose (one). 12 of 30 studies that evaluated non-neurodevelopmental primary outcomes were intervention studies. Only one cohort study compared outcomes in screened vs unscreened newborns. The guidelines did not arrive at a consensus definition of postnatal hypoglycaemic, and addressed potential harms of screening more often than primary studies.

Conclusions: The primary literature that informs hypoglycaemia screening is a series of studies that relate neurodevelopmental outcomes to postnatal hypoglycaemia. Further research is needed to better define an optimal threshold for hypoglycaemia that warrants intervention, based on long-term neurodevelopmental outcomes and a better delineation of potential screening harms.

Keywords: neonatology; paediatric endocrinology; paediatrics; perinatology; therapeutics.